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پیشگیری از بیماری کوه گرفتگی - emdadgar_shahed - 2011/11/13 12:35 AM

پیشگیری از بیماری کوه گرفتگی
ادم مغزی و ریوی در ارتفاع

بیماری کوه گرفتگی
Mountain sickness
وسائل سریع نقل و انتقال ( مثل : بالگرد و تله کابین ) سبب شیوع عوارش ناشی از ارتفاع زیاد در افراد حساس گردیده است . کمی فرصت برای تطابق شخص با تغییرات اختلاف ارتفاع ; فعالیت بدنی و میزان سلامتی جسمی در بروز و شدت اختلالات حاد یا مزمن ناشی از هیپوکسی ( کمبود اکسیژن خون ) مربوط به ارتفاعات بیش از 2000 متر تاثیر دارد . در افراد مختلف میزان تحمل به هیپوکسی فوق العاده متفاوت است .
سر درد Headache
سردرد در ارتفاعات زیر 3000 متر در افرادی که کوه نوردی را تازه شروع کرده اند یا تنفس خود را صحیح انجام نمی دهند دیده می شود . در این افراد بدلیل هیپرو نتیلاسیون ( تنفس سریع ) میزان اکسیژن خون افزایش و در نتیجه میزان دی اکسید کربن کاهش میابد . این کار باعث می شود که PH خون که در حالت نرمال بین 45/7 – 35/7 می باشد ; قلیائی تر شود . این حالت معمولا با بروز سر درد همراه است . درمان آن کاهش PH خون می باشد که با چند روش انجام می شود .
تنفس به مدت چند دقیقه در یک کیسه نایلونی به منظور افزایش دی اکسید کربن خون
خوردن مواد با PH اسیدی مثل لیمو ترش و قرص ویتامین C

بیماری کوه گرفتگی حاد
Acute mountain sickness

علایم اولیه :
سردرد ; سستی فوق العاده ; خواب آلودگی ; احساس سرما ; تهوع ; استفراغ ; پریدگی رنگ صورت ; تنگی نفس و سیانوز
در مرحله بعدی :
برافروختگی صورت ; تحریک پذیری ; اشکال در تمرکز حواس ; سرگیجه ; طنین گوش ; اختلالات بینائی ( گاه خونریزی شبکیه ) اختلالات شنوائی ; بی اشتهائی ; بی خوابی ; شدت تنگ نفس و ضعف عمومی هنگام حرکت ; سر درد شدید ( مربوط به ادم مغزی ) ; تپش قلب ; تنفس نامنظم و کاهش وزن
انجام تنفس عمیق در فواصل معین می تواند ; علائم را بهبود بخشد . در اکثر افراد این علائم ظرف 48 – 24 ساعت از بیم می رود . اما در بعضی موارد ممکن است علائم بصورت شدید و مقاوم باقی بماند تا آن حد که شخص مجبور به مراجعت به منطقه کم ارتفاع شود .
مصرف اکسیژن غالبا علائم حاد کوه گرفتگی را مرتفع می کند .

تدابیر پیشگیری عبارتند از :
استراحت و خواب کافی در روز قبل از حرکت
مصرف غذای سبک و پر انرژی
پرهیز از مصرف الکل و توتون
حرکات فیزیکی غیر لازم در طول سفر

خیز ریوی حاد ناشی از ارتفاع زیاد
Acute pulmonary edema
این عارضه خطر ناک معمولا در ارتفاعات بالاتر از 3000 متر دیده می شود .
اولین آثار ریوی 6 – 36 ساعت پس از رسیدن به نتقطه مرتفع ظاهر می شود و شامل موارد زیر است :
سرفه های خشک
تنگی نفس هنگام استراحت
سنگینی و فشار بر قفسه صدری
خس خس سینه

شناخت علائم اولیه هر چه زودتر بیمار را قادر می سازد که قبل از ادم شدید و ناتوان کننده ریوی به تنهائی یا با کمک دیگران به ارتفاع پائین تر برگردد . برگشت سریع به ارتفاعی حتی 1000 – 500 متر پائین تر ممکن است علائم را بهبود بخشد .

