进藏游客急性高原病发病情况及危险因素分析
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摘要
目的 探讨湖北籍进藏游客发生急性高原病的发病率并分析相关危险因素,为降低发病率提供科学依据。方法 选择2018年1月-2018年11月期间赴拉萨等西藏地区旅行的640名湖北籍游客为研究对象,入藏前进行健康体检,采取问卷调查的形式,对旅行者一般资料进行调查和收集。旅行结束后,收集患者旅行途中病历资料并填写高原反应调查表格,统计急性高原病发病率并分析发病危险因素。结果 进藏游客640人中患急性高原病146例,发病率为22.81%;急性高原反应、高原肺水肿、高原脑水肿的发病率分别为:19.38%、2.03%、1.41%,50～70岁年龄组高原肺水肿发病率高于其他两个年龄组,差异有统计学意义(χ~2=6.219,P<0.05);旅行期间急性高原反应、高原肺水肿、高原脑水肿发病率(13.59%、1.56%、1.09%)高于列车去程(3.91%、0.47%、0.31%)和列车返程(1.56%、0.16%、0.00%),差异均有统计学意义(均P<0.05);急性高原病的独立危险因素为年龄偏大(OR=1.057)、基础心率偏高(OR=1.178)。结论 降低进藏游客急性高原病发病率应充分考虑主客观因素,从多途径入手保障游客健康。
引文
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[2] 牟信兵,李素芝,王学凯.高原病学[M].拉萨:西藏人民出版社,2001:312-313.
[3] Gonggalanzi,Labasangzhu,Per Nafstad,et al.Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658m above sea level:a cross-sectional study[J].Arch Public Health,2016,74(8):23.
[4] 查瑞波,孙根年,董治宝,等.青藏高原大气氧分压及游客高原反应风险评价[J].生态环境学报,2016,25(1):92-98.
[5] 中华医学会第三次全国高原医学学术讨论会.我国高原病命名、分型及诊断标准[J].高原医学杂志,2010,20(1):9-11.
[6] 丁丽,柏维尧,柯涛,等.高原低氧习服研究进展[J].实用预防医学,2015,22(3):379-381.
[7] 杨燕,马慧萍,张汝学,等.急性高原病发病机制的研究进展[J].医学综述,2010,16(17):2561-2563.
[8] East D,Steele J.Occurrence of acute mountain sickness in nonclimbing tourists at mount mitchell,North Carolina (2037m)[J].High Alt Med Biol,2018,2(10):1123-1124.
[9] 李兆申,梅长林.现代野战内科学[M].上海:上海科学技术出版社,2013:100-103.
[10] Liang ZL,Zhang XY,Wang F,et al.Understanding molecular mechanisms of Rhodiola rosea for the treatment of acute mountain sickness through computational approaches (a STROBE-compliant article)[J].Medicine (Baltimore),2018,97(39):118-119.
[11] 郑必海,李素芝,何祎,等.吸入外源性一氧化氮对急性高原病患者内皮源性血管舒缩因子的影响[J].中华结核和呼吸杂志,2007,30(2):127-129.
[12] Conkin J,Sanders RW,Koslovsky MD,et al.A systematic review and meta-analysis of decompression sickness in altitude physiological training[J].Aerosp Med Hum Perform,2018,89(11):941-951.
[13] Slawson D.Single question is useful for identifying acute mountain sickness in travelers at high altitude[J].Am Fam Physician,2018,97(9):607.
[14] 余争平,钟敏,王登高.军事作业医学[M].北京:军事医学科学出版社,2009:237-256.