2019-12-18
from 元元
本來想找Dexamethasone預防HAPE劑量，看到快速上升的用藥
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文獻回顧法；空降任務(快速上升11500ft)，US Special Operations Command guidance預防AMS建議劑量 Dexamethasone 4mg PO q6h+acetazolamide 125mg PO bid (if not allergic to sulfa).
挑選516名3年內無高海拔活動紀錄的印軍，D0(sea level)->D1 2000公尺(6600ft)->D2 2868公尺(9404ft)->D3 4224 公尺(13850ft)->D4 3507公尺(11500ft)
256名使用acetazolamide 250mg slow release once daily +Dexamethasone 4mg BID
https://www.researchgate.net/publication/268392119_The_use_of_dexamethasone_in_support_of_high-altitude_ground_operations_and_physical_performance_review_of_the_literature?fbclid=IwAR3ZeriCwKCftxE1H9j8dnk4Jlyzw7ybwqovZjz4DtxvUluxIhKYRXzO0BI
https://www.sciencedirect.com/science/article/pii/S0377123718300017?fbclid=IwAR2YTtj9eRSwZ_bel25rKvqSE-x7tuuKtLW-bYsu1ESQBthJubwe7edNMBo
Results
Prevalence of AMS was found to be 1.56% and 1.59% in group ‘A’ and group ‘B’ respectively during the ascent with no cases of HAPE and HACE.
Conclusion
At least on SH road, troops can be inducted rapidly to HAL from SLL in 4 days under pharmaco-prophylaxis with Acetazolamide with minimal occurrence of acute high altitude illnesses.
from 元元
印軍那篇的實驗組Acz+Dex(1.56%)跟安慰劑組Acz+Placebo(1.59%)相近，沒有很好支持"吃類固醇. 預防突發性高海拔疾病"。
而且相較高度適應的組別(19.14%)，作者認為只是剛好沒有發生藥物的side-effects? 高度適應才是經過時間驗證可靠的預防AMS發生的方法。
所以我想只節錄實驗用的方法跟藥物劑量會不會比較好><"
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下面中文是用google自動翻譯
我們認為，用於預防HAI的藥物可能並非HAI「增強」ExC的可行方案。這些藥物的使用應僅限於預防HAI。雖然我們在研究組中未發現這些藥物的任何副作用，但考慮到已報告的副作用，預先適應應是預防HAI的首選方法，尤其是在和平時期。總而言之，低地男性在接受藥物幹預的RRIS後，於4天內從SLL抵達HAL，相比於AS通常的11天，在SH公路上節省了寶貴的7天時間，且AMS發生率極低。兩組在HAL接受RRIS後預測的ExC相似，並且與基於現有文獻的完全適應後的預期水準相當。總而言之，本研究清楚地表明，至少在SH公路上存在一種類似RRIS的「量身定制」方案，可以作為AS的替代方案，用於緊急情況下。現在是時候制定和驗證類似的針對特定軸線的快速誘導方案，以便在特定軸線上將部隊引導至HA區域了。此方案可在作戰緊急情況下實施，但需考慮該軸線上現有的後勤和行政資源。然而，在和平時期，穩健且久經考驗的傳統AS仍可繼續流行，無需任何修改。
We believe that drugs used for pharmaco-prophylaxis against HAI may not be a practicable option for ExC 'enhancement' at HA. Use of these drugs should remain limited to prevention of HAI. Although we did not come across any side effects of these drugs in our study groups but keeping in mind the reported side-effects, pre-acclimatization should be a preferred modality for prevention of HAI especially during peace time.
To summarize, lowlander males following RRIS with pharmacological intervention reached HAL in 4 days from SLL and saved valuable 7 days on SH road in comparison to the usual 11 days of AS with minimal occurrence of AMS. Predicted ExC achieved with RRIS at HAL was similar in both the groups and was comparable to the expected levels after complete acclimatization based on current literature. To conclude, the present study clearly brings out that a 'customized tailor made' schedule like RRIS, as an alternative to AS, exists atleast on SH road for use during exigency conditions. A time has come to develop and validate similar axis specific, rapid induction schedules for use at a particular axis for induction of troops to HA areas. This schedule can be implemented during operational exigencies keeping in mind the existing logistics and administrative resources available on that axis. However, during the peace time, the robust and time-tested conventional AS can continue to be in vogue without any revision.
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