這篇僅節錄AMS/HACE治療選擇這幾段. 選項包括下面八項(並不是說一定有效)
下降 Descent
氧氣治療 Supplemental Oxygen
加壓艙 Portable Hyperbaric Chambers
丹木斯 Acetazolamide (下面內容有兒童使用劑量建議)
類固醇 Dexamethasone
普拿疼 Acetaminophen
止痛消炎藥物 普服芬/布洛芬 Ibuprofen
持續性正壓呼吸器 Continuous positive airway pressure (CPAP)
下面是原文
Treatment
Potential therapeutic options for AMS and HACE include:
Potential therapeutic options for AMS and HACE include:
Descent
下降多少海拔才能治療 AMS/HACE, 通常是下降 300~ 1000 公尺海拔. 但下降多少高度才有效還是因人而異.
Descent remains the single best treatment for AMS and HACE. However, it is not necessary in all circumstances (discussed further below). Individuals should descend until symptoms resolve, unless terrain, weather, or injuries make descent impossible. Symptoms typically resolve following descent of 300 to 1000 m, but the required altitude decrease varies between persons. Individuals should not descend alone, particularly if they are suffering from HACE.
Recommendation
We recommend that descent is effective for any degree of AMS/HACE and is indicated for individuals with severe AMS or HACE. Strong recommendation, high-quality evidence.
下降多少海拔才能治療 AMS/HACE, 通常是下降 300~ 1000 公尺海拔. 但下降多少高度才有效還是因人而異.
Descent remains the single best treatment for AMS and HACE. However, it is not necessary in all circumstances (discussed further below). Individuals should descend until symptoms resolve, unless terrain, weather, or injuries make descent impossible. Symptoms typically resolve following descent of 300 to 1000 m, but the required altitude decrease varies between persons. Individuals should not descend alone, particularly if they are suffering from HACE.
Recommendation
We recommend that descent is effective for any degree of AMS/HACE and is indicated for individuals with severe AMS or HACE. Strong recommendation, high-quality evidence.
Supplemental Oxygen
使用氧氣治療, 將病患血氧濃度提升到超過 90% 即可. 低流量氧氣(每分鐘 1-2 公升)持續使用兩小時. 會比大流量氧氣使用幾分鐘更好. 因此不建議使用小型罐裝氧氣. 或短暫進入氧氣酒吧. 來預防 AMS
Oxygen delivered by a nasal cannula or mask at flow rates sufficient to relieve symptoms provides a suitable alternative to descent. An SpO2 (oxygen saturation measured by pulse oximetry) of >90% is usually adequate. The use of oxygen is not required in all circumstances and is generally reserved for mountain clinics and hospitals where supply is abundant. It should also be used when descent is indicated but not feasible or during descent in severely ill individuals. Supplemental oxygen should be administered to target an SpO2 of >90% rather than a specific fraction of inspired oxygen (FIO2). This is because the inspired oxygen fraction varies significantly between oxygen delivery systems, including nasal cannulas, simple facemasks, Venturi masks, or nonrebreather masks. Use of low-flow oxygen (1–2 L/min) for ≥2 h has much greater benefit than short bursts (several minutes) of large amounts of oxygen. Short visits to oxygen bars or use of over-the-counter oxygen cannisters has never been studied for AMS treatment and should not be relied on for this purpose.
Recommendation
We recommend that, when available, ongoing supplemental oxygen sufficient to raise SpO2 to >90% or relieve symptoms can be used while waiting to initiate descent or when descent is not practical. Strong recommendation, high-quality evidence.
使用氧氣治療, 將病患血氧濃度提升到超過 90% 即可. 低流量氧氣(每分鐘 1-2 公升)持續使用兩小時. 會比大流量氧氣使用幾分鐘更好. 因此不建議使用小型罐裝氧氣. 或短暫進入氧氣酒吧. 來預防 AMS
Oxygen delivered by a nasal cannula or mask at flow rates sufficient to relieve symptoms provides a suitable alternative to descent. An SpO2 (oxygen saturation measured by pulse oximetry) of >90% is usually adequate. The use of oxygen is not required in all circumstances and is generally reserved for mountain clinics and hospitals where supply is abundant. It should also be used when descent is indicated but not feasible or during descent in severely ill individuals. Supplemental oxygen should be administered to target an SpO2 of >90% rather than a specific fraction of inspired oxygen (FIO2). This is because the inspired oxygen fraction varies significantly between oxygen delivery systems, including nasal cannulas, simple facemasks, Venturi masks, or nonrebreather masks. Use of low-flow oxygen (1–2 L/min) for ≥2 h has much greater benefit than short bursts (several minutes) of large amounts of oxygen. Short visits to oxygen bars or use of over-the-counter oxygen cannisters has never been studied for AMS treatment and should not be relied on for this purpose.
Recommendation
We recommend that, when available, ongoing supplemental oxygen sufficient to raise SpO2 to >90% or relieve symptoms can be used while waiting to initiate descent or when descent is not practical. Strong recommendation, high-quality evidence.
Portable Hyperbaric Chambers
加壓艙能有效的治療高海拔疾病. 但需要有人持續監視患者. 但很難用在有幽閉空間恐懼症或嘔吐患者. 且患者離開加壓艙症狀可能會再發, 但以上種種情況並不代表不能使用加壓艙
以前的使用經驗發現, 病懨懨的患者經過加壓艙治療, 大多數都能緩解病情, 因此病患能自己照顧自己(脫離加壓艙), 能進行下降, 但不要因為想使用加壓艙, 反而耽誤最重要的治療"下降"
以前的使用經驗發現, 病懨懨的患者經過加壓艙治療, 大多數都能緩解病情, 因此病患能自己照顧自己(脫離加壓艙), 能進行下降, 但不要因為想使用加壓艙, 反而耽誤最重要的治療"下降"
Portable hyperbaric chambers are effective for treating severe altitude illness but require constant tending by care providers and are difficult to use with patients who are claustrophobic or vomiting. Symptoms may recur when individuals are removed from the chamber, but this should not preclude use of the chamber when indicated. In many cases, ill individuals may improve sufficiently to assist with their evacuation and descent once symptoms improve. Use of a portable hyperbaric chamber should not delay descent in situations where descent is required.
