Objective To compare the effects of oxygen therapy and local pressurization in alleviating plateau hypoxia at high altitude. Methods Forty-five healthy male soldiers were investigated at an altitude of 3992 meters. The subjects were randomly divided into three groups, ie. an oxygen inhalation group, a single-soldier oxygen increasing respirator ( SOIR) group and a BiPAP group. The oxygen inhalation group was treated with oxygen inhalation via nasal catheter at 2 L/ min. SOIR was used to assist breath in the SOIR group. The BiPAP group were treated with bi-level positive airway pressure ventilation, with IPAP of 10 cm H2O and EPAP of 4 cmH2 O. PaO2, PaCO2, SpO2 and heart rate were measured before and 30 minutes after the treatment. Results There were continuous increase of PaO2 from ( 53. 30 ±4. 88) mm Hg to( 58. 58 ±5. 05) mm Hg and ( 54. 43 ±3. 01) mm Hg to ( 91. 36 ±10. 99) mm Hg after BiPAP ventilation and oxygen inhalation, respectively ( both P lt; 0. 01) . However, the PaO2 of the SOIR group was decreased from( 56. 00 ±5. 75) mm Hg to ( 50. 82 ±5. 40) mm Hg( P lt; 0. 05 ) . In the other hand, the PaCO2 was increased from ( 30. 41 ±1. 51) mmHg to ( 32. 56 ±2. 98) mm Hg in the oxygen inhalation group ( P lt; 0. 05) , declined from( 28. 74 ±2. 91) mm Hg to ( 25. 82 ±4. 35) mm Hg in the BiPAP group( P lt;0. 05) ,and didn’t change significantly from( 28. 65 ±2. 78) mm Hg to ( 29. 75 ±3. 89) mmHg in the SOIR group ( P gt;0. 05) . Conclusions Both BiPAP ventilation and oxygen inhalation can alleviate plateau hypoxia by improving PaO2 at 3992 meter altitude while SOIR has no significant effect.
Objective To explore the efficacy of bi-level positive airway pressure ( BiPAP)ventilation plus plateau exhalation valve ( PEV) combined with respiratory stimulant for the treatment of pulmonary encephalopathy in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) . Methods 70 AECOPD patients with pulmonary encephalopathy were randomly divided into a control group and a treatment group. All patients received BiPAP ventilation and conventional therapyincluding antimicrobial, bronchodilation, and expectorant treatment. In the treatment group, the BiPAP ventilator was connected to PEV additionally, and naloxone and nikethamide were administered for 3 days.Clinical symptoms, blood gas analysis, vital signs, gas leakage conditions, and adverse reactions were recorded. Results Heart rate, respiratory rate, PaCO2 , and APACHEⅡ score were more significantly lower,the time to recover consciousness was shoter, meanwhile PaO2 , SaO2 , pH, and glasgow coma scale were significantly higher in the treatment group compared with the control group( all P lt; 0. 01) . Two cases in the treatment group and 5 cases in the control group received tracheal intubation and invasive ventilation due to treatment failure. Two elderly patients in the control group died in hospital. Conclusion Noninvasive positive pressure ventilation plus PEV combined with respiratory stimulant can significantly improve symptoms, shorten the time to recover consciousness, reduce the rate of endotracheal intubation, and improve hypoxemia and hypercapnia rapidly in AECOPD patients with pulmonary encephalopathy.
