With the opening of the Qinghai-Tibet Railway, more and more people can easily reach high-altitude areas, and more and more people will suffer from plateau reaction. For plateau reaction, we do not have to talk about it, nor can we take the harm it brings lightly. I hope this article can let you have a correct understanding of plateau reaction.
Plateau reaction, that is, plateau disease, refers to the unadapted people quickly into the plateau area of more than 3,000 meters, due to the partial pressure of oxygen in the atmospheric pressure is reduced, the body of the low-oxygen environment tolerance is reduced, and it is difficult to adapt to the cause of hypoxia, which triggered a series of plateau maladaptation. Of course, in addition to the factors of plateau hypoxia, there are bad weather such as wind, rain, snow, cold and strong ultraviolet radiation, etc., can exacerbate plateau maladaptation and trigger different plateau adaptation incomplete disease.
The body can undergo a series of adaptive changes after a period of acclimatization, such as an increase in ventilation in order to bring the tissue utilization of oxygen to a normal level or close to it; accelerating the heart rate, increasing the pumping capacity of the heart, in order to increase the volume of blood pumped by the heart per minute to improve the hypoxic condition; increasing the volume of erythrocytes and hemoglobin in order to increase the oxygen-carrying capacity of the body to ensure that the supply of oxygen, and so on. However, some people are more sensitive to the low partial pressure of oxygen in the air, poor adaptive capacity, there will be a series of symptoms and functional metabolic changes of plateau acclimatization incomplete disease, also known as acute plateau reaction. Foreign countries will be divided into acute plateau reaction, plateau pulmonary edema, plateau cerebral edema, plateau retinal hemorrhage and chronic alpine disease, our country is divided into acute and chronic plateau disease. For individuals, the onset of the disease is often mixed difficult to distinguish, the entire onset of the process, in a certain stage to a more prominent performance.
Symptoms of plateau reaction and self-judgment
Part of the first time to enter the plateau of the height of 3,000 meters above sea level, within 24 hours of headache, dizziness, dizziness, tinnitus, general weakness, walking difficulties, difficulty in falling asleep, and other symptoms, the serious abdominal distension, loss of appetite, nausea, vomiting, panic, shortness of breath, chest tightness, face and lips purple or facial edema and other symptoms. These symptoms, should stay at the original height to rest for 3 to 5 days, or immediately descending hundreds of meters in height, generally can return to normal.
It has been reported that the morbidity rate below 3500 meters is 37%~51%, and the morbidity rate of 3600 meters-5000 meters reaches 50%. This indicates that the higher the altitude, the higher the incidence of altitude sickness.
Severe plateau reaction is more serious damage to the human body, therefore, after entering the plateau, if the following symptoms appear, should be considered to have occurred plateau reaction:
1. Severe head pain, panic, shortness of breath, tightness in the chest, loss of appetite, nausea, vomiting, lips and nails cyanosis.
2. Trance of consciousness and a sudden drop in cognitive ability. The main manifestation of calculation difficulties, before entering the plateau to do a simple addition problem, record the time used, in the emergence of symptoms, repeat the same calculation problem, if the time used than the original prolongation, indicating that the plateau reaction has occurred.
3. Hallucinations, feelings of warmth, and often walking aimlessly behind others.
Precautions and medications to alleviate symptoms
Strict physical examination before entering the plateau, severe anemia, hypertension, obvious heart, liver, lung, kidney and other diseases, should not enter the plateau. Obese people due to higher oxygen consumption, the chance of altitude sickness is generally greater than the thinner people.
First into the plateau, to reduce physical activity to protect the heart, so we must strictly control the speed of climbing, generally in mountaineering activities should not be more than 1,000 meters of ascent in a day.
In the two days before entering the plateau to three days after entering the plateau, prophylactic oral intake of some drugs can reduce the symptoms of plateau reaction:
Acetazolamide 0.25 grams, 2 times / day. Acetazolamide itself has diuretic effect, mainly used for cardiac edema, cerebral edema and peptic ulcer. Taken prophylactically, it can reduce symptoms of altitude sickness. Side effects of acetazolamide are renal colic, kidney stones, sulfonamide urine crystals, nephrotic syndrome, and granulocyte deficiency (sulfa allergy). Prolonged use can cause low potassium ions in the blood, requiring potassium supplementation (you can eat oranges or bananas). It should not be taken by people with hepatic coma or reduced kidney function.
