登玉山對高山症及其生理因子的影響研究

Study on the influence of high altitudes on the physiological and biochemical parameters of Mount Jade climbers.

劉屏梅(Ping-Mei Liu)

指導教授 ： 梁有志 ； 高偉峰

臺北醫學大學/醫學院/醫學檢驗生物技術學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00036

摘要

一、中文摘要
目的
探討登玉山山友對高山症狀及生化、賀爾蒙等因子的影響。
方法
本研究採用前瞻相關性研究(prospective study)設計，招募登玉山健康受試者，於上山前後做肺功能檢測，並於上山前後及下山後一 週抽血檢測血球、生化及相關荷爾蒙試驗，以及於上山前後和沿路於不同高度測試高山症指數、血氧飽和度及肺吐出流量等相關生理指標。以SPSS13.0版，作統計分析。以P值小於0.05視為統計學上顯著差異。

結果
最後有18位符合條件山友完成測試，其中男性9位，女性9位。年齡由22至54歲，平均為41±11歲。依據露易絲湖急性高山病指數，有12位（67%）山友符合急性高山病診斷，5（28%）位為高山相關症候，無症狀者有一位。12位急性高山病山友自覺高山症最嚴重的地方，以排雲山莊佔最多，有8位(66.7%)，血氧飽和度在玉山主峰(3952公尺)，由70%至89%平均為82.83±5.35%。登山前後血液檢驗結果，其中Thyroid stimulating hormone （TSH）、Erythropoietin （EPO）及Antidiuretic hormone （ADH）於登玉山後有顯著之升高，Free Thyroxine （FT4）及renin於登玉山後有顯著之降低。Crdiac troponin I （CTNI）、Creatine kinase （CK）、Lactate dehydrogenase （LDH）、Alanine aminotransferase （ALT）、C-reactive protein （CRP）、Sodium（Na+）、Chloride（Cl-）等及白血球總數登山後顯著升高，Potassium（K+）、Calcium（Ca2+）、Total Protein （TP）、Lactate （LA）、Amylase （AMY）等登山後顯著降低，除CRP外其它下山一週後再測與登山前比較皆無顯著之差異。

結論
從這次的研究發現，登玉山山友約有67％符合急性高山病診斷，66.7%出現高山症最嚴重的地方，為排雲山莊，玉山主峰SpO2平均為82.83%，生化、賀爾蒙等因子於登玉山前後濃度有顯著差異，這些差異約一週後都回復到登玉山前的檢測值。

關鍵字

高山症

並列摘要

Study on the influence of high altitudes on the physiological and biochemical parameters of Mount Jade climbers.

Subject： To study the changes of biochemistry and hormones after climbing Mount Jade.

Methods： This was a prospective study. Eighteen healthy climbers were enrolled in this study. Data of biochemistry, hormones, blood cells, and pulmonary function tests were collected before and after the climb. A standardized form was used to collect information. Oxygen saturation (SpO2) was measured with a nellcor NPB40 handheld pulse oximeter（NPB40）at different altitudes. The Lake Louise consensus was used for the diagnosis of acute mountain sickness (AMS). The software used was SPSS 13.0 . Probabilities of less than 0.05 were considered to be statistically significant.

Results： Eighteen climbers：9 males and 9 females participated in this study. The ages of the participants ranged from 22-54 with an average of 41±11 years old. Twelve (67%) of the climbers met the diagnostic criteria of acute mountain sickness. Five (28%)met the diagnosis of high altitude related syndrome. One climber was asymptomatic. The location of the most severe discomfort reported by the climbers was in Paiyun lodge but not at the summit of the Mountain Jade. The average SpO2 was 70% to 89% with an average of 82.83±5.35% at the main peak. Thyroid stimulating hormone（TSH）、Erythropoietin（EPO）and Antidiuretic hormone（ADH）rose significantly after the climb. Free Thyroxine（FT4）and renin decreased significantly after the climb. Cardiac Troponin I（CTNI）、Creatine kinase（CK）、Lactate dehydrogenase（LDH）、Alanine aminotransferase（ALT）、C-reactive protein（CRP）、Sodium（Na+）、Chloride（Cl）、 and total White Blood Cell（WBC）count rose significantly after the climb. Potassium（K+）、Calcium（Ca2+）、Total protein（TP）、Lactic Acid（LA） and Amylase（AMY）decreased significantly after the climb.

Conclusions： 67% of the Mount Jade climbers met the diagnostic criteria of acute mountain sickness. The location of the most severe discomfort reported by the climbers was in Paiyun lodge but not at the summit. TSH、 EPO、 and ADH rose remarkably after the climb. FT4 and renin decreased significantly after the climb.

並列關鍵字

high altitudes

參考文獻

Hu SC, Kao WF A survey of disease patterns in high mountain recreational areas Tzu Chi Medical Journal.（2002）. 14(6): 373-80.

Chen WL, Kao WF, Huang HH, Lee CH. Emergency Medical Services in the Lishan Marathon. Tzu Chi Medical Journal.（2002）.14(4): 219-23.

Kao WF, Kuo BIT, Kuo CC, Yen DHT, Chih PS, Chang H, Chang YY, Kuo HL, Chang CM, Chiou MJ, Hu SC, Lee CH. High Altitude Illness and Emergency Medical Services at Remote Mountain Ho-Huan Resort area during the 1999 Snow Season. J Emerg Med, R.O.C. （2000）. 2(1): 34-45.

A.Lgabry, X. Ledoux, M. Mozziconacci and C. Martin, High-altitude pulmonary edema at moderate altitude(<2400m;7870feet):a series of 52 patients.Chest（2003）.123:49-53.

Buemi M, Nostro L, Giacobbe M, Aloisi C, Sturiale A, Bolignano D, Allegra A, Grasso G, Frisina N, From the oxygen to the organ protection erythopoietin as protagonist in internal medicine. Bentham Science Publishers.（2006）.pp.299-311(13).