高原疾病的种类、发病机制及治疗药物
摘要
急性接触低氧环境,肺血管首先发生低氧性收缩,进一步低氧导致肺血管重构,进而引发低氧性肺动脉高压,最终导致严重的右心室肥厚和右心衰竭。急性高原疾病(AAI)可分为急性高原病(AMS)、高原脑水肿(HACE)、高原肺水肿(HAPE)。但其确切的病理生理学仍不清楚。现对AAI的种类、发病机制及其治疗方式进行综述。
引文
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[29] Stelzner T J,O'Brien R F,Sato K,et al.Hypoxia-induced increases in pulmonary transvascular protein escape in rats.Modulation by glucocorticoids[J].J Clin Invest,1988,82:1840-7.
[30] Sekiyama A,Gon Y,Terakado M,et al.Glucocorticoids enhance airway epithelial barrier integrity[J].Int Immunopharmacol,2012,12(2):350-7.
[31] Zheng C R ,Chen G Z ,Yu J,et al.Inhaled budesonide and oral dexamethasone prevent acute mountain sickness[J].Am J Med,2014,127(10):1001-9.
[2] B?rtsch P,Swenson E R.Clinical practice:Acute high-altitude illnesses[J].N Engl J Med,2013,368(24):2294-302.
[3] Mehta S R,Chawla A,Kashyap A S.Acute mountain sickness,high altitude cerebral oedema,high altitude pulmonary oedema:the current concepts[J].Med J Armed Forces India,2008,64:149-53.
[4] Bhagi S,Srivastava S,Singh S B.High-altitude pulmonary edema:review[J].J Occup Health,2014,56:235-43.
[5] Martin D,Windsor J.From mountain to bedside:understanding the clinical relevance of human acclimatisation to high-altitude hypoxia[J].Postgrad Med J,2008,84(998):622-7.
[6] Hackett P H,Roach R C.High altitude cerebral edema[J].High Alt Med Biol,2004,5(2):136-46.
[7] West John B.The physiologic basis of high-altitude diseases[J].Ann Intern Med,2004,141:789-800.
[8] Benner D .High-altitude illnesses:from the limited to the potentially lethal[J].JAAPA,2007,20(1):37-41.
[9] Bradford J R,Dean H P.The pulmonary circulation[J].J Physiol,1894,16(1-2):34-96,158-9-158-25.
[10] Weissmann N,Grimminger F,Walmrath D,et al.Hypoxic vasoconstriction in buffer-perfused rabbit lungs[J].Respir Physiol,1995,100:159-69.
[11] Sommer N,Dietrich A,Schermuly R T ,et al.Regulation of hypoxic pulmonary vasoconstriction:basic mechanisms[J].Eur Respir J,2008,32:1639-51.
[12] Naeije R,Dedobbeleer C.Pulmonary hypertension and the right ventricle in hypoxia[J].Exp Physiol,2013,98(8):1247-56.
[13] B?rtsch P,Maggiorini M,Ritter M,et al.Prevention of high-altitude pulmonary edema by nifedipine[J].N Engl J Med,1991,325:1284-9.
[14] Luks A M,McIntosh S E,Grissom C K,et al.Wilderness medical society consensus guidelines for the prevention and treatment of acute altitude illness[J].Wilderness Environ Med,2010,21:146-55.
[15] Low E V,Avery A J,Gupta V,et al.Identifying the lowest effective dose of acetazolamide for the prophylaxis of acute mountain sickness:systematic review and meta-analysis[J].BMJ,2012,345:e6779.
[16] Montgomery A B,Luce J M,Michael P,et al.Effects of dexamethasone on the incidence of acute mountain sickness at two intermediate altitudes[J].JAMA,1989,261:734-6.
[17] Ellsworth A J,Larson E B,Strickland D.A randomized trial of dexamethasone and acetazolamide for acute mountain sickness prophylaxis[J].Am J Med,1987,83(6):1024-30.
[18] H?hne C,Krebs M O,Seiferheld M,et al.Acetazolamide prevents hypoxic pulmonary vasoconstriction in conscious dogs[J].J Appl Physiol(1985),2004,97(2):515-21.
[19] Shimoda L,A,Luke T,Sylvester J T,et al.Inhibition of hypoxia-induced calcium responses in pulmonary arterial smooth muscle by acetazolamide is independent of carbonic anhydrase inhibition[J].Am J Physiol Lung Cell Mol Physiol,2007,292(4):L1002-12.
[20] Teppema Luc J,Balanos George M,Steinback Craig D,et al.Effects of acetazolamide on ventilatory,cerebrovascular,and pulmonary vascular responses to hypoxia[J].Am J Respir Crit Care Med,2007,175(3):277-81.
[21] Basnyat B,Hargrove J,Holck P S,et al.Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans[J].High Alt Med Biol,2008,9(3):209-16.
[22] Kayser B,Hulsebosch R,Bosch F.Low-dose acetylsalicylic acid analog and acetazolamide for prevention of acute mountain sickness[J].High Alt Med Biol,2008,9(1):15-23.
[23] Wu T,Liu J.Alcohol and aspirin in combination with dexamethasone causes gastrointestinal bleeding at high altitude[J].Wilderness Environ Med,2006,17(1):69-71.
[24] Abdelmannan D,Tahboub R,Genuth S,et al.Effect of dexamethasone on oral glucose tolerance in healthy adults[J].Endocr Pract,2010,16(5):770-7.
[25] Erkut Z A,Pool C,Swaab D F.Glucocorticoids suppress corticotropin-releasing hormone and vasopressin expression in human hypothalamic neurons[J].J Clin Endocrinol Metab,1998,83(6):2066-73.
[26] Planès C,Escoubet B,Blot-Chabaud M,et al.Hypoxia downregulates expression and activity of epithelial sodium channels in rat alveolar epithelial cells[J].Am J Respir Cell Mol Biol,1997,17(4):508-18.
[27] Urner M,Herrmann I K,Booy C,et al.Effect of hypoxia and dexamethasone on inflammation and ion transporter function in pulmonary cells[J].Clin Exp Immunol,2012,169(2):119-28.
[28] Young S L,Ho Y S,Silbajoris R A.Surfactant apoprotein in adult rat lung compartments is increased by dexamethasone[J].Am J Physiol,1991,260(2 Pt1):L161-7.
[29] Stelzner T J,O'Brien R F,Sato K,et al.Hypoxia-induced increases in pulmonary transvascular protein escape in rats.Modulation by glucocorticoids[J].J Clin Invest,1988,82:1840-7.
[30] Sekiyama A,Gon Y,Terakado M,et al.Glucocorticoids enhance airway epithelial barrier integrity[J].Int Immunopharmacol,2012,12(2):350-7.
[31] Zheng C R ,Chen G Z ,Yu J,et al.Inhaled budesonide and oral dexamethasone prevent acute mountain sickness[J].Am J Med,2014,127(10):1001-9.