Recommendation
We recommend that, when available, portable hyperbaric chambers should be used for patients with severe AMS or HACE when descent is not feasible or must be delayed and supplemental oxygen is not available. Strong recommendation, moderate-quality evidence.
Recommendation
We recommend that, when available, portable hyperbaric chambers should be used for patients with severe AMS or HACE when descent is not feasible or must be delayed and supplemental oxygen is not available. Strong recommendation, moderate-quality evidence.
Acetazolamide
發生AMS的兒童使用丹木斯治療. 每次最大劑量 250mg. 每12小時吃一次.
發生AMS的兒童使用丹木斯治療. 每次最大劑量 250mg. 每12小時吃一次.
Only 1 study has examined acetazolamide for AMS treatment. The dose studied was 250 mg every 12 h; whether a lower dose might suffice is not known. No studies have assessed AMS treatment with acetazolamide in pediatric patients, but anecdotal reports suggest it has utility. The pediatric treatment dose is 2.5 mg·kg−1·dose−1 every 12 h up to a maximum of 250 mg·dose−1.
Recommendation
We recommend that acetazolamide be considered for treatment of AMS. Strong recommendation, low-quality evidence.
Recommendation
We recommend that acetazolamide be considered for treatment of AMS. Strong recommendation, low-quality evidence.
Dexamethasone
Dexamethasone is very effective for treating AMS.The medication does not facilitate acclimatization, so further ascent should be delayed until the patient is asymptomatic without the medication. Although systematic studies have not been conducted, extensive clinical experience supports using dexamethasone in patients with HACE. It is administered as an 8-mg dose (intramuscular, IV, or oral administration), followed by 4 mg every 6 h until symptoms resolve. The pediatric dose is 0.15 mg·kg−1·dose−1 every 6 h.
Recommendation
We recommend that dexamethasone be considered for treatment of AMS. Strong recommendation, low-quality evidence.
Recommendation
We recommend that dexamethasone be administered for treatment of HACE. Strong recommendation, low-quality evidence.
Dexamethasone is very effective for treating AMS.The medication does not facilitate acclimatization, so further ascent should be delayed until the patient is asymptomatic without the medication. Although systematic studies have not been conducted, extensive clinical experience supports using dexamethasone in patients with HACE. It is administered as an 8-mg dose (intramuscular, IV, or oral administration), followed by 4 mg every 6 h until symptoms resolve. The pediatric dose is 0.15 mg·kg−1·dose−1 every 6 h.
Recommendation
We recommend that dexamethasone be considered for treatment of AMS. Strong recommendation, low-quality evidence.
Recommendation
We recommend that dexamethasone be administered for treatment of HACE. Strong recommendation, low-quality evidence.
Acetaminophen
Acetaminophen has been shown to relieve headache at high altitude
106 but has not been shown to improve the full spectrum of AMS symptoms or effectively treat HACE.
Recommendation
We recommend that acetaminophen can be used to treat headache at high altitude. Strong recommendation, low-quality evidence.
Acetaminophen has been shown to relieve headache at high altitude
106 but has not been shown to improve the full spectrum of AMS symptoms or effectively treat HACE.
Recommendation
We recommend that acetaminophen can be used to treat headache at high altitude. Strong recommendation, low-quality evidence.
Ibuprofen
Ibuprofen has been shown to relieve headache at high altitude but has not been shown to improve the full spectrum of AMS symptoms or effectively treat HACE.
Ibuprofen has been shown to relieve headache at high altitude but has not been shown to improve the full spectrum of AMS symptoms or effectively treat HACE.
Recommendation
We recommend that ibuprofen can be used to treat headache at high altitude. Strong recommendation, low-quality evidence.
We recommend that ibuprofen can be used to treat headache at high altitude. Strong recommendation, low-quality evidence.
Continuous Positive Airway Pressure
Continuous positive airway pressure (CPAP) carries theoretical benefit in acute altitude illness by virtue of its ability to increase the arterial partial pressure of oxygen (PO2). This impact is not due to increases in barometric pressure, as application of 15 cm H2O of CPAP, for example, yields only an 11 mm Hg increase in barometric pressure. Instead, CPAP works by increasing transmural pressure across alveolar walls, thereby increasing alveolar volume and improving ventilation-perfusion matching and gas exchange. Two reports have demonstrated the feasibility of administering CPAP to treat AMS,
but this has not been studied in a systematic manner. Logistical challenges to use in field settings include access to power and the weight and bulk of these systems.
Recommendation
No recommendation can be made regarding use of CPAP for AMS treatment because of lack of data.
Continuous positive airway pressure (CPAP) carries theoretical benefit in acute altitude illness by virtue of its ability to increase the arterial partial pressure of oxygen (PO2). This impact is not due to increases in barometric pressure, as application of 15 cm H2O of CPAP, for example, yields only an 11 mm Hg increase in barometric pressure. Instead, CPAP works by increasing transmural pressure across alveolar walls, thereby increasing alveolar volume and improving ventilation-perfusion matching and gas exchange. Two reports have demonstrated the feasibility of administering CPAP to treat AMS,
but this has not been studied in a systematic manner. Logistical challenges to use in field settings include access to power and the weight and bulk of these systems.
Recommendation
No recommendation can be made regarding use of CPAP for AMS treatment because of lack of data.
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