高山病的黄金律是有漏洞的&队伍记录讨论 From Lin(老学长，脑神经内科总医师) 发表时间： 2002/7/26 上午 02:01:29 Email： [email protected] 有几点疑问(Be patient) 1.我不认为黄金律是有漏洞的 是翻译的问题吧 因他都没提到高海拔肺水肿一定会经过AMS阶段 相反的我Copy原文如下(同样出自 http://www.high-altitude-edicine.com/AMS.html#HAPE (我个人较贪生怕死要去西藏前 这网站上的特别勤看的特别用力但那时还没有黄 金律post) High Altitude Pulmonary Edema (HAPE Though it often occurs with AMS, it is not felt to be related and the classic signs of AMS may be absent.(中文 虽然HAPE常伴随AMS但典型 AMS症状也可能没有) Signs and symptoms of HAPE include any of the following: - Extreme fatigue / Breathlessness at rest / Cough, possibly productive of frothy or pink sputum / Gurgling or rattling breaths / Chest tightness, fullness, or congestion / Blue or gray lips or fingernails 对照以下记录- - 蛮传神的 几乎都帮我翻译出来了 Breathlessness at rest=> 我已经没办法躺下来了，一躺下 >肺部、气管里的水倒灌又会开始呛咳..咳嗽也越来越剧烈.>呼吸也觉得困难、 吃力， - Cough, possibly productive of frothy or pink sputum =>开始咳出水来.. 很难形容的感觉..一咳嗽，肺部气管里涌出水来(就很像咳出痰的样子，只是，是 水 - Gurgling or rattling breaths=> 且很恐怖地会听到哔剥哔剥、呼噜呼噜的声 音 - Chest tightness, fullness, or congestion - Blue or gray lips or fingernails 这点也是真的 我学弟(also a doctor)在尼泊 尔健行也得高海拔肺水肿 有提到这点 他至当地医护站也是位美国急诊医师(不 知是否就是他本人 )替他测血氧(SaO2 70%) 讲解了高海拔肺水肿原理(不在 此赘述) 开了Adalat(他没吃) 让他背了5-6Kg氧气瓶带氧气罩下山(本以为氧 气瓶不用钱没想到.NT6000.)-- (题外话) 命比较重要 2.北二段高山病山难--> 不是高山脑水肿吗 为什麽扯到高海拔肺水肿 再COpy原文如下(同样出自 http://www.high-altitude-medicine.com/AMS.html#HACE The Severe Forms of AMS--High Altitude Cerebral Edema (HACE) HACE, once present, can progress rapidly, and can be fatal in a matter of a few hours. Persons with this illness are often confused, and may not recognize that they are ill. ....The treatment is immediate descent. This is of the utmost urgency, and cannot wait until morning (unfortunately, HACE often strikes at night). Delay may be fatal. The moment this is recognized is the moment to start organizing flashlights, helpers, porters, whatever is necessary to get this person down.How far down? At least to the last elevation at which they woke up in the morning with no symptoms of AMS. Bearing in mind that the vast majority of cases of HACE occur in persons who ascend with symptoms of AMS, this is likely to be the elevation the person slept at two nights previous. If you are uncertain, 500-1000 meters descent is a good starting point. 上面说的是(摘要)高山脑水肿是很快的可以几小时内致命患者可能不认为自己生 病 需立即下降 准备手电筒挑夫(高山脑水肿大多晚上发生)停留可能致命(停留 过夜大概不妥) 下降至之前无AMS之高度...大部份高山脑水肿伴随AMS(我想 大概有些没有)...若不确定下降多低?500-1000米是个不错的起点 对照北二段记录 "说他还可以走，头也不会痛，我也鼓励他继续加油。"说上坡他还是不行，之後 下坡他就没问题了。但下山的路，..他仍然不太行，走得很慢，开始有呕吐的情 形" 的确没有头痛的脑水肿不常见(我怀疑他是硬撑的) 常见的脑水肿是头痛-->呕吐-->意识昏迷 脑水肿的呕吐我们叫Projectile vomiting不吃也吐 吃了更吐而且是喷射性 另外走的不行是不是像喝醉酒般 若是应是Cerebellar ataxia小脑性的步态失 调 以上是我的临床经验 参照原文 The hallmark of HACE is a change in mentation, or the ability to think. There may be confusion, changes in behavior, or lethargy. However, it is probably easier to recognize a characteristic loss of coordination that is called ataxia. This is a staggering walk that is identical to the way a person walks when very intoxicated on alcohol.To test for this abnormal walk, have the sick person do a straight line walk (in medicalspeak this is called the "tandem gait test").这TEST是测小脑功 能 先讨论到这(好累) 欢迎帮我POst到BBS(我没注册没法发言) 欢迎多一点人来念原文讨论 以求证我的看法 原文在我看来 vjso指的漏洞他都有提到 黄金律也没错 是否与VJSO先生先前认为 比较有出入之处为 1.高山脑水肿是较严重的AMS的一种(原文 The Severe Forms of AMS--High Altitude Cerebral Edema (HACE)) 2.而高海拔肺水肿是可在无典型高山病症状(如後)下发生(之前提过)(原文 RECOGNIZE AMS. In the context of a recent ascent, a headache, with any one or more of the following symptoms above 2500 meters (8000 feet) qualifies you for the diagnosis of AMS: - Loss of appetite, nausea, or vomiting/ - Fatigue or weakness - Dizziness or light-headedness - Difficulty sleeping - Confusion - Staggering gait 3.有高山脑水肿之前不一定会肺水肿 高海拔肺水肿本身就可致命不必等到脑水 肿 故两者不一定谁先谁後或一起出现 可单独出现(我觉的他是高山脑水肿) 4.高海拔肺水肿 高山脑水肿是有蛛丝马迹的(之前提过)没有徵兆是很恐怖的 希望我的看法没错 不然我该相信谁呢 若有错不吝指教Thanks 因字数过多 分做3篇POST 辛苦大家了 ------ 原始文章 ------ (2002/7/25 下午 05:18:40 留言：Makatau ) >高山病的黄金律是有漏洞的(转载) >作者: jinyih (飞扬) 看板: Mountain >标题: Re: 高山病的黄金律 >时间: Wed Jul 24 19:34:52 2002 >==> vjso (so) 提到: >> 经历几天前的北二段高山病山难, 才发觉黄金律是有漏洞的 >> 漏洞是 高海拔肺水肿可以直接发生 不先经过AMS阶段 >> 而黄金律是设计来处理AMS 防止进一步恶化用的 >> 当肺水肿开始时, 可能只是体力严重衰退, 而无头痛等AMS症状 >> 这时, 走不动不容易与单纯的体力不好区分, 缺乏AMS症状会使 >> 领队未能警觉. -- 一切恩爱会，无常难得久。 生世多畏惧，命危於晨露。 由爱故生忧，由爱故生怖。 若离於爱者，无忧亦无怖。 --

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