Basnyat Buddha, Gertsch Jeffrey H, Holck Peter S, Johnson E William, Luks Andrew M, Donham Benjamin P, Fleischman Ross J, Gowder Daniel W, Hawksworth Jason S, Jensen Brett T, Kleiman Richard J, Loveridge Adam H, Lundeen Elizabeth B, Newman Sheri L, Noboa Jesse A, Miegs Daniel P, O'Beirne Kenneth A, Philpot Kelly B, Schultz Miriam N, Valente Matthew C, Wiebers Mandie R, Swenson Erik R
Himalayan Rescue Association and Nepal International Clinic, Kathmandu, Nepal.
High Alt Med Biol. 2006 Spring;7(1):17-27. doi: 10.1089/ham.2006.7.17.
750 mg per day of acetazolamide in the prevention of acute mountain sickness (AMS), as recommended in the meta-analysis published in 2000 in the British Medical Journal, may be excessive and is controversial. To determine if the efficacy of low-dose acetazolamide 125 mg bd (250 mg), as currently used in the Himalayas, is significantly different from 375 mg bd (750 mg) of acetazolamide in the prevention of AMS, we designed a prospective, double-blind, randomized, placebo-controlled trial. The participants were sampled from a diverse population of (non-Nepali) trekkers at Namche Bazaar (3440 m) in Nepal on the Everest trekking route as they ascended to study midpoints (4280 m/4358 m) and the endpoint, Lobuje (4928 m), where data were collected. Participants were randomly assigned to receive 375 mg bd of acetazolamide (82 participants), 125 mg bd of acetazolamide (74 participants), or a placebo (66 participants), beginning at 3440 m for up to 6 days as they ascended to 4928 m. The results revealed that composite AMS incidence for 125 mg bd was similar to the incidence for 375 mg bd (24% vs. 21%, 95% confidence interval, -12.6%, 19.8%), in contrast to significantly greater AMS (51%) observed in the placebo group (95% confidence interval for differences: 8%, 46%; 12%, 49% for low and high comparisons, respectively). Both doses of acetazolamide improved oxygenation equally (82.9% for 250 mg daily and 82.8% for 750 mg daily), while placebo endpoint oxygen saturation was significantly less at 80.7% (95% confidence interval for differences: 0.5%, 3.9% and 0.4%, 3.7% for low and high comparisons, respectively). There was also more paresthesia in the 375-mg bd group (p < 0.02). We conclude that 125 mg bd of acetazolamide is not significantly different from 375 mg bd in the prevention of AMS; 125 mg bd should be considered the preferred dosage when indicated for persons ascending to altitudes above 2500 m.
2000年发表在《英国医学杂志》上的荟萃分析推荐，每日服用750毫克乙酰唑胺预防急性高原病（AMS），这一剂量可能过高且存在争议。为确定目前在喜马拉雅地区使用的低剂量乙酰唑胺125毫克，每日两次（250毫克）与375毫克，每日两次（750毫克）在预防AMS方面的疗效是否存在显著差异，我们设计了一项前瞻性、双盲、随机、安慰剂对照试验。研究对象从尼泊尔珠穆朗玛峰徒步路线上的南池市场（3440米）的不同人群（非尼泊尔人）徒步者中选取，他们在攀登至研究中点（4280米/4358米）和终点洛布杰（4928米）时进行数据收集。参与者被随机分配接受375毫克，每日两次的乙酰唑胺（82名参与者）、125毫克，每日两次的乙酰唑胺（74名参与者）或安慰剂（66名参与者），从3440米开始服用，在攀登至4928米的过程中最多服用6天。结果显示，125毫克，每日两次的乙酰唑胺组的复合AMS发病率与375毫克，每日两次的乙酰唑胺组相似（24%对21%，95%置信区间，-12.6%，19.8%），相比之下，安慰剂组观察到的AMS发病率显著更高（51%）（低剂量和高剂量比较的差异的95%置信区间分别为：8%，46%；12%，49%）。两种剂量的乙酰唑胺在改善氧合方面效果相同（每日250毫克为82.9%，每日750毫克为82.8%），而安慰剂终点氧饱和度显著更低，为80.7%（低剂量和高剂量比较的差异的95%置信区间分别为：0.5%，3.9%和0.4%，3.7%）。此外，375毫克，每日两次的组中感觉异常更多（p<0.02）。我们得出结论，125毫克，每日两次的乙酰唑胺在预防AMS方面与375毫克，每日两次的乙酰唑胺无显著差异；对于攀登至海拔2500米以上的人，如有需要，125毫克，每日两次应被视为首选剂量。
