野外與登山醫學~~---32--WMS 2019 update HAPE TREATMENT Nifedipine 32

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
HAPE 高海拔肺水腫
acute altitude illness 急性高海拔疾病

Nifedipine
A single, nonrandomized, unblinded study demonstrated utility of nifedipine (10 mg of the short-acting version followed by 20 mg slow-release every 6 h) for HAPE treatment when oxygen or descent was not available.9 Although participants in this study received a loading dose of the short-acting version of the medication, this initial dose is no longer employed because of concerns about provoking systemic hypotension. Although hypotension is less common with the extended-release preparation, it may develop when nifedipine is given to patients with intravascular volume depletion. A prospective, cross-sectional study of individuals with HAPE demonstrated that addition of nifedipine (30 mg sustained release every 12 h) to descent, oxygen, and rest offered no additional benefit in terms of time to resolution of hypoxemia and radiographic opacities or hospital length of stay.96 Recommendation. Nifedipine should be used for HAPE treatment when descent is impossible or delayed and reliable access to supplemental oxygen or portable hyperbaric therapy is unavailable. Recommendation Grade: 1C