a Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences , Arabian Gulf University , Manama , Bahrain.
b School of Oral Health, College of Medicine, Nursing and Health Sciences , Fiji National University , Suva , Fiji.
Ann Med. 2018 Mar;50(2):147-155. doi: 10.1080/07853890.2017.1407034. Epub 2017 Nov 23.
Individuals ascending to high altitude are at a risk of getting acute mountain sickness (AMS). The present study is a network meta-analysis comparing all the interventions available to prevent AMS.
Electronic databases were searched for randomized clinical trials evaluating the use of drugs to prevent AMS. Incidence of AMS was the primary outcome and incidence of severe AMS, paraesthesia (as side effect of acetazolamide use), headache and severe headache, and oxygen saturation were the secondary outcomes. Odds ratio [95% confidence interval] was the effect estimate for categorical outcomes and weighted mean difference for oxygen saturation. Random effects model was used to derive the direct and mixed treatment comparison pooled estimates. Trial sequential analysis and grading of the evidence for key comparisons were carried out.
A total of 24 studies were included. Acetazolamide at 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen had statistically significant lower incidence of AMS compared to placebo. All the above agents except ibuprofen were also observed to significantly reduce the incidence of severe AMS. Acetazolamide alone or in combination with Ginkgo biloba were associated with lower incidence of headache, but higher risk of paraesthesia. Acetazolamide at 125 mg and 375 mg twice daily significantly reduce the incidence of severe headache as like ibuprofen. Trial sequential analysis indicates that the current evidence is adequate for the incidence of AMS only for acetazolamide 125 and 250 mg twice daily. Similarly, the strength of evidence for acetazolamide 125 and 250 mg twice daily was moderate while it was either low or very low for all other comparisons.
Acetazolamide at 125, 250 and 375 mg twice daily, ibuprofen and dexamethasone significantly reduce the incidence of AMS of which adequate evidence exists only for acetazolamide 125 and 250 mg twice daily therapy. Acetazolamide 125 mg twice daily could be the best in the pool considering the presence of enough evidence for preventing AMS and associated with lower incidence of paraesthesia. Key messages Acetazolamide 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen reduce the incidence of AMS in high altitudes. Adequate evidence exists supporting the use of acetazolamide 125 mg and 250 mg twice daily for preventing AMS of which acetazolamide 125 mg twice daily could be the best.
前往高海拔地区的个体有患急性高原病（AMS）的风险。本研究是一项网络荟萃分析，比较了预防 AMS 的所有可用干预措施。
电子数据库中检索了评估药物预防 AMS 效果的随机临床试验。AMS 的发生率是主要结局，严重 AMS 的发生率、感觉异常（乙酰唑胺使用的副作用）、头痛和严重头痛以及氧饱和度是次要结局。比值比[95%置信区间]是分类结局的效应估计值，氧饱和度的加权均数差。使用随机效应模型得出直接和混合治疗比较的汇总估计值。进行了试验序贯分析和关键比较的证据分级。
共纳入 24 项研究。乙酰唑胺 125、250 和 375mg 每日两次、地塞米松和布洛芬与安慰剂相比，AMS 的发生率有统计学意义降低。除布洛芬外，所有上述药物也可显著降低严重 AMS 的发生率。单独使用乙酰唑胺或与银杏叶合用可降低头痛的发生率，但感觉异常的风险增加。乙酰唑胺 125mg 和 375mg 每日两次与布洛芬一样可显著降低严重头痛的发生率。试验序贯分析表明，目前的证据仅足以证明乙酰唑胺 125 和 250mg 每日两次的 AMS 发生率。同样，乙酰唑胺 125 和 250mg 每日两次的证据强度为中度，而其他所有比较的证据强度要么为低或极低。
乙酰唑胺 125、250 和 375mg 每日两次、布洛芬和地塞米松可显著降低 AMS 的发生率，其中仅乙酰唑胺 125 和 250mg 每日两次的治疗有足够的证据。考虑到预防 AMS 的证据充足且感觉异常发生率较低，乙酰唑胺 125mg 每日两次可能是最佳选择。
乙酰唑胺 125、250 和 375mg 每日两次、地塞米松和布洛芬可降低高海拔地区 AMS 的发生率。有足够的证据支持使用乙酰唑胺 125mg 和 250mg 每日两次预防 AMS，其中乙酰唑胺 125mg 每日两次可能是最佳选择。