ObjectiveTo study the distribution of bone-specific alkaline phosphatase (BALP), type Ⅰ collagen cross-linked C-telopeptide (CTX) and tartrate-resistant acid phosphatase (TRAP)-5b in plateau area builders, and analyze the influencing factors under plateau environment. MethodsBetween April and May, 2014, using random stratified cluster sampling, we included in our study 650 blood samples from the power grid construction people in Batang County of Ganzi Autonomous Prefecture of Sichuan Province and Mangkang County of Tibet Autonomous Region with an altitude ranging from 2 600 to 4 450 meters, averaging (3 586.50±610.85) meters. We collected their fasting blood and detected their TRAP-5b, CTX and BALP by enzyme-linked immunosorbent assay method. By using SPSS 13.0, we analyzed the relationship between TRAP-5b, CTX, BALP and the influencing factors such as age, working intensity, residence time in the plateau area and altitude of the plateau. In the end, we tried to find out the main influencing factors of bone metabolic markers in the plateau environment.ResultsThe levels of CTX, BALP and TRAP-5b were the highest before the age of 20, and the average levels of them were respectively (1.04±0.38) ng/mL, (52.09±14.62) μg/L, and (4.22±1.38) U/L. With the increase of age, the levels of CTX, TRAP-5b and BALP showed a downward trend, but CTX and BALP reached the lowest level in the age group of 40 to 49 years old, and the average levels of CTX and BALP were (0.44±0.26) ng/mL and (24.77±9.89) μg/L, respectively. Then they gradually increased after the age of 50. TRAP-5b reached the lowest level in the age group of 30 to 39 years old, and the average level of TRAP-5b was (2.59±0.95) U/L. Then it gradually increased after the age of 40. The activity of CTX and BALP increased obviously with the increase of altitude. With the increase of labor intensity, BALP, TRAP-5b and CTX all increased. However, no matter what labor intensity, the bone formation marker BALP first increased and then decreased with the plateau residence time, while the bone absorption marker TRAP-5b increased after the first reduction.ConclusionsBone metabolic markers are different in different age groups. Altitude, working intensity and plateau working time have significant effects on bone metabolism markers.
Objective To explore the effect of antihypertensive therapy for hypertension patients from plateau area. Method A retrospective analysis of medical records for Tibetan patients with hypertension from October to December 2013 in Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region. Results The study recruited 165 patients. The rate of treatment, control, and compliance of hypertension patients were 86.7% (143/165), 23.8% (34/143), 43.4% (62/143), respectively. The main characteristics of hypertension treatment were higher proportions of single-drug therapy (81.1%, 116/143); among those the Tibetan drug (24.1%), calcium channel blockers (21.6%), diuretics (19.0%), and traditional compound preparation (18.1%) were most commonly used in the antihypertensive therapy. Conclusions The rate of treatment was high, but the rate of control and compliance were low in Tibetan patients with hypertension. It was necessary to carry out hypertension education to patients and strengthen the training of doctors at the plateau.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.
Objective To explore the clinical characteristics of patients with combined use of ≥2 kinds of anti-seizure medications in Tibetan plateau. Methods Epilepsy patients who were hospitalized in the People’s Hospital of Tibet Autonomous Region from September 2018 to September 2023 and used ≥2 kinds of anti-seizure medications in combination were selected. Their demographic data such as gender, age, and ethnicity, as well as diagnostic information, medication and other clinical data were collected, and relevant demographic and clinical characteristics were analyzed. In the later stage, telephone follow-up was used to record medication and epileptic seizure control. Results A total of 2295 patients with epilepsy were included, of which 142 (6.2%) met the inclusion criteria, of which 133 (93.7%) were Tibetans. There were more males than females (86 vs. 56, P<0.05), and more minors and young patients than middle-aged and elderly patients (106 vs. 36, P<0.05). 87.3% of the patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and 71.1% of the patients were abnormal. The main cause of epilepsy was structural etiology (84/142, 59.2%). The most common combination was two drugs (127/142, 89.4%). The largest proportion of combination was sodium valproate and levetiracetam (46/142, 32.4%). After standardized multi-drug combination therapy, the average frequency of epilepsy seizures was significantly reduced compared with the baseline, and the difference was statistically significant (P<0.05). Among the 98 patients aged ≥14 years, 15 cases (15.3%) had drug-refractory epilepsy, 18 cases (18.4%) had seizures controlled by standardized combination medication, 16 cases (16.3%) had seizures controlled by reducing combination medication to a single drug, 5 cases (5.1%) had good control and had stopped medication, 3 cases (3.1%) had frequent epileptic seizures due to poor medication compliance, 15 cases (15.3%) had irregular medication, 17 cases (17.3%) died, and 9 cases (9.2%) were lost. Conclusion The proportion of epilepsy treated with multiple drugs and refractory to drugs was lower than the conclusion of previous studies, and the anti-epileptic effect of multiple drugs was positive. Structural causes (stroke, etc.) are the main causes of epilepsy, and brain parasitic infection is a unique factor of high-altitude epilepsy. Strengthening the standardized use of drugs will help improve the treatment status and prognosis of patients.