急性高山病 AMS 診斷標準修正, 剔除失眠

Wilderness medicine at high altitude: recent developments in the field 2015 Sep 24

AMS= acute mountain sickness 急性高山病
Diagnosis of AMS 
Lake Louise Scoring system 路易斯湖評分系統 LLS

LLS原始設計的目的是為了做研究, 後來變成通用的AMS 診斷工具, 在LLS中. 必須先有頭痛, 再加上以下任一症狀: 腸胃道症狀, 疲憊虛弱, 頭暈, 睡眠品質不佳.
頭痛是診斷AMS的鑑別特徵, 在海拔 4500 公尺以上 100% 會有頭痛. 在一項德瑪峰的研究報告指出, 87% 健行者出現頭痛症狀, 在這些頭痛患者中, 70% 合併其他症狀, 符合 AMS 診斷. 這表示頭痛患者中有 30% 與 AMS 無關, 所以用頭痛作為診斷AMS的必須條件似乎有問題, 其他高海拔地區頭痛原因包括: 脫水, 偏頭痛, 壓力緊張型頭痛, 鼻竇炎, 曝曬引起前額肌肉收縮等等. 

Despite its development as a research tool, the LLS is widely used to diagnose AMS. Headache must be present for the diagnosis of AMS with at least one other symptom (gastrointestinal symptoms, fatigue and/or weakness, dizziness, difficulty sleeping). Each symptom is scored from 0 (none) to 3 (severe). A total score of 3 or more in the presence of a headache is diagnostic for AMS. The use of this score has been validated in a recent normobaric hypoxia chamber study. Much has been published about the utility and value of headache being a discriminatory feature of AMS. The incidence of headache at altitude is up to 100% >4,500 m. A survey on Mount Damavand reported that 87% of trekkers at high altitude suffer from a headache. Of these, 70% had other features suggestive of AMS. This suggests that 30% of trekkers have headache that is not related to AMS, questioning the validity of using headache as a compulsory feature of an AMS diagnosis. Other causes of headache at altitude can include dehydration, migraines, tension headaches, sinusitis, and frontal muscle contraction from sun glare. 

枕部或顳部頭痛比較能診斷為AMS, 不過還要配合病患過去頭痛相關疾病的病史 
Headache pattern may be useful in AMS diagnosis; 100% of trekkers with an occipital headache and 83% of those with a temporal headache had other features of AMS. This is supported by a study measuring changes in cerebral hemodynamics after acute exposure to altitude, which demonstrated significantly greater blood flow in the posterior cerebral circulation in individuals suffering from AMS, compared with those without symptoms. It seems occipital or temporal headaches at high altitude are almost diagnostic for AMS, and there is, perhaps, a need for the headache of AMS to be characterized as such. The issue of whether headache should be afforded preponderance remains hotly debated. While the place of headache in the diagnosis of AMS is being debated, an algorithm has been developed for assessing individuals with headache at altitude, using a pragmatic approach, taking into account a past medical history of headache-associated illness and other features consistent with AMS. 

睡眠品質不佳的地位也受到質疑, 同時頭痛及睡不好的人不多, 睡不好與其他高山病症狀相關性也不大, 將睡眠問題去除之後, 更能準確診斷高山病. 
The place of poor sleep quality in the diagnosis of AMS has also been questioned. A large symptomatology analysis using a novel correlation networks methodology demonstrated two clusters of symptoms, one with a preponderance of individuals with poor sleep quality and the other with headaches. Few individuals suffered from both headaches and poor sleep quality. Another study demonstrated a poor correlation between poor sleep quality and the other features of AMS, and that by eliminating sleep from the score, the repeatability of an AMS diagnosis was stronger.