Rhodiola rosea is a drug that many people pin their hopes on to prevent plateau reactions. Its function is to clear away heat and detoxify toxins and dry dampness, and it is used for lung heat, pulse heat, distemper, and swelling of limbs. In recent years, China has isolated rhodiola rosea glycosides from rhodiola rosea, which has been experimentally proved to have the effects of cardiotonic, sedative, blood pressure elevation and anti-fatigue. Rhodiola rosea extract is used for anti-fatigue, increase physical strength and endurance, weakness after illness. Whether it can prevent and treat plateau reaction, the author has not found the scientific basis.
According to the hypoxia situation can be added to take dexamethasone 0.75 ~ 6 mg, divided into 2 ~ 4 times / day to take. The main effect of this drug in reducing plateau reaction hypoxia is to increase the content of red blood cells and hemoglobin to improve the ability to carry oxygen. Dexamethasone is a glucocorticoid drug and must be used for strict indications. Abuse of this drug will reduce its proper effect when resuscitation is really needed. In large doses, it can cause obesity, increased intraocular pressure, hypertension and peptic ulcers, bleeding and even perforation. Especially with viral infections, taking glucocorticoid drugs, can make viral infections spread and aggravate.
Ulophen can reduce headaches caused by high altitude, take 50 mg orally, 3~4 times/day. Nifedipine (cardioplegia) dilates small arteries and can reduce pulmonary edema. Moderate sedatives, multivitamins and aminophylline can reduce symptoms.
Entering the plateau, but also pay attention to eat a reasonable diet, eat more carbohydrates, eat less difficult to digest food. Special reminder of the ban on drinking alcohol. Drinking alcohol can speed up the heartbeat, to the heart has not yet been accustomed to serve to increase the load; drinking alcohol can expand blood vessels throughout the body, making the skin to increase heat dissipation, and then speed up the heartbeat again, week after week, a vicious circle, heart failure and plateau cerebral edema chances greatly increased.
The plateau environment, long-term oxygen deprivation can cause a significant increase in the number of red blood cells, blood viscosity increased. Mountaineering sweating too much, coupled with too fast and too deep breathing, the body's water consumption increases, aggravating blood viscosity. Viscous blood leads to poor blood circulation and insufficient blood and oxygen supply, and many people therefore experience severe headaches, chest tightness, shortness of breath, fatigue and other symptoms, leading to heart failure in severe cases. Therefore, drink at least 3 to 4 liters of water a day to ensure that the body is well hydrated, blood dilution can reduce the load on the heart, reducing the symptoms of plateau reaction. Water supplementation is reasonable or not, with sufficient urine volume, clear urine shall prevail, and pay attention to electrolyte balance.
Pulmonary edema, cerebral edema
Plateau reaction is a serious threat to the health of people's lives, how can we find and timely in situ self-help mutual aid?
Pulmonary edema is a common severe plateau disease, the incidence rate is about 3%. It usually occurs above 4,000 meters and often develops rapidly 3-48 hours after mountaineering, and later in 3-10 days. Important triggers are cold, exertion, and decreased resistance resulting in respiratory infections. When there is a headache, chest tightness, different degrees of cough (dry cough at first, and sputum later), dyspnea can not lie down, the heaviest cluck pink bubble sputum, the rescuer will be close to the patient's chest wall can be heard in the lungs of the blister-like respiratory sounds (medically known as wet rhonchi). At this time, the patient panic, panic, lips and face cyanosis, severe hematuria or gradual delirium. Severe pulmonary edema condition can deteriorate rapidly, within a few hours the patient coma, death.
The on-site first aid measures for pulmonary edema are absolute semi-recumbent rest, legs down, immediate and adequate oxygen intake, preferably oxygen containing 50% to 70% alcohol, flow rate of 6 to 8 liters / min; immediately oral furosemide (tachyzoite) 40 mg / day. Mild nausea, diarrhea, drug rash, blurred vision, upright vertigo, muscle cramps, and thirst may occur with the use of tachyphylaxis; be careful not to overdose to begin with, and depending on the situation, add up to 80 mg 2x/day. Nifedipine reduces pulmonary edema. Against upper respiratory tract infections available antibiotics plus dexamethasone 4 mg (oral only once). In case of agitation, a small amount of sedative can be used. Pay attention to warmth, and strictly prohibit drinking large amounts of water. After the initial first aid, the condition is stabilized, quickly transferred to a lower altitude. Once respiratory and cardiac arrest, immediately carry out cardiopulmonary resuscitation.
It is important to note that colds should be avoided in highland areas. The temperature of the fever in the highland cold has an artifact, and the temperature measurement will often be 1 degree lower than the actual temperature, so it is easy to be ignored. Respiratory infections, even if very mild, can increase the risk of plateau pulmonary edema. Therefore, it is necessary to strengthen the prevention of warmth. After entering the plateau, reduce the number of baths or do not wash. Take anti-flu medicine immediately when you notice the first symptoms of a cold. If you take anti cold medicine two days later, it is generally ineffective.
