Evaluating the Risks of High Altitude Travel in Chronic Liver Disease Patients
Evaluating the Risks of High Altitude Travel in Chronic Liver Disease Patients
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DOI：
10.1089/ham.2014.1122
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发表时间：
2015-06-01
影响因子：
2.1
通讯作者：
Swenson, Erik R.
中科院分区：
文献类型：
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作者：
Luks, Andrew M.;Swenson, Erik R.
安德鲁·M·卢克斯 (Luks) 和埃里克·R·斯文森 (Erik R. Swenson)。临床医生之角：评估慢性肝病患者高原旅行的风险。 High Alt Med Biol 16:80-88, 2015。随着医疗保健质量的提高，患有慢性疾病的人正在经历更好的生活质量，并越来越多地参与更广泛的活动，包括去高海拔地区旅行。每当患有慢性病的人前往这种环境时，重要的是要考虑对低压缺氧的生理反应是否会与潜在的医疗状况相互作用，从而增加急性高原病的风险或医疗状况本身可能恶化。本综述考虑了这些与慢性肝病患者相关的问题。虽然有限的现有证据表明，没有证据表明正常人在海拔 5000m 的高度旅行时会出现肝损伤或功能障碍，但有理由怀疑两组肝硬化患者出现问题的风险增加：肝肺综合征患者，在上升后有严重低氧血症的风险；门脉性肺动脉高压患者，可能有高原肺水肿和急性右心室功能障碍的风险。虽然肝移植患者可以毫无困难地忍受高海拔暴露，但没有关于长期居住在高原上患有慢性肝病的风险的信息。所有患有肝硬化的旅行者都需要进行仔细的旅行前评估，以确定可能导致高原问题的条件，并针对这些问题制定风险缓解策略。患者还需要有关急性高原病的识别、预防和治疗的详细咨询，并且可能需要与健康个体不同的药物治疗方案来预防或治疗高原病。
Luks, Andrew M., and Erik R. Swenson. Clinician's Corner: Evaluating the risks of high altitude travel in chronic liver disease patients. High Alt Med Biol 16:80-88, 2015.With improvements in the quality of health care, people with chronic medical conditions are experiencing better quality of life and increasingly participating in a wider array of activities, including travel to high altitude. Whenever people with chronic diseases travel to this environment, it is important to consider whether the physiologic responses to hypobaric hypoxia will interact with the underlying medical condition such that the risk of acute altitude illness is increased or the medical condition itself may worsen. This review considers these questions as they pertain to patients with chronic liver disease. While the limited available evidence suggests there is no evidence of liver injury or dysfunction in normal individuals traveling as high as 5000m, there is reason to suspect that two groups of cirrhosis patients are at increased risk for problems, hepatopulmonary syndrome patients, who are at risk for severe hypoxemia following ascent, and portopulmonary hypertension patients who may be at risk for high altitude pulmonary edema and acute right ventricular dysfunction. While liver transplant patients may tolerate high altitude exposure without difficulty, no information is available regarding the risks of long-term residence at altitude with chronic liver disease. All travelers with cirrhosis require careful pre-travel evaluation to identify conditions that might predispose to problems at altitude and develop risk mitigation strategies for these issues. Patients also require detailed counseling about recognition, prevention, and treatment of acute altitude illness and may require different medication regimens to prevent or treat altitude illness than used in healthy individuals.