威而鋼可以預防AMS or HACE嗎?
名詞: AMS 高山症, HACE 高海拔腦水腫, HAPE 高海拔肺水腫
威而鋼對於高海拔疾病的應用. 目前僅限於預防 HAPE. 未曾罹患過 HAPE 的民眾並不需要預防性服用, 而罹患HAPE的治療, 主要是下降, 氧氣可輔助治療, 也可以使用 nifedipine.
威而鋼對於治療 HAPE 目前研究不多, 所以不列入治療選項
預防HAPE首選藥物是 nifedipine.
威而鋼目前認知, 並無預防 AMS或HACE效果, 反而在一篇研究發現, 會增加 AMS 嚴重度.
美國CDC黃皮書. 裡面的圖表. Sildenafil (威而鋼) 是用來預防 HAPE 的.
2016-05-25 22:11 修改
威而鋼是否可以治療高海拔腦水腫,剛才查了一下,在 pubmed 搜尋醫學期刊,沒有一篇期刊提到兩者有關連性,過去應該沒有學者醫師認為可以這樣使用
在 2010 美國家庭醫師期刊,關於威而鋼的使用,也只有註明是預防 HAPE,沒有提到 HACE 或 AMS 的部分
在 2010 WMS 期刊,同樣也沒有提到可以用威而鋼預防或治療 HACE
http://www.wemjournal.org/article/S1080-6032(10)00114-6/fulltext
http://www.wemjournal.org/article/S1080-6032(10)00114-6/fulltext
總之,根據以前文獻和唸過的書籍,威而鋼目前沒有建議使用在 預防或治療 HACE。在以前研究報告甚至發現,使用威而鋼雖然不改變 AMS 盛行率,但會增加 AMS 罹病的患者的嚴重度
High Alt Med Biol. 2014 Apr;15(1):46-51. doi: 10.1089/ham.2013.1110.
Meta-analysis of clinical efficacy of sildenafil, a phosphodiesterase type-5 inhibitor on high altitude hypoxia and its complications.
Xu Y1, Liu Y, Liu J, Qian G. Author information
Meta-analysis of clinical efficacy of sildenafil, a phosphodiesterase type-5 inhibitor on high altitude hypoxia and its complications.
Xu Y1, Liu Y, Liu J, Qian G. Author information
Abstract
OBJECTIVE:
High altitude illness can be life-threatening if left untreated. Acute mountain sickness and high altitude pulmonary hypertension are two syndromes of high altitude illness. Recent clinical studies showed the beneficial effects of phosphodiesterase type 5 (PDE-5) inhibitors on the treatment of pulmonary hypertension. In this report, we performed a meta-analysis to evaluate the clinical efficacy of PDE-5 inhibitors on highaltitude hypoxia and its complications.
METHODS:
Randomized controlled trials evaluating the efficacy of PDE-5 inhibitor in the setting of high altitude were identified by searching Cochrane Central Register of Controlled Trials (September 2013), PubMed (from 1990 to September 2013), and EMBASE (from 1990 to September 2013). Extracted outcomes from selected studies for meta-analysis included arterial oxygen saturation, pulmonary artery systolic pressure, heart rate, and Lake Louise Consensus AMS symptom score. Weighted mean differences with 95% confidence intervals were presented for the continuous outcomes.
RESULTS:
Five clinical trials that met the selection criteria were identified for the meta-analysis. All of these studies used sildenafil as the PDE-5 inhibitor. A total of 60 subjects received sildenafil, and 72 subjects were given placebo. In accordance with previous report, short-term treatment withsildenafil (1-2 days) significantly reduced pulmonary artery systolic pressure at rest (MD -4.53; 95% CI -6.72, -2.34; p<0.0001). However, treatment with sildenafil (1-2 days) did not improve oxygen saturation after exposure to high altitude (MD 0.07; 95% CI -1.26, 1.41; p=0.91). Moreover, no significant difference was observed in heart rate between sildenafil and placebo-treated group (MD 6.95; 95% CI -3.53, 17.43; p=0.19). AMS score did not improve after treatment at different time points.
CONCLUSION:
Short-term treatment with sildenafil can attenuate the altitude-induced high pulmonary systolic arterial pressure, but has no significant beneficial effects on arterial oxygen saturation, heart rate, and acute mountain sickness.
PMID: 24673534 [PubMed - indexed for MEDLINE]
OBJECTIVE:
High altitude illness can be life-threatening if left untreated. Acute mountain sickness and high altitude pulmonary hypertension are two syndromes of high altitude illness. Recent clinical studies showed the beneficial effects of phosphodiesterase type 5 (PDE-5) inhibitors on the treatment of pulmonary hypertension. In this report, we performed a meta-analysis to evaluate the clinical efficacy of PDE-5 inhibitors on highaltitude hypoxia and its complications.
METHODS:
Randomized controlled trials evaluating the efficacy of PDE-5 inhibitor in the setting of high altitude were identified by searching Cochrane Central Register of Controlled Trials (September 2013), PubMed (from 1990 to September 2013), and EMBASE (from 1990 to September 2013). Extracted outcomes from selected studies for meta-analysis included arterial oxygen saturation, pulmonary artery systolic pressure, heart rate, and Lake Louise Consensus AMS symptom score. Weighted mean differences with 95% confidence intervals were presented for the continuous outcomes.
RESULTS:
Five clinical trials that met the selection criteria were identified for the meta-analysis. All of these studies used sildenafil as the PDE-5 inhibitor. A total of 60 subjects received sildenafil, and 72 subjects were given placebo. In accordance with previous report, short-term treatment withsildenafil (1-2 days) significantly reduced pulmonary artery systolic pressure at rest (MD -4.53; 95% CI -6.72, -2.34; p<0.0001). However, treatment with sildenafil (1-2 days) did not improve oxygen saturation after exposure to high altitude (MD 0.07; 95% CI -1.26, 1.41; p=0.91). Moreover, no significant difference was observed in heart rate between sildenafil and placebo-treated group (MD 6.95; 95% CI -3.53, 17.43; p=0.19). AMS score did not improve after treatment at different time points.
CONCLUSION:
Short-term treatment with sildenafil can attenuate the altitude-induced high pulmonary systolic arterial pressure, but has no significant beneficial effects on arterial oxygen saturation, heart rate, and acute mountain sickness.
PMID: 24673534 [PubMed - indexed for MEDLINE]
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