高山旅遊地區疾病型態之調查

A Survey of Disease Patterns in High Mountain Recreational Areas

10.6440/TZUCMJ.200212.0373

胡勝川(Sheng-Chuan Hu)；高偉峰(Wei-Fong Kao)

緊急醫療救護 ； 高山症 ； 旅遊地區 ； Emergency medical services ； high altitude syndrome ； recreational area

慈濟醫學雜誌

14卷6期（2002 / 12 / 01）

373 - 380

繁體中文

目的：為了解國內不同高山旅遊地區傷病特質，做為未來推展高山旅遊及教育民眾預防高山症的參考。材料與方法：於89年11月1日至90年6月30日期間，我們選擇合歡山莊(3,050公尺)、玉山塔塔加遊客服務中心(2,600公尺)、太平山莊(1,920公尺)等三個旅遊勝地做為執行緊急醫療救護的地方。不同地區研究的日期分別是：合歡山1-2月，太平山3-4月，玉山5-6月。每次出勤一位醫師、二位護士，記錄必要資訊並輸入電腦，並比較高山症和非高山症患者的各項特徵，包括：年齡、血氧飽合度、脈搏、血壓、體溫，及不同高山地區之間的相互比較。統計方法為Students’s test和ANOVA，p值小於0.05為統計上有意義。結果：381位病人中創傷佔8.9%、非創傷91.1%。347例非創傷病人中，高山症有160位、非高山症187位，只有1例須以加護型救護車後送，其餘均可自行離去。34例創傷病人中，4例須以一般型救護車後送，其餘均可治療後離去。將高山症與非高山症病人各項特徵做比較，有顯著差異的如下：平均血氧飽合度88.0±6.1%和91.7±5.0%(t=5.625，p=0.000)、平均脈搏(跳/分)96.0±17.2和91.3±21.6(t=-2.051，p=0.041)、平均體溫(攝氏度)36.1±1.2和36.8±1.1(t=4.860，p=0.000)。若比較合歡山、玉山、與太平山各自地區高山症與非高山症病人各類特徵，具顯著差異者為：在合歡山為血氧飽和度85.1±5.9%和87.5±6.0%(t=2.157，p=0.033)和體溫(攝氏度)35.5±1.0和36.4±1.4(t=3.293，p=0.001)；在玉山為個案所佔比率46.5%和53.5%(t=-2.177，p=0.033)和年齡(歲)46.0%±18.8和33.0±22.0(t=-2.516，p=0.014)；在太平山則均未達統計學上的顯著意義。若比較不同海拔高山症之間的各項特徵，統計學上有意義的差別為高山症所佔比率、年齡、血氧飽合度、脈搏與體溫。在160例高山症中，155例急性高山病、3例高山肺水腫、2例高山腦水腫，最常見的症狀依序為：頭暈、頭痛、噁心、嘔吐、肢體無力。非高山症病人最常見的主訴依序為：頭暈、噁心、嘔吐、頭痛、咳嗽、肢體無力、呼吸困難、腹瀉。其疾病診斷排行依序為：暈車、感冒、腸胃炎。創傷病人中最常創傷機轉是運動傷害，其次是跌倒和撞傷。結論：一、高山旅遊地區的病人雖然不是很多，但確有重大傷病事件發生。二、海拔2,000公尺左右的高山，都會有高山症的病人，且海拔愈高，高山症病人愈多。三、高山症比非高山症病人的血氧飽合度低、體溫低及脈搏高，且此特性與高度成反比，但與脈搏成正比。四、非高山症病人中以暈車最常見。創傷只佔全部病人的8.9%。

Objective: To examine the characteristics of disease patterns in high mountain recreational area, and to investigate the prevalence of high altitude syndrome. Materials and Methods: The study was conducted from November 2000 to June 2001 in three travel sports (Ho-Hwan Mountain-3,050 meters meter, Yu Mountain -2,600 meters, and Tai-Ping Mountain -1,920 meters). To compare altitude and non-altitude illnesses, we used Student’s t test and ANOVA as statistical methods. A P value less than 0.05 was considered statistically significant. Results: The majority (347, 91.1%) of the 381 patients in this study had non-trauma conditions. One of these non-trauma cases needed to be transported via intensive care ambulance and the others could leave after emergency care. Of the 34 trauma cases, five were transported to the hospital for further management via ordinary ambulance. The 347 non-trauma cases were divided into either altitude or non-altitude illness and pulse rate, oxygen saturation and body temperature were compared between groups (96.0±17.2 Vs 91.3±21.6, 88.0±6.1% Vs 91.7±5.0%, 36.1℃±1.1 Vs 36.8℃±1.1, respectively). Among 160 patients with high altitude syndrome, 155 had acute mountain sickness, 3 had pulmonary edema, and 2 had cerebral edema. The most common symptoms of high altitude syndrome were dizziness, headache, nausea, vomiting and weakness. The most commonly used therapy was oxygen administration. The most common chief complaints in the non-altitude illness group were dizziness, nausea, vomiting, headache, coughing, weakness, dyspnea, diarrhea and abdominal distention. The most common diagnoses in this group were motion sickness, common cold, and gastroenteritis in that order. The most commonly seen trauma mechanisms were sport injuries, followed by falls and contusions. Conclusions: Although patient numbers were low, some patients in the high mountain recreational areas had critical illnesses. We did have high altitude syndrome in areas more than 2,000 meters above sea level. The higher the altitude, the higer the number of patients with high altitude syndrome. Lower oxygen saturation and body temperatures, as well as higher pulse rates were found in high altitude syndrome patients. The most common problem in patients with non-altitude diseases was motion sickness. Trauma occurred in less than 10% of cases.