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ISSN 2070-1004 (print)
ISSN 2686-7966 (online)


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МЕДИЦИНА КАТАСТРОФ №2•2021

https://doi.org/10.33266/2070-1004-2021-2

Профилактика и лечение высотной болезни

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Самойлов А.С. 1, Рылова Н.В. 1, Большаков И.В. 1, Казаков В.Ф. 1

1 ФГБУ «ГНЦ – Федеральный медицинский биофизический центр им. А.И.Бурназяна» ФМБА России, Москва, Россия

УДК 616-032:612.213:796.077.2

С. 55–58

Резюме. Цель исследования – определение тактики эффективной профилактики и лечения высотной болезни в условиях средне- и высокогорья.

Материалы и методы исследования. Проанализированы данные отечественной и зарубежной литературы о высотной болезни. Поиск проводился с использованием электронных баз данных MEDLINE, Embase, Scopus, Web of Science, eLIBRARY за период с 2013 г. по 2021 г. Для поиска использовались следующие ключевые слова и их сочетания: высотная болезнь, лечение, профилактика.

Результаты исследования и их анализ. Рассмотрены особенности развития высотной болезни, факторы риска, современные подходы к лечению данной патологии, а также возможности фармакологических и нефармакологических методов профилактики. Отмечено, что ключевой метод профилактики высотной болезни – постепенное восхождение на большие высоты, а перспективным методом её профилактики может быть заблаговременное проведение интервальных гипоксических тренировок. При необходимости быстрого подъема на высоты свыше 2,5 тыс. м возможно применение таких препаратов, как ацетазоламид и дексаметазон. В случае неэффективности профилактики и развития любой из форм высотной болезни самое эффективное средство лечения – незамедлительный спуск на более низкие высоты. При невозможности спуска оправдано применение кислородо- и фармакотерапии, возможно также использование гипербарических камер.

Ключевые слова: высокогорный отек легких, высокогорный отек мозга, высотная болезнь, лечение, острая горная болезнь, профилактика, спортсмены

Для цитирования: Самойлов А.С., Рылова Н.В., Большаков И.В., Казаков В.Ф. Профилактика и лечение высотной болезни // Медицина катастроф. 2021. №2. С. 55-58. https://doi.org/10.33266/2070-1004-2021-2-55-58

СПИСОК ИСТОЧНИКОВ

1. Kurtzman R.A., Caruso J.L. High-altitude illness death investigation // Acad. Forensic Pathol. 2018. Vol. 8, № 1. P. 83–97.

2. Davis C., Hackett P. Advances in the prevention and treatment of high altitude illness // Emerg. Med. Clin. North Am. 2017. Vol. 35, № 2. P. 241–260.

3. Roach R.C., Hackett P.H., Oelz O., Bärtsch P., Luks A.M., MacInnis M. J. Baillie J.K. The 2018 Lake Louise Acute Mountain Sickness Score // High Altitude Medicine & Biology. 2018. Vol. 19, №1. P. 4–6.

4. Jin J. Acute Mountain Sickness // JAMA. 2017. Vol. 318, №18. 1840 p.

5. Luks A.M., Auerbach P.S., Freer L. et al. Wilderness medical society Practice guidelines for the prevention and treatment of acute altitude illness: 2019 update // Wilderness Environ. Med. 2019. Vol. 30, № 4. P. 3-18.

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15. Ветряков О.В., Быков В.Н., Фатеев И.В., Халимов Ю.Ш. Применение ацетазоламида для профилактики симптомов острой горной болезни при краткосрочном перемещении из среднегорья в высокогорье // Обзоры по клинической фармакологии и лекарственной терапии. 2018. Т. 16, № 2. С. 42–48.

16. McIntosh S.E., Hemphill M., McDevitt M.C. et al. Reduced acetazolamide dosing in countering altitude illness: a comparison of 62.5 vs. 125 mg (the RADICAL Trial) // Wilderness Environ. Med. 2019. Vol. 30, № 1. P. 12–21.

17. Burns P., Lipman G.S., Warner K. et al. Altitude sickness prevention with ibuprofen relative to acetazolamide // Am. J. Med. 2019. Vol. 132, № 2. P. 247–251.

