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研究生:鄭斐茵
研究生(外文):Fei-Ying Cheng
論文名稱:台灣孩童健行雪山之急性高山病及相關症狀的發生率和嚴重度研究
論文名稱(外文):Incidence and severity of acute mountain sickness and associated symptoms in children trekking on Xue mountain, Taiwan
指導教授:鄭玫枝鄭玫枝引用關係
指導教授(外文):Mei-Jy Jeng
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:急重症醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:45
中文關鍵詞:急性高山病孩童高海拔露易絲湖急性高山病指數性別身體質量指數
外文關鍵詞:acute mountain sicknesschildrenhigh altitudeLake Louise ScoregenderBMI
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研究背景:
急性高山病(Acute Mountain Sickness, AMS)為非高度適應者在快速上升至海拔2500公尺或更高處所出現的症狀。本研究的目的乃為探討孩童出現AMS及相關症狀的發生率和嚴重度。

研究方法:
本前瞻式觀察研究以11至12歲居住於平地的健康學童為對象,觀察他們在三天中由登山口至台灣雪山山頂(海拔2179公尺至3886公尺)來回的狀況。分別於第一天在七卡山莊(海拔2460公尺),第二天在三六九山莊(海拔3100公尺),以及第三天登頂(海拔3886公尺)後回到三六九山莊做急性高山病的評估。本研究使用露易絲湖急性高山病指數(Lake Louise Score, LLS)做為急性高山病的診斷依據,於每日記錄每位學童的AMS相關症狀。我們對輕度至中度AMS的孩童給予acetazolamide,嚴重AMS者則給予類固醇治療(dexamathasone)。對頭痛症狀的孩童投以acetaminophen,有噁心、嘔吐症狀者給予metoclopramide。

研究結果:
本研究之合格研究對象共197名。AMS的總發生率為40.6%,較多見於男性和身體質量指數(Body mass index, BMI)較高的孩童。第一天AMS的發生率為5.6%,顯著低於第二天(29.4%)和第三天(23.4%)。所有研究對象的LLS平均分數為1.77 ± 2.08,嚴重AMS(LLS ≥5)的總發生率為12.5%。健行過程中有發生過一次或以上急性高山病的孩童即歸類為AMS組,未發生過任何一次高山病的孩童歸類為非AMS組。AMS組的LLS平均分數(3.02 ± 2.46)顯著高於非AMS組(0.92 ± 1.16, p <0.001)。AMS組中,第一天的LLS平均分數為1.00 ± 1.55,第二天為4.09 ± 1.97,第三天為3.98 ± 2.42。最常見的高山病症狀是失眠,接下來為頭暈和頭痛。第二天在海拔3100公尺處,頭痛的發生率為46.2%,第三天登頂後回到同一高度,頭痛發生率為31.3%。男性經歷的頭痛和疲憊顯著多於女性(p <0.05)。AMS組的LLS和所有AMS相關症狀發生率皆顯著高於非AMS組(p <0.05)。

結論:
攀登雪山健行的孩童整體急性高山病發生率為40.6%。急性高山病常見,且大多以輕症表現。本篇研究中,男性和較高的BMI為發生AMS之獨立危險因子。失眠是最常見的症狀。第三天頭痛發生率降低,可能是藥物的使用及高度適應之影響。
Background
Acute mountain sickness (AMS) occurs in non-acclimatized people after an acute ascent to an altitude of 2,500 m or higher. The aim of this study was to examine the incidence and severity of AMS and associated symptoms in children.

Methods
The prospective observational study included 197 healthy, non-acclimatized 11 and 12-year-old children trekking the round-trip from the trailhead to the summit of Xue Mountain, Taiwan (2,179 m to 3,886 m) over 3 days. AMS was evaluated at Qika Hut (2,460 m) on Day 1, at Sanliujiu Hut on Day 2 (3,100 m), and at the same altitude (3,100 m) after reaching the summit on Day 3. We used the Lake Louise Score (LLS) to diagnose AMS and record daily AMS-associated symptoms. We gave acetazolamide to children with mild to moderate AMS. Dexamethasone was reserved for individuals suffering from severe AMS. Acetaminophen was administrated to children with headache, and metoclopramide for those with nausea or vomiting.

Results
There were 197 subjects eligible for analysis. The overall incidence of AMS was 40.6%, which was higher in males and in subjects with a higher body mass index (BMI) (p <0.05). The prevalence of AMS on Day 1 was 5.6%, which was significantly lower than that on Day 2 (29.4%) and Day 3 (23.4%). The mean LLS of all subjects was 1.77 ± 2.08. The overall incidence of severe AMS (LLS ≥5) was 12.5%. The mean LLS of the AMS group (3.02 ± 2.46) was significantly higher than that of the non-AMS group (0.92 ± 1.16, p <0.001). Among the AMS group, the mean LLS was 1.00 ± 1.55 on Day 1, 4.09 ± 1.97 on Day 2, and 3.98 ± 2.42 on Day 3. The most common symptom was sleep disturbance followed by dizziness, and headache. The prevalence of headache was 46.2% on Day 2 at 3,100 m, and 31.3% on Day 3 at the same altitude after climbing the summit (3,886 m). Males experienced significantly more headache and fatigue than females (p <0.05). The LLS and prevalence of all AMS symptoms were significantly higher in the AMS than the non-AMS group (p <0.05).

Conclusions
The AMS incidence among children trekking to Xue Mountain was 40.6%. AMS is common and mostly manifests as mild symptoms. Gender (male) and a higher BMI could be considered two independent risk factors of higher AMS incidence. Sleep disturbance is the most common symptom, and the lower prevalence of headache on Day 3 may be due to the effects of medication and/or acclimatization.
致謝 i
中文摘要 ii
英文摘要 iv
目錄 vi
第一章 緒論 1
第二章 研究方法 3
2.1 研究對象 3
2.2 研究設計 3
2.3 AMS的評估 4
2.4 統計方法 4
第三章 研究結果 6
3.1 AMS發生率與研究對象基本特徵 6
3.2每日AMS發生率與LLS 6
3.3平均心率及血氧濃度 7
3.4 AMS相關症狀 8
3.5藥物治療 8
第四章 研究討論 10
4.1孩童與成人的AMS發生率比較 10
4.2影響AMS的因素 11
4.3藥物治療在本研究的影響 12
4.4 AMS的症狀表現 13
4.5醫療小組及高海拔醫療站的設置 13
4.6研究限制 14
第五章 結論 15
圖與表 16
圖一 16
圖二 17
圖三 18
圖四 20
表一 22
表二 25
表三 26
表四 27
參考文獻 28
附錄 30
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