藥物治療包括:
Nifedipine: 可作為氧氣和下降的輔助治療. 或沒有氧氣也無法下降的輔助治療. 但實驗證據不夠多.
Tadalafil/sildenafil:
dexamethasone: 學理上有效但沒有臨床試驗證實, 目前建議用於合併AMS/HACE的 HAPE病患
beta agonist: 也許有效但沒有臨床試驗證實
無效的藥物包括: 其他利尿劑, 硝化甘油, 嗎啡.
Pharmacologic interventions — A summary of medications used to treat HAPE is provided (table 4). More thorough discussions of these treatments are found below.
Nifedipine — In the field setting, oxygen and descent remain the most important treatments for HAPE. Nifedipine may be considered adjunctive therapy when oxygen is unavailable and descent is difficult or impossible, although little clinical evidence supports the practice. (See 'General approach to treatment' above.)
Nifedipine is a nonspecific calcium channel blocker that acts by reducing pulmonary vascular resistance and PA pressure, as well as systemic resistance and blood pressure. It also slightly improves PaO2.
Recommended dosages vary, but a common regimen is to give 30 mg of a slow release formulation every 12 hours. Nifedipine is well tolerated by most patients and is unlikely to cause significant hypotension in previously healthy persons. Clinicians should give or be prepared to give isotonic intravenous fluid (eg, normal saline) to any critically ill HAPE patient who may be intravascularly depleted and is receiving nifedipine.
One unblinded uncontrolled study of six patients with HAPE found that nifedipine treatment led to clinical improvement [40]. However, another observational study involving 133 patients with HAPE reported that nifedipine offered no advantage when used as an adjunct to oxygen and descent [30].
Tadalafil and sildenafil — Tadalafil and sildenafil are phosphodiesterase-5 (PDE-5) inhibitors that augment the pulmonary vasodilatory effects of nitric oxide by blocking the degradation of cyclic guanosine monophosphate (cGMP), the intracellular mediator of nitric oxide. Nitric oxide is a potent pulmonary vasodilator and reduces hypoxic pulmonary vasoconstriction (HPV) and pulmonary hypertension in HAPE [5]. Both tadalafil and sildenafil have been shown to be effective as prophylaxis for HAPE, but neither has been studied as treatment [41-43]. (See 'Prophylactic medications' below.)
Nevertheless, based upon their mechanism of action, both tadalafil and sildenafil may be effective adjunct treatments for established HAPE when neither oxygen nor descent is an available option. These drugs may have advantages over nifedipine because they lower PA pressure with less risk of lowering systemic blood pressure. The appropriate dose for treatment is unknown but might be similar to that used for prophylaxis (tadalafil 10 mg by mouth every 12 hours; sildenafil 50 mg by mouth every eight hours).
Dexamethasone — Although glucocorticoids may have a role in prophylaxis, they have not been studied as treatment for HAPE. We reserve glucocorticoids for treatment of high altitude cerebral edema or severe acute mountain sickness, which may co-exist with HAPE. (See 'Prophylactic medications' below.)
Beta agonist — Salmeterol may be useful in the treatment of HAPE, but this remains unstudied. (See 'Prophylactic medications' below.)
Ineffective or contraindicated therapies — Diuretic therapy, nitrates, and morphine are no longer recommended in the treatment of HAPE and could be harmful.
