這篇僅討論dexamethasone(以下以類固醇代替)在HAPE高海拔肺水腫的角色, 不包含所有HAPE預防或治療
(之前筆記在此"2014-07-28 曾經罹患HAPE如何預防再次發生")
類固醇預防HAPE(或許可以.尚待更多研究資料佐證)
類固醇是否能預防HAPE還需要更多研究, 目前實證不足, 且機轉尚未完全明瞭.
(2023-10-16 五天前WMS指引更新, 過去有一篇評估犀利士預防HAPE的研究, 同一篇研究也比較受測者使用類固醇預防HAPE, 對於曾罹患 HAPE 的人, 在這篇研究發現類固醇可預防HAPE, 但因為臨床醫師群體很少這樣使用. 因此過去對於類固醇用於預防HAPE的經驗不多. 需要更多資料佐證. 才能做出建議)
Dexamethasone*(這段是2024指引更新的內容)
In the same study that assessed the role of tadalafil in HAPE prevention, dexamethasone (8 mg every 12 h) also prevented HAPE in susceptible individuals.116 The mechanism for this effect is not clear, and there is very little clinical experience using dexamethasone for this purpose. Further data are necessary before it can be recommended for HAPE prevention.
Recommendation
We recommend that dexamethasone can be used for HAPE prevention in known susceptible individuals who are not candidates for nifedipine and tadalafil. Strong recommendation, low-quality evidence. )(之前的筆記在這2018-11-13"類固醇及其他藥物預防高海拔肺水腫 HAPE 機轉")
(另一篇筆記是關於2006年的一篇研究"犀利士 tadalafil 和類固醇 dexamethasone 都可以降低 HAPE 機率 (2006年)")
Dexamethasone — Further study is needed to determine whether dexamethasone is an appropriate medication for prophylaxis against HAPE. In one randomized trial of 29 individuals with a history of HAPE, none of the 10 participants given dexamethasone prophylaxis (8 mg every 12 hours) developed HAPE during a rapid ascent from 490 to 4559 meters with an overnight stay [43]. Prophylaxis with dexamethasone has the added advantage of preventing acute mountain sickness/high-altitude cerebral edema (HACE), whereas nifedipine and the PDE-5 inhibitors have no such effect.
Dexamethasone's mechanism of action remains unclear. It may involve upregulation of nitric oxide production and upregulation of alveolar epithelial membrane sodium channels and sodium-potassium ATPase.
關於類固醇使用於HAPE患者
1. 治療HAPE最有效的還是給氧與降低海拔高度
2. 單純高海拔肺水腫, 類固醇療效不明. 有些研究報告說類固醇可預防HAPE, 但實證仍不足, 至於用類固醇治療HAPE, 這不是被證實效的治療方式. 若沒有禁忌症, 我覺得不妨當輔助治療使用.
3. 丹木斯能加速高度適應, 但需要時間, 丹木斯預防HAPE的效果仍未被證實, 丹木斯也沒有被證實能治療 HAPE. 跟類固醇一樣, 若沒有禁忌症, 我覺得不妨當輔助治療使用.
4. 不可因為有給類固醇或丹木斯, 而不選擇其他被證實有效的HAPE治療. 例如給氧,下撤,
5. 無法給氧或立即下撤, PAC是不錯的選擇. 下面這段是uptodate關於類固醇用於HAPE治療的說明
Dexamethasone — Although glucocorticoids may have a role in prophylaxis, they have not been studied as treatment for HAPE. Nonetheless, some experts have recommended their use based on the mechanism of action [46], while others disagree [47]. We reserve glucocorticoids for treatment of HACE or severe acute mountain sickness, which may co-exist with HAPE. (See 'Prophylactic medications' below.).
另. 下面這段也是uptodate的. 順便貼上來
對於高海拔肺水腫HAPE, 不建議使用利尿劑, 硝化甘油, 嗎啡, 以上幾種不但無效且可能有害.
Ineffective or contraindicated therapies — Diuretic therapy, nitrates, and morphine are no longer recommended in the treatment of HAPE and could be harmful
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