The mountain disease is the pathological state caused by decrease in saturation of blood oxygen, developing at stay at considerable height. Clinical manifestations consist of signs of respiratory insufficiency, damage of a brain, blood circulatory system and digestive tract. The diagnosis is exposed on the basis of the clinical symptoms connected with rise on essential height. Easy manifestations can independently be stopped. In hard cases posindromny pathogenetic therapy with the subsequent emergency descent of the victim is shown.
The mountain (high-rise) disease develops because of decrease in partial pressure of atmospheric gases in the inhaled air. At rise on height from 3000-4000 meters the sharp mountain disease arises at 10-20% which rose over 4500-5000 m – at 100%. Its heavy manifestations occur at 1-4% which are at height. 8000 meters above sea level are considered a deadly zone. Stay in such conditions without special equipment is limited for 1-2 days. Inhabitants of the flat area, lowlands are more subject to a disease. At a part of indigenous people of the highlands which are constantly living from 3000 m above sea level the chronic high-rise disease develops.
Oxygen starvation is the main reason for development of a pathological state. Decrease in partial pressure of oxygen in the resolved mountain air causes a gipoksemiya. Thanks to compensatory opportunities the human body during the certain temporary period is capable to adapt to high-rise conditions. Emergence and weight of a disease are caused by the following factors:
- Rise height. At intermediate and big heights (from 1500 to 3500 meters) the disease arises at bystry rise. Practically everyone, risen by very big height (3500-5800 m), suffers from gipoksemiya consequences. The period of acclimatization makes 2-6 days. Long stay on extreme (it is higher than 5800 m) heights is impossible, full adaptation does not happen.
- Climate and weather conditions. Incidence is higher in a humid and frigid climate. The mountain disease meets in winter season more often. An additional adverse effect on an organism is made by differences of daytime and night time temperature of air and strong gusty wind.
- Individual qualities. The frequency of emergence and weight of a course of a high-rise disease are influenced by the fitness level, a physical and psychoemotional state, resistance to a hypoxia. Men transfer oxygen starvation worse. Young people are more subject to negative impact of the resolved atmosphere.
The physical overstrain, dehydration and improper feeding, excess weight, sleep disorders provoke development of a disease at rather low heights. Blood loss, colds, an exacerbation of chronic diseases, alcohol intake and coffee aggravate oxygen insufficiency and promote developing of hypostasis of lungs and (or) a brain.
The mechanism of development of the pathological state caused by stay at height is insufficiently studied. Oxygen insufficiency leads to a fabric gipoksemiya. The organism seeks to compensate this state, adaptation mechanisms turn on. Ventilation amplifies - breath becomes frequent, becomes deeper. Warm emission increases, the rhythm accelerates. The erythrocytes and other blood cells deposited in a liver, a spleen and red marrow are thrown out a blood-groove. The organism gets used to deficiency of oxygen, there is an acclimatization.
If the hypoxia accrues, reserves of a human body are exhausted. Bodies and systems are damaged at the cellular level. Irreversible changes develop. Permeability of cellular membranes increases. There is an activation of apoptosis – the programmed death of cages. The most vulnerable bodies are the brain and alveolar pulmonary fabric. A lack of oxygen along with the gipokapniya developing against the background of a hyperventilation have the damaging effect on nervous system. There is a neurologic symptomatology. Increase in permeability of a vascular wall leads to brain hypostasis. Gas exchange violation, stagnation in a small circle of blood circulation promote development of hypostasis of lungs.
On severity the mountain disease happens easy, medium-weight and heavy. Expressiveness of clinical symptomatology depends not only on height and compensatory opportunities of an organism. Rise speed is of great importance. At bystry ascension the organism does not manage to acclimatize. There is a damage of bodies and fabrics. Depending on the speed of development and weight of displays of a disease allocate the following forms of the disease state arising at height:
- The sharpest. Develops within several minutes after rise. Arises at hit on big height by means of the air transport, depressurization of a cabin of the plane, bystry ascension. Proceeds extremely hard.
- Sharp. Signs of an indisposition appear within 6-12 hours. Arises because of bystry rise, and also at very big and extreme heights. Weight of a current depends on adaptation abilities of an organism.
- Subsharp. Develops gradually within a week at the correct slow ascension. The clinical picture is similar to manifestations of a sharp state.
- Chronic. Such form of a disease is characteristic for is constant or long living in highlands. The disease proceeds slowly and rather favorably.
Symptoms of a mountain disease
Signs of the pathological state arising in the resolved mountain atmosphere are various. They depend on what system of a human body suffered more. The intensive headache amplifying at physical activity and in horizontal position belongs to frequent displays of high-rise pathology. It is accompanied by dizziness, flashing of "front sights" before eyes. There is a feeling of the expressed weakness and fatigue. Habitual loadings trouble. The dream becomes uneasy, faltering with disturbing dreams. There is short wind, increase of warm reductions, feeling of heartbeat. Quite often there are pressing zagrudinny pains. Appetite decreases, join nausea with vomiting or without, a meteorizm. The urination becomes rare, portions of urine – small.
