耳穴贴压联合耳尖放血预防新兵高原反应效果观察

目的：观察耳穴贴压联合耳尖放血预防新兵急性高原反应（AMS）的效果。方法：选择即将进驻高原新兵60例,随机分为观察组与对照组各30例。观察组采用耳穴贴压联合耳尖放血预防治疗,疗程1个月;对照组30例为空白对照。对比观察两组进驻高原后AMS发生情况。结果：观察组进入高原24h内发生AMS4例,占13．3％;对照组新兵进入高原24h内发生AMS12例,占40．0％。两组AMS发病率比较,差异非常显著（P〈0．01）。结论：耳穴贴压联合耳尖放血预防新兵AMS效果较好。     

预防急性高原病研究现状及发展方向分析

目的:探讨部队急进高原执行应急任务情况下,有效预防急性高原病(AMS)的措施.方法:对每年空运进入西藏的新兵部队的AMS的发病率及采取的预防和控制(简称防制)措施进行跟踪调查,总结分析目前部队预防AMS工作取得的成效及存在的问题,提出今后深入研究的方向.结果:在目前条件下,虽然进藏新兵部队预防AMS取得了巨大的成就,但...     

高原部队耐寒锻炼预防手冻疮效果观察

目的：探讨高原部队建立耐寒锻炼预防手冻疮的方法。方法：将首次进入高原的新兵114例，随机分为观察组（54例）和对照组（60例），参照有关手部耐寒锻炼方法，连续锻炼4周，观察两组2个月军事训练中手冻疮的发病率。结果：观察组手冻疮的发病率（20．4％），低于对照组（46．7％），两组比较差异非常显著（P〈0．01）；观察组手冻疮的严重程度（11．1％）明显低于对照组（31．7％），两组比较差异非常显著（P〈0．01）。结论：耐寒锻炼预防高原部队手冻疮效果明显。     

对快速进入高原部队预防急性高原病的措施探讨

目的了解急性高原病(AMS)的发病情况并探讨其预防措施。方法2006—2007年两次进入高原某地进行军事演练,伴随卫勤保障任务,通过在平原集结时之前,进行身体调整,加大训练强度,进入高原后,延长休整天数,进行心理干预,开展AMS知识的宣传教育,采用问卷、卫生队、卫生室进行病员登统计、个别问诊、检查的方法,了解部队进入高原后AMS的发病情况。结果2006年9—10月份与2007年9—10月份两次进入高原人员年龄分布无统计学差异(P>0.05),而发病率由21.6%下降为13.4%及住院率0.72%下降为0.48%,2007年9—10月份与2006年9—10月份重度急性高原反应、高原肺水肿和高原脑水肿发病率都有所减低。结论在常规的卫勤保障基础上,应调整进入高原的休整期,一般7d左右为宜,加强高原卫生宣传教育,正确引导官兵们对低氧危害性和机体代偿能力的认识,克服高原恐惧心理和麻痹大意思想;提高医务人员的业务水平,增强责任心。这样可以大大地降低AMS的发病率和住院率,有效地保障官兵的身体健康。     

急进高原劳动作业预防急性高原病的措施探讨

经过50余年的深入研究和实践,我军对急性高原病(acute mountain sickness,AMS)的预防和控制(简称防制)措施不断完善,大部队急进高原的AMS发病率逐年下降〔1-2〕,可以这样说,在平时情况下,AMS已经不再是急进高原部队的严重威胁。但是,如果部队是急进高原执行应急任务,得不到足够的休息时间,则AMS的威胁仍然较大。如2009年新     

高原肺水肿398例临床分析

目的：探讨高原肺水肿的临床特点，总结其诊治经验；方法：对我院1986年6月至2001年4月收住的资料较为完整的高原肺水肿患者临床资料进行回顾性分析研究；结果：海拔4000m以上者发病178例，占44.72%；以上呼吸道感染为诱因发病者172例，占43．22％；X线表现单侧肺病变以右肺为多；窦性心动过速为心电图异常主要类型，占62．31％；合并高原脑水肿者死亡9例，占死亡的75％，是导致死亡的重要因素；结论：高原肺水肿海拔愈高，发病率愈高；上呼吸道感染可诱发高原肺水肿；合并高原脑水肿者，病死率明显增高。     