Recurring episodes of plateau pulmonary edema for susceptible people, male morbidity is five times more than women. If you have already had a previous episode of pulmonary edema, we recommend that you do not climb mountains over 3,000 meters.
Plateau cerebral edema is another serious plateau disease, with rapid onset, often at night; low morbidity but high mortality. Symptoms: in addition to early plateau reaction, there are severe headache, vomiting and even projectile vomiting; gradually trance, poor orientation, individual convulsions, urinary and fecal incontinence, and finally lethargy to coma. A few people may develop retinal hemorrhage.
In the past, when mountaineers judged whether cerebral edema had occurred according to their experience, they often used the method of letting people suspected of having cerebral edema walk in a straight line to determine whether their orientation was poor or not. From a scientific point of view, this method is not desirable! In patients with cerebral edema, the brain tissue has been severely deprived of oxygen, at this time, let the person in a trance walking, it is likely to immediately fall to the ground unconscious. This aggravates the damage of the examination method, is to take risks. The correct method of judgment is to let the patient in a semi-recumbent position, and ask him or her to point to his or her nose, ears, eyes, etc. with fingers as instructed, to see if his or her movements can be accurate. Once they can't, it means that cerebral edema may have occurred.
Found cerebral edema and coma, to quickly and continuously give oxygen containing 5% carbon dioxide until awake, awake still intermittent oxygen. Hypertonic glucose, mannitol, adrenocorticotropic hormone, cytochrome C and other treatments should be applied to reduce cerebral edema and promote recovery if available. Central nervous system stimulants such as santalbumin hydrochloride (Lobelin) and niclosamide (Colamine) can be used as appropriate. Pay attention to water, salt and electrolyte balance as well as necessary anti-infection measures. After the condition is stabilized, go downhill immediately and rush to the hospital.
In an oxygen-deficient environment, people will use to speed up and deepen their breathing to improve the oxygen-deficient condition, which increases the amount of carbon dioxide exhaled and leads to respiratory alkalosis. Respiratory alkalosis not only causes cerebral vasoconstriction, but can also result in loss of consciousness and plateau cerebral edema. The most effective way to prevent respiratory alkalosis is to use newspaper rolled into a cone shape, in the cone at the tip of the tear a diameter of 1-2 centimeters of small holes, will be cone-shaped newspaper close to the face, so that the exhaled gas back again, that is, the exhaled carbon dioxide again back to improve the body's acidity and alkalinity, to correct the respiratory alkalosis.
Facing the plateau without reluctance
Not every person on the plateau will appear plateau reaction, the incidence of plateau reaction, the recovery of fast and slow with the ability of individuals to compensate for the adaptive capacity of the individual, individual differences are very large, this time there is no plateau reaction of the people may not be in the next time to climb to the plateau on the no reaction. There are some people who will have plateau reaction every time, these people are sensitive or highly susceptible to plateau reaction. It should be reminded here that plateau reaction cannot be overcome by repeated exercise. Therefore, in order to ensure the health of the body, it is recommended that the plateau reaction prone people do not continue to Dengda so high in the region, in the lower altitude areas of fitness mountaineering can be just as temperament and physical exercise.
Tibet travel strategy of Lhasa area:
Potala Palace
Every day are open 09:00-12:30 15:00-18:00
The visit time shall be more than 2 hours. But the opening time after more than 1 hour, basically no longer sell tickets. Every Monday, Wednesday and Friday are the days when Tibetans make pilgrimages to Buddha, and there are a lot of people. You can also take the car directly from the back door to the top, after visiting the front door down, more labor-saving.
Note:
1. The palace is high, up and down to walk slowly.
2. Inside the palace is cold, even in summer, it is best to prepare a jacket.
3. If you want to take pictures in the temple, the charge is very high, Gu suggests that the camera hanging on the chest, do not hit the flash blind shooting, can also be satisfied.
4. less restrooms in the Palace is also difficult to find, the best before the tour at the entrance to solve as well. Another back door of the Palace of the toilet is very distinctive, is also a scene, do not miss.
5. The Palace check is very strict, escape ticket is basically impossible, there is a way to try, that is, one, three, five Tibetans to go when the scripture, into the front door first do not buy a ticket, in the end of the steps there is a small room, Tibetans are here to buy a ticket for 2 yuan / Zhang, you can ask the Tibetans to help you buy a ticket to enter the main hall before there is a ticket to check, so it is best to dress up a little bit ahead of time, and then mention an ambiguous kettle in the hand or take some ghee, Hada, pretending to be the Buddha, it is estimated that can be mixed through.