The mountain disease of easy degree is shown by a headache, short wind, heartbeat at physical and psychoemotional pressure, overcooling. Existence of symptoms of a disease at rest is characteristic of a medium-weight current. Violations of sight and hearing join. Character changes, irritability, symptoms of a depression appear. Sometimes, on the contrary, there are euphoria, excitement. Disease symptoms in an easy and medium-weight form gradually weaken or amplify for several days-weeks.
The heavy course of high-rise pathology is shown by sharp increase of short wind, the cough which is quite often complicated by a blood spitting or pulmonary bleeding. The constant painful headache amplifies at the slightest movement. Considerably the general weakness increases. The patient becomes sluggish, apathetic, slowed down. Thought processes are broken. There are hallucinations and spasms. At further progressing of process there comes the coma.
At the correct delivery of health care and urgent descent down the mountain disease usually regresses, and there occurs recovery. Treat complications of a disease mountainous swelled lungs and mountainous swelled a brain. Less often the sharp renal and liver failure, a miokardiodistrofiya develops. In the conditions of height, without treatment these states inevitably lead to death of the patient. Owing to long oxygen starvation at inhabitants of highlands chronic pulmonary heart is formed, functions of breath and blood circulation are broken.
To be able to distinguish adverse influence of a hypoxia not only the representative of sports medicine, but also any making ascension has to. The diagnosis is exposed according to clinical data. There is a simple questionnaire helping to define existence of pathological process. Presence of a headache, dizziness, sleep disorder and functions of a gastrointestinal tract, decrease in working capacity is considered. At survey unsteadiness of gait, an incoordination of movements comes to light. Pallor or cyanosis of integuments is observed. The sports doctor of mountaineering camp for the purpose of specification of the diagnosis carries out:
- Fizikalny research. At an auskultation in lungs dry and damp mixed rattles can be listened. Increase of heart rate, violation of a rhythm are observed. Sometimes are defined splitting of the first tone on a heart top, bifurcation of the second tone over an aorta.
- Electrocardiography and pulsoksimetriya. On the ECG signs of an overload of the right departments of heart, tachycardia, premature ventricular contraction, violations of conductivity and a rhythm come to light. By means of a pulsoksimetr hypoxia level is defined. Blood saturation by oxygen lower than 90% testifies to the average or heavy course of a disease.
In the nearest medical institution the victim looks round the therapist, the neurologist, if necessary - the resuscitator. The radiological research or KT of bodies of a thorax, laboratory analyses are in addition carried out. The high-rise disease should be differentiated with pneumonia, infectious diseases, cardiogenic hypostasis of lungs, alcoholic intoxication.
Treatment of a mountain disease
First aid is carried out as prevalence of this or that symptomatology depending on severity of a disease. Further ascension is forbidden to the patient with easily proceeding pathological state, rest, the balanced food, the vitaminized drink before the end of the period of acclimatization is recommended. If in 3 days improvement does not occur, the victim is subject to evacuation down. At the heavy and medium-weight course of a disease it is necessary to apply:
- Oxygenotherapy. Inhalation of the moistened oxygen allows to compensate a state temporarily. The headache decreases or is completely stopped. The nervous system is stabilized. Gas exchange improves, breath is restored. At suspicion on development of hypostasis of lungs it is necessary to apply oxygen with the defoaming agent.
- Kortikosteroidny hormones. Have ability to stabilize cellular membranes. Reduce local and system consequences of the inflammatory reaction caused by the damaging action of a hypoxia. Are effective at any zhizneugrozhayushchy complication of a sharp gipoksemiya.
If necessary kardiotropny medicines, diuretics, antibacterial means are appointed. Patients are subject to the emergency descent in the foothills. Whenever possible, evacuation has to be carried out by means of vehicles. For further pathogenetic treatment patients are hospitalized in office of therapy, neurology or resuscitation.
Forecast and prevention
After timely evacuation the mountain disease quickly regresses. Functions of an organism are restored completely and without consequences. Lack of medical care, further stay can become high in mountains a cause of death of the victim. The chronic mountain hypoxia leads to pulmonary heart failure with gradual deterioration of life and the patient's invalidization.
In the preventive purposes trainings are necessary. Before the first ascension special preparation is required. The mountain area with intermediate heights is suitable for acclimatization. Gradual, slow rise will be organized. Participants of an expedition have to be acquainted with disease symptoms, risk factors, rules of rendering most and mutual aid. For rise on extreme heights it is recommended to use oxygen masks. The athletes making ascensions are subject to regular routine medical examinations.