Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas
Disoriented and ataxic pilgrims: an epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas
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DOI：
10.1580/1080-6032(2000)011
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发表时间：
2000-06-01
影响因子：
1.4
通讯作者：
Subedi, N
中科院分区：
文献类型：
--
作者：
Basnyat, B;Subedi, D;Subedi, N
目的：确定朝圣者中高原脑水肿（HACE）、急性高山病（AMS）和高原肺水肿（HAPE）的发病率。虽然众所周知西方徒步旅行者在喜马拉雅山会患急性高山病，但关于前往高海拔地区的尼泊尔当地人口中急性高山病的发病率却鲜有记录。
方法：该研究是在尼泊尔喜马拉雅山戈萨因昆德海拔4300米的一个神圣高山湖泊进行的随机研究。在尼泊尔加德满都的帕斯帕提那神庙海拔1300米处进行了对照研究。研究对象是具有不同尼泊尔族裔背景的朝圣者。采用了针对急性高山病、高原脑水肿和高原肺水肿的路易斯湖共识标准，并对高原脑水肿患者使用脉搏血氧仪测量了血氧饱和度。
结果：在5000名朝圣者中，随机选取了228名。68%患有急性高山病，31%患有高原脑水肿，5%患有高原肺水肿。在该海拔高度，高原脑水肿患者的平均血氧饱和度为77%，而海拔4300米正常血氧饱和度为87%。研究人群中73%为男性，但女性患急性高山病（优势比为4.34；95%置信区间为1.83 - 10.68）、高原脑水肿（优势比为3.15，置信区间为1.62 - 6.12）和高原肺水肿（优势比为5.2；95%置信区间为1.24 - 24.73）的比率明显更高。
结论：据我们所知，在使用路易斯湖标准的流行病学研究中，高原脑水肿如此高的发病率此前尚未有过报道。高海拔朝圣者，尤其是本研究中的女性朝圣者，似乎是一个非常易感的群体。需要对这些朝圣者采取预防措施以避免急性高山病，特别是危及生命的高原脑水肿和高原肺水肿。
Objective.-To determine the incidence of high-altitude cerebral edema (HACE), acute mountain sickness (AMS), and high-altitude pulmonary edema (HAPE) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in the Himalayas, not much is documented about the incidence of AMS in the local population of Nepal that go to high altitude.Methods.-The design was a randomized study set at a sacred high-altitude lake at 4300 m at Gosainkund in the Nepal Himalayas. There was a control study at 1300 m at Pashupatinath in Kathmandu, Nepal. The subjects were pilgrims of different ethnic Nepali backgrounds. The Lake Louise consensus for AMS, MACE, and HAPE was used, and oxygen saturation with a pulse oximeter was performed on HACE subjects.Results.-Out of 5000 pilgrims, 228 were randomly chosen. Sixty-eight percent had AMS, 31% had MACE, and 5% had HAPE. The mean oxygen saturation of HACE subjects at that altitude was 77%, 87% being normal for 4300 m altitude. Seventy-three percent of the study population were men, yet women had a significantly higher rate of AMS (odds ratio, 4.34; 95% confidence interval, 1.83-10.68), HACE (odds ratio 3.15, confidence interval 1.62-6.12), and HAPE (odds ratio, 5.2; 95% confidence interval, 1.24-24.73).Conclusions.-Such a high incidence of HACE in an epidemiological study using the Lake Louise criteria has, to our knowledge, not been reported before. High-altitude pilgrims, especially women pilgrims in this study, seem to be a very susceptible group. Preventive measures in these pilgrims need to be adopted to avoid AMS, specifically life-threatening HACE and HAPE.