如何使用藥物預防高海拔疾病2025-08-15修正
2025-06-27 11:05AM
(全文)2024-Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update
威而鋼或犀利士仍未被列入 HAPE 治療選項(因研究資料不夠充足)
要注意的是, 很多藥物沒有列在治療選項中, 並非不能用於特定疾病, 而是發生疾病之後, 僅給予未列治療選項的藥物是不夠的.
舉例. 丹木斯並非治療HACE的選項, 但並非不能使用, 而是HACE僅給予丹木斯治療可能無效. 治療HACE首選是類固醇. 丹木斯可做為輔助類固醇治療HACE使用
類固醇可以治療兒童的AMS/HACE. 但不建議用於預防兒童的AMS/HACE
(應以其他方式預防兒童發生高海拔疾病, 例如每天爬升)
Ibuprofen 是消炎止痛藥物. 表格僅列在高海拔頭痛治療. 且劑量是台灣常用的劑量1.5倍(台灣常用的是400mg)
** 頭痛應該不限制用ibuprofen止痛. 其他止痛藥物都可以用
** ibuprofen 可預防高海拔頭痛. 其他止痛藥物則無此效果. 但這個表格沒列出
治療HAPE首選是 nifedipine. (如果有持續性氧氣供應, 氧氣優於 NIFEDIPINE)
威而鋼及犀利士可用於預防HAPE. 不建議單獨用於HAPE治療
** 若身上僅有犀利士.發生HAPE還是可以嘗試使用, 但目前尚未有充足的研究證據顯示有療效.
**對於HAPE患者, 在有其他治療選擇的情況. 不能將犀利士或威而剛做為唯一治療選項
Table 1. Recommended dosages for medications used in the prevention and treatment of altitude illness
MedicationIndicationRouteDosageAcetazolamide AMS, HACE prevention Oral 125 mg every 12 ha,b
Pediatrics: 1.25 mg·kg−1 every 12 h (maximum 125 mg per dose)
AMS treatmentc Oral 250 mg every 12 h Pediatrics: 2.5 mg·kg−1 every 12 h (maximum: 250 mg per dose)
Dexamethasone AMS, HACE prevention Oral 2 mg every 6 h or 4 mg every 12 ha
Pediatrics: should not be used for prophylaxis
AMS, HACE treatment Oral, IV, IM AMS: 4 mg every 6 h
HACE: 8 mg once then 4 mg every 6 h
Pediatrics: 0.15 mg·kg−1·dose−1 every 6 h (maximum: 4 mg per dose)
Ibuprofen HAH treatment Oral 600 mg every 8 h
Nifedipine HAPE prevention Oral 30 mg ER version every 12 h or 20 mg ER version every 8 hd
HAPE treatment Oral 30 mg ER version every 12 h or 20 mg ER version every 8 h
Tadalafil HAPE prevention Oral 10 mg every 12 hd
Sildenafil HAPE prevention Oral 50 mg every 8 hd
AMS：急性高山病；ER：緩釋；HACE：高海拔腦水腫；HAH高海拔頭痛：；HAPE：高海拔肺水腫
1. 對於攀登至並停留於特定海拔高度的人員，到達目標海拔高度後，若攀登速度符合建議，則應繼續用藥2天；若攀登速度超過建議速度，則應繼續用藥2-4天。若攀登至目標海拔高度後立即下撤，則可在下撤開始後停止用藥。
2 此劑量適用於低至中度風險的攀登路線。對於高風險攀登路線，可考慮丹木斯每日兩次，每次 250 毫克。海拔 5000 公尺以上攀登的合適劑量尚不清楚。
3 丹木斯(乙醯唑胺)也可以在此劑量下作為 地塞米松治療 HACE 的輔助藥物，但地塞米松仍是 HACE 的主要治療方法。
4. 對於需要進行高海拔肺水腫預防的人員，若需攀登至目標海拔並停留在該海拔，則在到達目標海拔後，若遵循建議的攀登速度，應繼續用藥4天；若攀登速度超過推薦速度，則應繼續用藥4-7天。若攀登至目標海拔高度後立即下撤，則可在下撤開始後停止用藥。
AMS: Acute mountain sickness; ER: extended release; HACE: High altitude cerebral edema; HAH: High altitude headache; HAPE: High altitude pulmonary edema
1 For individuals ascending to and remaining at a given elevation, following arrival at the target elevation, the medication should be continued for 2 days in individuals adhering to the recommended ascent rate and 2-4 days in individuals ascending faster than recommended rates. Individuals who ascend to a target elevation and immediately descend can stop the medication once descent is initiated.