The ticket is 40 yuan, if you go to the Golden Roof visit 10 yuan, 10 yuan of cultural relics exhibition room.
Dazhao Temple
morning 07:00-12:00 15:00-18:30
visit shall be more than 1 hour, the morning is basically a pilgrimage to the Buddha to go, there are a lot of people, the tour group is generally going to go in the afternoon from the side door into. If you are self-service casual, it is recommended that you go in the morning, from the main door with the people from the Chaofei into, without having to buy a ticket, and in the morning a lot of small halls are open. From the Da Zhao Temple out, Bajiao Street is particularly worth a stroll, this is both the turn of the road, but also to buy souvenirs and experience the Tibetan folk customs best place. You can stop by to visit the residential houses in the alley, there is a song that describes this: "the old Bajiao Street, the window is more than the door, the window of the girl, the bones are softer than the meat."
Note:
1. Come to the Da Zhao Temple, be careful of the beggars here, either prepare more 10 cents of change, or ignore them, quickly walk away, otherwise you will have a lot of painful experience.
2. Stroll Bajiao Street shopping is best not impulsive, beware of regret.
Tickets 25 yuan
Sera Monastery
morning 08:00 open to 18:30 end, the visit time shall be 2 hours, Monday to Friday afternoon there are lamas discernment (15:00-17:00) is worth a look, the 5 road bus can be directly to the door of the temple 2 yuan / person, in the parking lot of the Da Zhao Temple, the youth intersection as well as Niangjie Road can be waited. Sera Temple is not far from the city, playing 10 yuan.
Note:
1. It is recommended to visit from Monday to Friday afternoon, arrive before 15:00.
2. Sera Temple inspection is not strict, the ticket office outside the road side of the small house, dress up not like tourists, then you can drive straight into the house, if they see that you are not towards the Buddha, tell them that they are next door to the General Hospital of the military region, over to find people, can also be mixed.
Tickets 30 yuan
Drepung Monastery
08:00 am open to 18:30 pm, the visit time shall be 2 hours and a half from the city is far away from the morning, there are 4-way bus to the temple 3 yuan / person, 3-way only to the foot of the mountain, go up to 1 hour, hit 15-20 yuan. Drepung Monastery is very large, built on the mountain, the natural opportunity to escape.
Note: every Wednesday there is a puja activities, many lamas gathered together to recite the sutra, can rush to this time to go, the harvest is greater.
Tickets 30 yuan
Roblinka
09:30-18:30
Visit time 1 hour and a half, 2 buses through, 3 buses to walk a little way, this attraction is not big, if time is tight to give up. Sunday or important holiday to go, the ticket 2 yuan. Because of the holidays, the local people shopping Linka more.
Tickets 25 yuan
Medicine King Mountain cliff painting
Turning on the road to a spot, open all day, no bus passes by, easy to play, here stone cliff painting is very distinctive, physical fitness can be climbed to the top of the hill at a glance of the city of Lhasa, this is also a great location to shoot a panoramic view of the Potala Palace.
Note:
1. Tickets are generally free of charge, occasionally a lama over to charge you 5 yuan.
2. There are a lot of carved stone blocks in Tibetan language on the mountain, which is a holy object of worship for Tibetans, don't take it carelessly.
Gandan Monastery
Gandan Monastery, located 40 kilometers east of Lhasa, was built in 1409, for the Gelug sect of the first monastery; the Cultural Revolution period was seriously damaged, in recent years have been rebuilt.
Tickets: Free for Tibetans, ￥15 for tourists; Open: 09:00-16:00
Visiting time: the visit should take less than 2 hours, but the road is long and the bus frequency relationship, it takes a whole day
Note: the bus may be canceled due to insufficient number of people or change to other destinations. Along the way, the scenery is unique, there are mountains, water, grasslands, two-way $ 16, to preserve the ticket back to use.
Chubu Monastery
Located 60 kilometers west of Lhasa on the upper reaches of the Chubu River. There is no accommodation at Chubu Monastery, so it's best not to miss the only return trip. However, along the way back, accommodation is available in school buildings in several villages, and the road is so scenic that you can consider hiking and stopping the hitchhiker halfway back to Lhasa.
Tickets: Tibetans free, tourists ￥ 20 each; Open: 09:00-14:00
Visit time: 12:00 by car to arrive, two hours has been quite enough. But the whole process will take a day.
Transportation: the west side of the Da Zhao Temple flower garden southbound 200 meters in the alley, 07:00-08:00, the bus full of passengers that is open, the ticket price of ￥ 15, the original car 15:00 return.