18. Simancas-Racines D., Arevalo-Rodriguez I., Osorio D., Franco J. V., Yihan Xu, Hidalgo R. Interventions for treating acute high altitude illness // Cochrane Database Syst. Rev. 2018. Vol. 6, № 6: CD009567. doi: 10.1002/14651858.CD009567.pub2.

19. Irons H.R., Salas R.N., Bhai S.F., Gregorie W.D., Harris N.S. Prospective Double-Blinded Randomized Field-Based Clinical Trial of Metoclopramide and Ibuprofen for the Treatment of High Altitude Headache and Acute Mountain Sickness // Wilderness Environ. Med. 2020. Vol. 31, № 1. P. 38-43.

20. Weaver T.E. Novel Aspects of CPAP Treatment and Interventions to Improve CPAP Adherence // Journal of Clinical Medicine. 2019. Vol. 8, № 12. 2220 p.

21. Joyce K.E., Lucas S.J.E., Imray C.H.E., Balanos G., Wright, A. D. Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema. Expert Opinion on Pharmacotherapy. 2018. Vol. 19, № 17. P. 1891-1902.

Материал поступил в редакцию 28.03.21; статья принята после рецензирования 31.03.21; статья принята к публикации 15.06.21



DISASTER MEDICINE No. 2•2021

https://doi.org/10.33266/2070-1004-2021-2

Prevention and Treatment of Altitude Disease

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Samoylov A.S.1, Rylova N.V.1, Bol’shakov I.V.1, Kazakov V.F.1

1 State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russian Federation

UDC 616-032:612.213:796.077.2

Pp. 55-58

Abstract. The aim of the study is to determine the tactics of effective prevention and treatment of altitude sickness in the conditions of medium and high mountains.

Materials and research methods. Domestic and foreign literature on altitude sickness are analyzed. The search was carried out using the electronic databases MEDLINE, Embase, Scopus, Web of Science, eLIBRARY for the period from 2013 to 2021. The following keywords and their combinations were used for the search: altitude sickness, treatment, prevention.

Research results and their analysis. The features of the development of altitude sickness, risk factors, modern approaches to the treatment of this pathology, as well as the possibilities of pharmacological and non-pharmacological methods of prevention are considered. It is noted that the key method of preventing altitude sickness is a gradual ascent to great heights, and a promising method for its prevention can be an early implementation of interval hypoxic training. If one needs to quickly climb to heights of over 2.5 thousand meters, it is possible to use drugs such as acetazolamide and dexamethasone. In case of ineffectiveness of prevention and of development of any form of altitude sickness, the most effective treatment is an immediate descent to lower altitudes. If the descent is impossible, the use of oxygen and pharmacotherapy is justified, it is also possible to use hyperbaric chambers.

Key words: acute mountain sickness, altitude sickness, athletes, high-altitude cerebral edema, high-altitude pulmonary edema, prevention, treatment

For citation: Samoylov A.S., Rylova N.V., Bol’shakov I.V., Kazakov V.F. Prevention and Treatment of Altitude Disease. Meditsina katastrof = Disaster Medicine. 2021;2:55-58 (In Russ.). https://doi.org/10.33266/2070-1004-2021-2-55-58

REFERENCES

1. Kurtzman R.A., Caruso J.L. High-Altitude Illness Death Investigation. Acad. Forensic. Pathol. 2018;8;1:83–97.

2. Davis C., Hackett P. Advances in the Prevention and Treatment of High Altitude Illness. Emerg. Med. Clin. North Am. 2017;35;2:241–260.

3. Roach R.C., Hackett P.H., Oelz O., Bärtsch P., Luks A.M., MacInnis M. J. Baillie J.K. The 2018 Lake Louise Acute Mountain Sickness Score. High Altitude Medicine & Biology. 2018;19;1:4–6.

4. Jin J. Acute Mountain Sickness. JAMA. 2017;318;18:1840.

5. Luks A.M., Auerbach P.S., Freer L., et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 update. Wilderness Environ. Med. 2019;30;4:3-18.

