Введение
Заболевание человека
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
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|Very high altitude
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|Extreme altitude
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Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Высотная лёгочная edema (ВЛЁ) – это опасная для жизни форма некардиогенного лёгочного edema, которая возникает у здоровых людей на высотах, обычно выше. Однако случаи также сообщались на высотах между у более восприимчивых людей. Классически, ВЛЁ возникает у людей, обычно проживающих на небольшой высоте, которые поднимаются на высоту более 2500 метров (8200 футов).
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
| Высокая высота |
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| Очень высокая высота |
|---|
| Экстремальная высота |
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Физиологические и симптоматические изменения часто варьируются в зависимости от высоты. Консенсусное определение озера Луиза для высотной лёгочной edema установило широко используемые критерии для определения симптомов ВЛЁ. При недавнем подъеме на высоту, наличие следующих признаков:
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Симптомы: по крайней мере два из:
Одышка в покое
Кашель
Слабость или снижение переносимости физических нагрузок
Сжатие или заложенность в груди
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Признаки: по крайней мере два из:
Хрипы или свистящее дыхание (при дыхании) хотя бы в одном лёгком
Цианоз (синюшность) кожных покровов
Тахипнея (учащённое дыхание)
Тахикардия (учащённое сердцебиение)
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Острая горная болезнь и высотная церебральная edema также могут присутствовать одновременно с ВЛЁ, однако эти симптомы могут быть слабо выражены или отсутствовать вовсе. Наиболее достоверным признаком ВЛЁ является выраженная усталость или непереносимость физических нагрузок, особенно у альпиниста, у которого ранее не наблюдалось этих симптомов.
High altitude pulmonary edema (HAPE) is a life threatening form of non cardiogenic pulmonary edema that occurs in otherwise healthy people at altitudes typically above However, cases have also been reported between in more vulnerable subjects. Classically, HAPE occurs in persons normally living at low altitude who travel to an altitude above 2,500 meters (8,200 feet). |
|High altitude
|
|
|Very high altitude
|
|
|Extreme altitude
|
|}
Physiological and symptomatic changes often vary according to the altitude involved. The Lake Louise Consensus Definition for high altitude pulmonary edema has set widely used criteria for defining HAPE symptoms. In the presence of a recent gain in altitude, the presence of the following:
Symptoms: at least two of:
Shortness of breath at rest
Cough
Weakness or decreased exercise performance
Chest tightness or congestion
Signs: at least two of:
Crackles or wheezing (while breathing) in at least one lung field
Central blue skin color
Tachypnea (rapid breathing)
Tachycardia (rapid heart rate)
Acute mountain sickness and high altitude cerebral edema may also be present in conjunction with HAPE, however these symptoms may be subtle or not present at all. The most reliable sign of HAPE is severe fatigue or exercise intolerance, especially in a climber that was previously not displaying this symptom.
Факторы риска
Существует множество факторов, которые могут способствовать развитию HAPE, включая пол (мужской), генетические факторы, ранее перенесенный HAPE, скорость набора высоты, воздействие холода, максимальную высоту, интенсивность физической нагрузки и определенные сопутствующие заболевания (например, легочная гипертензия). Возникшая гипоксия, как считается, провоцирует развитие:
Повышенного давления в легочных артериях и капиллярах (легочная гипертензия) вследствие гипоксического легочного вазоспазма. Повышенного капиллярного давления (гидростатического давления) с перерастяжением капиллярного русла и увеличением проницаемости сосудистого эндотелия, также известного как "стрессовая недостаточность". Это приводит к последующей утечке клеток и белков в альвеолы, то есть к развитию отека легких.
Лечение
Рекомендуемым методом лечения первой линии является как можно более быстрый спуск на меньшую высоту, при котором симптоматическое улучшение наблюдается уже на высоте от 500 до 1000 метров. Однако спуск не является обязательным для людей с легкой формой HAPE, и лечение методами согревания, отдыхом и дополнительным кислородом может облегчить симптомы, хотя его лучше использовать в сочетании со спуском, гипербарической терапией или кислородной терапией и не заменять ими. Его можно рассматривать как дополнительное лечение, если терапия первой линии невозможна; однако оно может усилить головную боль, вызванную горной болезнью. Определенной роли для ингаляционного бета-агониста сальметерола не установлено, хотя его применение можно рассмотреть. Впоследствии это состояние было обнаружено у здоровых альпинистов, которые вскоре после прибытия на большую высоту умирали.