درمان :

استراحت در بستر به حالت نیمه نشسته
تجویز اکسیژن با ماسک به میزان 6 – 8 لیتر در دقیقه به مدت 15 – 20 دقیقه
پس از آن میزان اکسیژن کاهش یابد تا زمانی که بیمار بهبود یابد یا بتوان او را به ارتفاع پائین تر نقل مکان داد .
باید توجه داشت در صورتی که بیمار سیگار مصرف می نماید . میزان اکسیژن داده شده کمتر از افراد عادی باشد و بیمار از نظر وقفه تنفسی کنترل شود . اکسیژن با میزان زیاد ممکن است باعث وقفه تنفسی در افراد سیگاری بشود

تدابیر پیشگیری عبارتند از :
آموزشهای لازم به افراد جدید و آگاه کردن آنها از امکان بروز ادم ریوی
شرابط مساعد فیزیکی قبل از آغاز سفر
صعود ملایم برای تطابق و هماهنگی با ارتفاع
شب ماندن در پناهگاه برای هم هوائی
انجام صعود های تمرینی به ارتفاعات پائین تر از قله مورد نظر در هفته های قبل
1 تا 2 روز استراحت بعد از رسیدن به نقطه مرتفع
کاربرد سریع تدابیر طبی درصورت بروز آثار تنفسی و بستری کردن افرادی که سابقه ادم ریه در جریان کوهنوردی های قبلی داشته اند .
در طول برنامه های صعود به ارتفاعات بالا ، به افرادی که دچار کوه گرفتگی شدید می شوند ; آمپول دگزامتازون به صورت داخل وریدی و آهسته تزریق می شود

تجربه های شخصی در زمینه مقابله با کوه گرفتگی
استفاده از قرص دگزامتازون بعنوان پیشگیری ..... Tab. Dexametasone 0.5 mg
این دارو با دوز 5/0 – 9 ( میلی گرم در روز ) بصورت مقدار واحد یا در مقادیر منقسم قابل مصرف است .
( حداکثر معادل 18 عدد قرص در روز )
دور پیشنهادی در هر وعده مصرف 2-3 قرص می باشد که تا 5 عدد قابل افزایش است .
ظهر قبل از صعود 2 قرص در پناهگاه ; شب قبل از صعود 3 قرص ; صبح و ظهر روز صعود 1-2 قرص
بسته یه میزان علائم فرد در ارتفاع دوز این دارو را می توان کاهش یا افزایش داد .

از آنجا که دارو های کورتنی باعث افزایش ترشح اسید معده می شود ; توصیه می شود که حتما همراه غذا و قرص آنتی اسید ( آلومینیوم ام جی اس ) مصرف شود .
آنتی اسید مذکور باعث کاهش نفخ کردن نیز می گردد .
در مورد مجوز مصرف این دارو در صورتی که بیمار هستید ( مخصوصا بیماریهای دستگاه گوارش و سیستم ایمنی ) با پزشک معالج خود مشورت کنید .
همچنین برای کاهش نفخ شکم ; مصرف عرق نعناع ; عرق کاکوتی و یا قرص نعناع پیشنهاد می شود
ضمنا در برنامه های کوهنوردی بدلیل به هم خوردن رژیم غذائی ; بی اشتهائی و تهوع ناشی از ارتفاع ; موارد زیادی مشاهد می شود که فرد دچار کمبود انرزی می گردد . در این موارد توصیه می شود از مصرف نوشابه گاز دار اکیدا خود داری نموده و بجای آن از نوشابه کوهستان استفاده نمائید .

نوشابه کوهستان :
آب + پودر گلوکز + آبلیمو تازه با عرق نعناع


منابع :
تشخیص و درمان طبی بیماریها – دکتر عباس ادیب – استاد دانشگاه اصفهان
دارو های ژنریک ایران



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