Ellsworth A J, Larson E B, Strickland D
School of Pharmacy, University of Washington, Seattle 98195.
Am J Med. 1987 Dec;83(6):1024-30. doi: 10.1016/0002-9343(87)90937-5.
Forty-seven climbers participated in a double-blind, randomized trial comparing acetazolamide 250 mg, dexamethasone 4 mg, and placebo every eight hours as prophylaxis for acute mountain sickness during rapid, active ascent of Mount Rainier (elevation 4,392 m). Forty-two subjects (89.4 percent) achieved the summit in an average of 34.5 hours after leaving sea level. At the summit or high point attained above base camp, the group taking dexamethasone reported less headache, tiredness, dizziness, nausea, clumsiness, and a greater sense of feeling refreshed (p less than or equal to 0.05). In addition, they reported fewer problems of runny nose and feeling cold, symptoms unrelated to acute mountain sickness. The acetazolamide group differed significantly (p less than or equal to 0.05) from other groups at low elevations (1,300 to 1,600 m), in that they experienced more feelings of nausea and tiredness, and they were less refreshed. These drug side effects probably obscured the previously established prophylactic effects of acetazolamide for acute mountain sickness. Separate analysis of an acetazolamide subgroup that did not experience side effects at low elevations revealed a prophylactic effect of acetazolamide similar in magnitude to the dexamethasone effect but lacking the euphoric effects of dexamethasone. This study demonstrates that prophylaxis with dexamethasone can reduce the symptoms associated with acute mountain sickness during active ascent and that acetazolamide can cause side effects that may limit its effectiveness as prophylaxis against the disease.
47名登山者参与了一项双盲随机试验，该试验比较了每8小时服用250毫克乙酰唑胺、4毫克地塞米松和安慰剂，作为在快速、积极攀登雷尼尔山（海拔4392米）期间预防急性高山病的措施。42名受试者（89.4%）在离开海平面后平均34.5小时到达山顶。在山顶或大本营以上到达的最高点，服用地塞米松的组报告的头痛、疲劳、头晕、恶心、笨拙感较少，并且感觉更清爽（p小于或等于0.05）。此外，他们报告的流鼻涕和感觉寒冷的问题较少，这些症状与急性高山病无关。乙酰唑胺组在低海拔（1300至1600米）时与其他组有显著差异（p小于或等于0.05），因为他们经历了更多的恶心和疲劳感，并且感觉不那么清爽。这些药物副作用可能掩盖了乙酰唑胺先前已确定的对急性高山病的预防作用。对在低海拔时未出现副作用的乙酰唑胺亚组进行单独分析发现，乙酰唑胺的预防作用在程度上与地塞米松的作用相似，但缺乏地塞米松的欣快感。这项研究表明，地塞米松预防可减少在积极攀登期间与急性高山病相关的症状，并且乙酰唑胺可引起副作用，这可能会限制其作为该疾病预防措施的有效性。