6. Sagoo R.S., Hutchinson C.E., Wright A., et al. Magnetic Resonance Investigation into the Mechanisms Involved in the Development of High-Altitude Cerebral Edema. J. Cereb. Blood Flow Metab. 2017;37;1:319-331.

7. Raberin A., Nader E., Ayerbe J.L., et al. Evolution of Blood Rheology and its Relationship to Pulmonary Hemodynamic during the First Days of Exposure to Moderate Altitude. Clin. Hemorheol. Microcirc. 2020;74;2:201-208.

8. Luks A.M., Swenson, E.R., Bärtsch P. Acute High-Altitude Sickness. European Respiratory Review. 2017;26;143:160096. doi : 10.1183/16000617.0096-2016.

9. Aksel G., Çorbacıoğlu Ş.K., & Özen C. High-Altitude Illness: Management Approach. Turkish Journal of Emergency Medicine. 2019;19;4:121-126.

10. Gudbjartsson T., Sigurdsson E., Gottfredsson M., Bjornsson O.M., Gudmundsson G. High Altitude Illness and Related Diseases - a Review. Laeknabladid. 2019;105;11:499-507.

11. Murray A.J., Montgomery H.E., Feelisch M., Grocott M.P.W., Martin D.S. Metabolic Adjustment to High-Altitude Hypoxia: From Genetic Signals to Physiological Implications. Biochem Soc Trans. 2018;46;3:599-607.

12. Basnyat B., Hofmeyr R., Tölken G., De Decker R. Acute High-Altitude Illness. S. Afr. Med. J. 2017;107;12:1047-1048.

13. Ashyrbayev A.A., Tolbashiyeva G.U. Prevalence Rate of Acute Mountain Sickness and Factors Influencing on It. Vestnik KRSU. 2019;19;1:65-67 (In Russ.).

14. Fulco C.S., Beidleman B.A., Muza S.R. Effectiveness of Preacclimatization Strategies for High-Altitude Exposure. Exerc. Sport Sci. Rev. 2013;41;1:55-63.

15. Vetryakov O.V., Bykov V.N., Fateev I.V., Halimov Yu.Sh. The Administration of Acetazolamidum for the Symptom Prophylaxis of an Acute Mountain Sickness when Short-Term Dislocation from Middle Mountains to Highlands Takes Place. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16;2:42–48 (In Russ.).

16. McIntosh S.E., Hemphill M., McDevitt M.C., et al. Reduced Acetazolamide Dosing in Countering Altitude Illness: a Comparison of 62.5 vs. 125 mg (the RADICAL Trial). Wilderness Environ. Med. 2019;30;1:12–21.

17. Burns P., Lipman G.S., Warner K., et al. Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide. Am. J. Med. 2019;132;2:247–251.

18. Simancas-Racines D., Arevalo-Rodriguez I., Osorio D., Franco J.V., Yihan Xu, Hidalgo R. Interventions for Treating Acute High Altitude Illness. Cochrane Database Syst. Rev. 2018;6;6:CD009567. doi: 10.1002/14651858.CD009567.pub2.

19. Irons H.R., Salas R.N., Bhai S.F., Gregorie W.D., Harris N.S. Prospective Double-Blinded Randomized Field-Based Clinical Trial of Metoclopramide and Ibuprofen for the Treatment of High Altitude Headache and Acute Mountain Sickness. Wilderness Environ Med. 2020;31;1:38-43.

20. Weaver T.E. Novel Aspects of CPAP Treatment and Interventions to Improve CPAP Adherence. Journal of Clinical Medicine. 2019; 8; 12: 2220.

21. Joyce K.E., Lucas S.J.E., Imray C.H.E., Balanos G., Wright, A.D. Advances in the Available Non-Biological Pharmacotherapy Prevention and Treatment of Acute Mountain Sickness and High Altitude Cerebral and Pulmonary Oedema. Expert Opinion on Pharmacotherapy. 2018;19;17:1891-1902.

The material was received 28.03.21; the article after peer review procedure 31.03.21; the Editorial Board accepted the article for publication 15.06.21


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