驻北方高原寒区某部官兵冻伤情况调查与分析

目的：调查了解驻北方高原寒区某部官兵冻伤情况。方法：选择2009年1月-2012年1月驻高原寒区某部官兵1024例，发放冻伤调查问卷表，了解是否发生过冻伤、冻伤发生时间、冻伤部位、致伤原因、冻伤面积及深度、早期处理及预后情况。结果：共回收有效问卷1016份。1016例中，共发生冻伤95例，发生率9．35％。新兵冻伤发生率15．03％，显著高于老兵的7．12％（P〈0．05）；南方籍士兵冻伤发生率16．92％，显著高于北方籍士兵的5．79％（P〈0．05）。冻伤集中发生于每年11月至次年2月，冻伤面积（3．1±3．5）％TBSA；致伤原因以野外驻训和潜伏为主，分别占34．74％、30．53％；冻伤部位以四肢末端为主共78例，占82．11％。结论：每年12月至次年2月为北方高原寒区冻伤的高发季节，冻伤人群以新兵、南方籍士兵为主，冻伤程度以四肢末端中小面积中度冻伤为主。采取有效防护措施，积极进行快速复温，可有效降低冻伤发病率，缩短冻伤愈合时间，提高冻伤伤员救治成功率。     

平原水负荷后的排尿量与急性高原反应症状学评分之间的相关分析

目的：探讨平原饮水后2．5h内的排尿量与进入高原后急性高原反应(benigh form of acute mountain sickness，AMS)症状学评分之间的相关关系；方法：113名入藏新兵，在平原饮水1000ml后，测定2.5h内的排尿量；进入高原后进行AMS症状评分；两组数据进行相关分析；结果：饮水后急性高原反应者在1h～1．5h、2h～2．5h时间段内排出的尿量和2．5h内排出的总尿量显著低于基本无反应者，而1h～1．5h、2h、2．5h时间段内排出的尿量及1．5h内、2h内和2．5h内的总尿量与舢AMS评分之间存在显著负相关；结论：平原饮水后机体在2．5h内排出的尿量越多，进入高原后急性高原反应症状越轻。通过该实验，可在一定程度上对AMS的发生作出预测。     

高原地区野外驻训卫生防病的主要做法与体会

目的探讨提高高原地区野外驻训卫生防病保障能力，保障指战员身心健康。方法卫勤分队随部队实施全方位防病保障。结果针对执行野外驻训卫生防病保障特点，总结了4点做法：（1）周密计划，充分准备；（2）综合治理。完善设施；（3）做好经常性的管理和监督指导工作；（4）加强健康教育和做好心理疏导、咨询工作。由于措施得力，驻训部队昼夜发病率控制在1．5‰以内，无急性高原病发生，无传染病爆发和食物中毒发生，有效地保障了部队驻训任务的完成。结论高原地区长时间驻训卫生防病保障有其特殊要求，根据高原卫勤特点，严密组织，能有效提高卫生防病保障能力。     