I. Self-help two-day tour itinerary recommended
Day 1:
8:30: Post hotel dinner, walk 5 minutes to the Potala Palace.
9:00-12:00: Visit Potala Palace, come out and take a panoramic view at Potala Palace Square.
12:30-13:00: Go to the Tibetan Restaurant of the Snow God's Palace on the west side of the Potala Palace to enjoy an authentic flavorful meal.
14:00-16:00: Sera Monastery, Monday to Saturday around 15:00 pm is the discernment time, it is worth seeing.
16:30-17:30: to visit the Da Zhao Temple, the second floor of the golden roof to shoot the Potala Palace vista, the effect is excellent.
17:30-19:30: shopping and sightseeing in Barkhor Street, by the way, go to Barkhor Café or Maji Amee while having a drink, and look at the crowd of people transiting the scriptures.
19：30-20：30：Taste the Nepalese meal in the Snowland Restaurant and feel the exotic taste (50 meters to the right of the Da Zhao Temple Square).
Day 2:
9:30-12:30: Drepung Monastery visit (from the Post Hotel by 3 buses, but the Chinese bus only to the foot of the mountain, you need to change to motorized three-wheeler or the Chinese bus up the mountain, the walk is farther; you can also directly take a taxi)
14:30-16:00: go to the Lopblingka visit. (From Drepung Monastery can be directly by Chinese bus to)
16:30-18:00: out and walk to the opposite side of the museum to visit.
19:00-21:00: Enjoy a variety of flavorful snacks at Xijiao Night Market.
Note: If time is tight in Lhasa, you can choose only the first day of the trip, has been representative; if more time, the Yakuo Mountain cliff paintings, Xiaozhao Temple, nuns Temple, Chongsaikang, Longwangtan Park and other attractions are also worth a visit.
City attractions open time fares
Potala Palace: 9:00-13:00 15:00-18:00 40 yuan
Dazhao Temple: 9:00-12:30 15:00-18:30 25 yuan
Lobolinka: 09:30-17:30 25 yuan Drepung Monastery: 09:30-17:00 30 yuan
Museum: 10:00-18:00 20 yuan Sala Temple: 9:30-17:00 30 yuan
Lhasa Tourism Practical Information
City Transportation:
1. Taxi: 10 yuan in the city, to go to the far places need to be bargaining, do not play the meter.
2. Bus: the city passenger transportation to the main bus, to go to several major attractions can take the bus, near and far all 2 yuan.
3. Pedicabs: stop, bargaining, generally 3-6 yuan.
Shopping recommendations:
1. Tibet's unique Tibetan medicine, medicinal herbs (if you want to rest assured that it is best to buy in the state-run drugstores)
2. Tibetan characteristics of souvenirs: the transepts, thangkas, Tibetan boots, handmade carpets, sheep and cattle head, Buddha beads, eye of the sky stone, turquoise ornaments, Tibetan knives (must be sent by mail) and so on.
3. Nepal, India's handicrafts: economic, chic, handicraft stores are sold, Bajiao Street, there are several specialty stores. (Crafts are mainly concentrated in the Bajiao Street Yutuo East Road (opposite the Great Buddha Temple Square) and the Potala Palace, Lopblingka entrance)
Dining and Entertainment:
1. Tibetan flavor: located in the Beijing East Road, Jiri Hotel's mad cow Tibetan food and the west end of the Potala Palace of the snow Palace of Tibetan food authentic characteristics.
2. Nepalese flavor: is located in the Tibetan Hospital Road, No. 4, north of the Great Zhaoji Square, the snowy restaurant environment is elegant, good taste.
3. Chinese food: mainly concentrated in the western suburbs, mainly Sichuan flavor, there are also special snacks, such as jade buns.
4. Café: Barkhor Café and Bajiao Street, located in the Barkhor Square side of the Showa Monastery Café and the Maggie Ammi has a variety of chic drinks and Western food, very moody, and inside are equipped with Internet cafes.
5. Entertainment: nightclubs are concentrated in the western suburbs, Tibetan-style Rangma dance halls everywhere. Jiangsu Road, the peak of the disco is particularly worth a visit.
Other:
1. Banks: Bank of China, Agricultural Bank of China, Bank of China, there are many outlets, but there is no Industrial and Commercial Bank of China, Peony card can not be used.
2. Post office: the post and telecommunications building on the east side of the Potala Palace, it is very convenient to send letters and parcels.
3. Bookstore: Xinhua Bookstore opposite to the Department Store, which has more books, postcards and stamps about Tibet.