野外與登山醫學---06-Acute altitude illness WMS 2019 update AMS/HACE prevention Ibuprofen 6 (done)

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
統一名詞翻譯
AMS 急性高山病
HACE 高海拔腦水腫
acute altitude illness 急性高海拔疾病
NSAID 非類固醇消炎止痛藥
Ibuprofen 布洛芬/芬必得/普羅芬是一種常使用的非類固醇消炎止痛藥, 有兩篇研究顯示每天服用三次 600 mg 布洛芬(一天總量 1800mg)有預防AMS效果 (台灣常見的劑型是 400 mg, 例如 purfen). 第三篇較小規模的研究顯示沒有預防效果.
另一篇研究雖然說有效, 但該研究並無設計對照組, 而是採用該地區以往的AMS發生率作參照

Two trials demonstrated that ibuprofen (600 mg 3 times daily) is more effective than placebo at preventing AMS,42,43 while a third, smaller study showed no benefit.44 Another study claimed to show benefit, but the trial did not include a placebo arm and instead compared the incidence of AMS with ibuprofen with historically reported rates from the region in which the study was conducted.45

目前並無布洛芬與類固醇的療效比較, 有兩篇研究比較布洛芬與丹木斯的差異, 第一篇說, 兩組的高海拔頭痛與AMS發生率相近, 兩篇都顯示, 相較於安慰劑, 布洛芬有預防AMS效果.
Although no studies have compared ibuprofen with dexamethasone, 2 studies have compared ibuprofen with acetazolamide. The first found an equal incidence of high altitude headache and AMS in the acetazolamide and ibuprofen groups, with both showing significant protection compared to placebo.46

一篇更近期的研究顯示, 布洛芬預防AMS效果比丹木斯差,
A more recent trial failed to show that ibuprofen was noninferior to acetazolamide (ie, ibuprofen is inferior to acetazolamide for AMS prophylaxis).47

上面提到的這些研究, 服藥時間較短, 大約 24-48 小時, 因此常時間服用布洛芬, 效益與安全性是否大於副作用, 仍屬未知, 需要更多研究比較丹木斯, 類固醇, 布洛芬的差異. 對於布洛芬是否可用於預防AMS, 目前無法給出明確建議
建議: 對於不想吃(或有禁忌)丹木斯或類固醇的人, 可以服用布洛芬預防AMS, 證據等及 2B

The aforementioned trials all used the medication for a short duration (~24 to 48 h). As a result, efficacy and safety (eg, the risk of gastrointestinal bleeding or renal dysfunction) over longer periods of use at high altitude remain unclear. For these reasons, as well as more extensive clinical experience with acetazolamide and dexamethasone, ibuprofen cannot be recommended over these medications for AMS prevention for rapid ascent. Recommendation. Ibuprofen can be used for AMS prevention in persons who do not wish to take acetazolamide or dexamethasone or have allergies or intolerance to these medications. Recommendation Grade: 2B.