高原环境下急性高原病预后与慢性高原病关系的随访研究

目的：了解在高原环境下急性高原病患者的预后的与慢性高原病的关系。方法：对地处海拔3658m医院40年间（1955年12月－1995年12月）收治并符合筛选标准的18090例住院病例为样本，随访（1－15）年不等，样本中初入高原且以急性高原病首次住院者为病例组，而以非高原病首次住院者作为对照组，对两组在观察期间慢性高原病的发病情况进行临床流行病学的分析。结果：（1）两组慢性高原病患病率随观察年限延长而降低，在第（1－4）年和10年以上观察年度慢性高原病患病率与总患病率，病例组显著高于对照组（P＜0．005），RR＝3．726，AR＝73．16％，PAR＝9．42％；（2）急性轻型高原病组的各型慢性高原病患病率与总患病率均显著高于对照组（P＜0．005），并且居急性高原病之最，RR＝5．29，AR＝81．11％，PAR＝13．7％；高原肺水肿与高原脑水肿组的慢性高压病患病率高于对照组是源于高原心脏病发病率高造成；（3）急性轻型高原病组的各型慢性高原病患病率均高于高原肺水肿组（P＜0．05－0．005）。结论：急性高原病与慢性高原病有关联，初入高原的急性高原病患者发生高原心脏病风险显著增加，在急性高原病类型中急性轻型高原病与慢性高原病的关系最密切。     

Altitude illness in Qinghai–Tibet railroad passengers

It takes ≈24 h to travel the ≈3000-km-long Qinghai–Tibet railroad of which 85% is situated above 4000 m with a pass at 5072 m. Each year about 2 million passengers are rapidly exposed to high altitude traveling on this train. The aim of this study was to quantify the occurrence of altitude illness on the train. Three subject groups were surveyed: 160 Han lowlanders, 62 Han immigrants living at 2200 to 2500 m, and 25 Tibetans living at 3700 to 4200 m. Passengers reached 4768 m from 2808 m in less than 1.5 h, after which 78% of the passengers reported symptoms, 24% reaching the Lake Louise criterion score for AMS. AMS incidence was 31% in nonacclimatized Han compared to 16% in Han altitude residents and 0% in Tibetans. Women and older subjects had a slightly greater risk for AMS. Most cases of AMS were mild and self-limiting, resolving within days upon arrival in Lhasa. Some cases of more severe AMS necessitated medical attention. To curb the health risk of rapid travel to altitude by train, prospective travelers should be better informed, medical train personnel should be well trained, and staged travel with 1 to 2 days at intermediate altitudes should be suggested to nonacclimatized subjects.     

急进高原新兵对高原及急性高原病的认知调查及防病建议

目的 调查新兵对高原地理及急性高原病（AHAD）认知情况,为降低新兵AHAD发病率、提高高原适应能力和作战能力提供建议和参考.方法 对急进海拔3650 m高原地区的280名新兵进行平原及高原跟踪问卷调查,并对结果进行分析.结果 新兵对高原地理及AHAD的认知率普遍较差,只有18.92%的新兵了解,71.79%的新兵渴望了解.结论 应该采取多种措施,加强对新兵高原地理及AHAD的认知教育.     

Displaced femoral neck stress fractures in Royal Marine recruits--management and results of operative treatment

Femoral neck stress fractures (FNSF) represent 3.5%-8% of stress fractures in military recruits; potentially resulting in medical discharge and/or complications. The incidence of displaced FNSF in the British Army has been reported as 1.8 in 10,000 recruits. We aimed to review the incidence and outcome of displaced FNSF in Royal Marine recruits. Retrospective review identified 6 recruits who sustained a displaced FNSF from 2001 to 2011 representing an incidence of 9.3 in 10,000 recruits. All were treated urgently by internal fixation. There were no cases of avascular necrosis, no surgical complications and no further procedures required. All united with a mean time to union of 11 months. 50% had a union time greater than 1 year. These fractures are slow to unite but with urgent surgical intervention and stable fixation 100% union was achieved. Awareness of this guides the management and rehabilitation whilst avoiding the risks of unnecessary secondary surgical interventions.     

Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya

INTRODUCTION: The aim of this study was to ascertain the incidence of acute mountain sickness (AMS) at different altitudes in the Solu-Khumbu. This was a pilot to examine the feasibility of investigating demographic, behavioral, and physiological factors related to the etiology of AMS and to assess the region's suitability for a future study. METHODS: A convenience sample of 150 recreational trekkers staying in teahouses was interviewed at altitudes above 2500 m. Two interviews were performed, firstly in the evening and then the subsequent morning. Trekker's age, gender, ascent profile, and use of acetazolamide were noted. A Lake Louise score was calculated to determine the presence of AMS. RESULTS: The incidence of AMS was 0% at 2500-3000 m, 10% between 3000-4000 m, 15% between 4000-4500 m, 51% between 4500-5000 m, and 34% over 5000 m. There was no significant association between age or gender and the altitude studied or incidence of AMS. Subjects with AMS ascended significantly further in the preceding 72 h than subjects without AMS, with a mean altitude gained of 846 m vs. 722 m. DISCUSSION: We concur with the literature that incidence of AMS increases with altitude. We found an abrupt increase in incidence over 4500 m. This appears to be a new finding. A future study examining factors predisposing to AMS would be most effectively performed above 4500 m. No association was found between age or gender and AMS. Mean vertical ascent gained in the previous 72 h was significantly higher among the trekkers with AMS but remained within recommended guidelines.     

Acute mountain sickness in Jade Mountain climbers of Taiwan

BACKGROUND: Although there are more than 200 peaks higher than 3000 m in the Taiwan Alps, no data on the incidence of acute mountain sickness (AMS) are available. This study investigated the incidence of AMS in Jade Mountain climbers. METHODS: The study was performed at the entrance of Jade Mountain, the highest peak (3952 m) in Taiwan. A standardized form was used to collect information. All the recorders had previously been trained in the management of high altitude illness. The Lake Louise consensus was used for the diagnosis of AMS. RESULTS: There were 93 trekkers (18 females and 71 males) who were surveyed. Four records with incomplete data were excluded, leaving 89 records for analysis. The ages ranged from 20-68 yr, with an average age of 41.1 +/- 11.2 SD. All subjects had a home residence below 1 km. The most common high altitude symptoms were headaches. Some 25 trekkers (28%) [corrected] met the diagnoses of AMS. The most common site of the AMS cases feeling their worst symptoms was in the midway overnight hut, and not on the summit. The lower the O2 saturation recorded at the entrance (2659 m) of Jade Mountain, the higher the score of the Lake Louise Acute Mountain Sickness Score (LLAMSS). CONCLUSIONS: Acute mountain sickness is a common problem in Taiwan summit climbers. In our study, 28% [corrected] of the Jade Mountain trekkers met the diagnosis of AMS; however, the incidence of AMS was lower than that of other studies at similar altitudes.     

肺功能测定对急性高原反应易感者预测价值的初步探讨

目的：探讨肺功能测定对急性高原反应(AMS)易感者的预测作用。方法：随机选择内地籍人藏新兵113人，进藏前(海拔300m)进行肺功能检测，然后空运进入高原地区(海拔3658m)；人藏后第2天和第3天进行急性高原反应症状学评分。将两组数据进行相关分析。结果：急性高原反应者的用力肺活量(FVC)、最大呼气流量(PEF)和18用力呼气容积(FEV1．0)显著低于无反应者，AMS与受试者FVC、FEV1、PEF等指标显著相关。结论：平原肺功能测定有益于AMS易感者的筛选。     