2 This dose applies to low-moderate risk ascent profiles. For high-risk ascent profiles, consider 250 mg BID. The appropriate dose for ascent above 5000 m is not clear.
3 Acetazolamide can also be used at this dose as an adjunct to dexamethasone in HACE treatment, but dexamethasone remains the primary treatment for HACE.
4 For individuals requiring HAPE prophylaxis, ascending to and remaining at a given elevation, following arrival at the target elevation, the medication should be continued for 4 days in individuals adhering to the recommended ascent rate and 4-7 days in individuals ascending faster than recommended rates. Individuals who ascend to a target elevation and immediately descend can stop the medication once descent is initiated.
Table 1. Recommended dosages for medications used in the prevention and treatment of altitude illness
MedicationIndicationRouteDosageAcetazolamide AMS, HACE prevention Oral 125 mg every 12 ha,b
Pediatrics: 1.25 mg·kg−1 every 12 h (maximum 125 mg per dose)
AMS treatmentc Oral 250 mg every 12 h Pediatrics: 2.5 mg·kg−1 every 12 h (maximum: 250 mg per dose)
Dexamethasone AMS, HACE prevention Oral 2 mg every 6 h or 4 mg every 12 ha
Pediatrics: should not be used for prophylaxis
AMS, HACE treatment Oral, IV, IM AMS: 4 mg every 6 h
HACE: 8 mg once then 4 mg every 6 h
Pediatrics: 0.15 mg·kg−1·dose−1 every 6 h (maximum: 4 mg per dose)
Ibuprofen HAH treatment Oral 600 mg every 8 h
Nifedipine HAPE prevention Oral 30 mg ER version every 12 h or 20 mg ER version every 8 hd
HAPE treatment Oral 30 mg ER version every 12 h or 20 mg ER version every 8 h
Tadalafil HAPE prevention Oral 10 mg every 12 hd
Sildenafil HAPE prevention Oral 50 mg every 8 hd
AMS：急性高山病；ER：緩釋；HACE：高海拔腦水腫；HAH高海拔頭痛：；HAPE：高海拔肺水腫
1. 對於攀登至並停留於特定海拔高度的人員，到達目標海拔高度後，若攀登速度符合建議，則應繼續用藥2天；若攀登速度超過建議速度，則應繼續用藥2-4天。若攀登至目標海拔高度後立即下撤，則可在下撤開始後停止用藥。
2 此劑量適用於低至中度風險的攀登路線。對於高風險攀登路線，可考慮丹木斯每日兩次，每次 250 毫克。海拔 5000 公尺以上攀登的合適劑量尚不清楚。
3 丹木斯(乙醯唑胺)也可以在此劑量下作為 地塞米松治療 HACE 的輔助藥物，但地塞米松仍是 HACE 的主要治療方法。
4. 對於需要進行高海拔肺水腫預防的人員，若需攀登至目標海拔並停留在該海拔，則在到達目標海拔後，若遵循建議的攀登速度，應繼續用藥4天；若攀登速度超過推薦速度，則應繼續用藥4-7天。若攀登至目標海拔高度後立即下撤，則可在下撤開始後停止用藥。
AMS: Acute mountain sickness; ER: extended release; HACE: High altitude cerebral edema; HAH: High altitude headache; HAPE: High altitude pulmonary edema
1 For individuals ascending to and remaining at a given elevation, following arrival at the target elevation, the medication should be continued for 2 days in individuals adhering to the recommended ascent rate and 2-4 days in individuals ascending faster than recommended rates. Individuals who ascend to a target elevation and immediately descend can stop the medication once descent is initiated.
2 This dose applies to low-moderate risk ascent profiles. For high-risk ascent profiles, consider 250 mg BID. The appropriate dose for ascent above 5000 m is not clear.
3 Acetazolamide can also be used at this dose as an adjunct to dexamethasone in HACE treatment, but dexamethasone remains the primary treatment for HACE.
4 For individuals requiring HAPE prophylaxis, ascending to and remaining at a given elevation, following arrival at the target elevation, the medication should be continued for 4 days in individuals adhering to the recommended ascent rate and 4-7 days in individuals ascending faster than recommended rates. Individuals who ascend to a target elevation and immediately descend can stop the medication once descent is initiated.
沒有留言:
張貼留言