Ataxia: an early indicator in high altitude cerebral edema

Wu, Tianyi, Shouquan Ding, Jinliang Liu, Jianhou Jia, Ruichen Dai, Baozhu Liang, Jizhui Zhao, and Detang Qi. Ataxia: an early indicator in high altitude cerebral edema. High Alt. Med. Biol. 7:275-280, 2006.--As a result of industrial development in the western region of China, in 2001 the Chinese government decided to build Qinghai-Tibetan Railway. The new railroad stretches 1118 km from Golmud (2808 m) to Lhasa (3658 m), with more than three-quarter of the distance above 4000 m, through the Mt. Kun Lun and Tanggula ranges. From the beginning of the project on June, 29, 2001, to the end of the year of 2003, about 74,735 construction workers worked in the harsh climate, in adverse circumstances and a low-barometric-pressure environment. The construction provided an opportunity for the investigation and study of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). These altitude illnesses were very common in the construction workers. From July 1, 2001, to October 31, 2003, the overall incidence of AMS, HAPE, and HACE in the total workers was approximately 45%-95%, 0.49%, and 0.26%, respectively. Altitude illnesses were studied at two hospitals near the construction site. One hospital is located on the Fenghuoshan (Mt. Wind-gap) at an altitude of 4779 m (PB 428 torr), and the second hospital is situated in the Kekexili area at an altitude of 4505 m (PB 440 torr). Kekexili is a sparsely populated zone because the weather conditions are very bad all year round. These two hospitals received patients from the construction sites, where workers were working at altitudes between 4464 and 4905 m. A total of 8014 workers were treated at Fenghuoshan and 5488 were in Kekexili over the past 3 years. According to local guidance about proper medical care, workers ascending to high altitude should be examined physically, complete an AMS questionnaire, and be monitored for ataxia as an early warning sign of the impending, more serious aspects of HACE. The onset of HACE is frequently characterized by an ataxic gait, as reported since the middle of the 20th century (Gray et al., 1971; Wilson, 1973; Houston and Dickinson, 1975; Dickinson, 1979; Clarke, 1988; Hackett and Oelz, 1992; Hackett, 2002; Hackett and Roach, 2004). However, there are no detailed analyses of ataxia in HACE. This paper considers the relation between ataxia and HACE and its frequency, significance, and importance.     

间断减压缺氧适应对脑血流的影响

16名身体健康男性青年为受试对象.用脑血流图(REG)评价间断缺氧适应后再暴露5000m急性缺氧时的脑血流(CBF)改变.结果表明,适应组急性高山反应的发生率低,发病程度较轻.分析REG的主峰波幅,流入容积速度、重搏波深度、上升角和顶峰角等参数显示,急性缺氧时适应组CBF减少,对照组CBF增加.高山反应轻度者CBF减少;中度者CBF改变不明显;重度者CBF增多.这提示:(1)急性高山病的发生可能与CBF的改变有关.(2)间断减压缺氧适应可以改善脑循环和减轻高山反应症状.     

Everest or bust: a cross sectional, epidemiological study of acute mountain sickness at 4243 meters in the Himalayas.

BACKGROUND: Thousand of tourists trek in the Himalayas every season and risk acute mountain sickness (AMS). Prior studies have shown that the rate of ascent is one of the primary risk factors for the development of AMS but the role of body hydration, age, gender, alcohol and medication usage, body weight, and altitude of residence continues to be in question. This study estimates the incidence of AMS at 4234 m at Pheriche in the Everest region, explores a number of risk factors predisposing trekkers to a diagnosis of AMS and attempts to quantify the relationship between the Lake Louise AMS diagnostic criteria and oxygen saturation. METHODS: Demographic data and information about risk factors felt to place trekkers at increased risk of AMS was collected from 550 trekkers for 1 mo in the fall of 1996 at 4234 m in the Everest region. RESULTS: Diagnosis of AMS was made in 29.8% (159 trekkers) of the study population. Low water intake (odds ratio 1.57; 95% confidence interval,1.02-2.40), the presence of respiratory symptoms (odds ratio 2.21; 95% confidence interval, 1.43-3.40), and an oxygen saturation below 85% at 4243 m (odds ratio 2.35; 95% confidence interval, 1.55-3.56) were identified as independent risk factors for AMS diagnosis in this sample. In addition, AMS risk decreased 18.7% (95% confidence interval, 3.8-31.2%) for each additional night spent between Lukla (2804 m) and the study site at 4243 m. CONCLUSION: Increased reported fluid intake decreased the risk of AMS in this cross sectional prospective study. Further studies need to be done to confirm this finding before recommendations can be made. In addition the rise in the risk of AMS as the rate of ascent increased along this popular Everest trek was quantified for the first time. Finally, AMS was also associated with respiratory symptoms and with a lower oxygen saturation.