氧输送量及其代偿因素与急性高原病的关系研究  

Relationship between oxygen delivery and its compensatory factors and acute mountain sickness

作　　者：李明[1] 张继航[1] 卞士柱[1] 郑双锦[1] 高旭滨[1] 余洁[1] 黄岚[1] 

机构地区：[1]第三军医大学新桥医院全军心血管内科研究所,重庆400037

出　　处：《解放军医学杂志》2013年第3期245-248,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家卫生部行业专项课题(201002012)~~

摘　　要：目的研究全身和大脑氧输送量(DO2)及其代偿因素在急性低氧适应过程中的变化以及与急性高原病(AMS)的关系。方法选取世居平原、乘飞机进藏的青年男性147人作为受试对象,入藏后48h内填写制式AMS流行病学观察表,于进藏前1周、入藏后48h内进行心率(HR)、血压(BP)、血氧饱和度(SaO2)、心输出量(CO)、每搏输出量(SV)及大脑中动脉流速(MCAv)测量,严格按照路易斯湖评分系统(LLS)进行诊断并做作统计学分析。结果 147名受试对象中58.5%(86人)发生AMS。低氧暴露后,SaO2降低10%,与AMS评分呈负相关;全身DO2提高19%、CO提高32.5%、HR升高31.7%,且AMS者明显高于非AMS者,SV无显著性改变;MCAv加快10%,且AMS者具有更快的MCAv;由于SaO2降低10%与MCAv加快相匹配,使得大脑氧输送量(DO2C)无改变;平均动脉压(MBP)增加,大脑中动脉阻力单位(RMCA)明显降低,且AMS者降得更低。以DO2的关键代偿因素HR、MCAv作为AMS的客观评估指标,联合HR≥85次/min与MCAv≥66cm/s,其诊断的阳性预测值为82.4%,特异性为90.2%。结论 DO2及其代偿因素在急性低氧暴露后的调节适应过程中具有重要作用,其中HR、MCAv可能与AMS的发生机制有关且可间接反映对机体氧债的补偿水平,对AMS具有较好的评估能力,可作为AMS诊断的客观辅助指标。Objective To investigate the changes in oxygen delivery （DO2） to the body and brain and its compensatory factors to acute hypoxia and their relation to acute mountain sickness （AMS）. Methods One hundred and forty-seven participants were recruited from Chinese young men who had lived in plain all along arrived in Tibet by flight. All of them were asked to complete an AMS questionnaire within 48h after arrival. The resting heart rate （HR）, blood pressure （BP）, cardiac output （CO）, oxygen saturation （SaO2）, stroke volume （SV） and blood flow velocity in the middle cerebral artery （MCAv） were measured one week before departure from the plain and within 48h after arrival in Tibet. AMS was diagnosed according to Louis Lake Score System （LLS）, and the results were then statistically analyzed. Results AMS was diagnosed in eighty-six subjects （58.5%）. After exposure to hypoxia, SaO2 was decreased by 10% and was negatively correlated with AMS score. Systemic DOE, CO and HR were increased by 19%, 32.5% and 31.7%, respectively, and were positively correlated with AMS, while the SV remained unchanged. MCAv accelerated by 10%, and that of AMS subjects was higher than of non-AMS ones. The cerebral DO2 （DO2C） was maintained because the MCAv matched with SaO2 changes. The middle cerebral artery resistance units （RMcA） decreased obviously with an increase in MBP, and RMcA in AMS subjects was lower than that in non-AMS ones. HR and MCAv, the key compensation factors of DO2, were used as the objective evaluation indices, in collaboration of HR≥ 85 beat/min and MCAv≥ 66cm/s, could be a better means to evaluate AMS, with a positive predictive value of 82.4% and specificity of 90.2%. Conclusions DO2 and its compensatory factors may play a key role in the regulation response to acclimatize to acute hypoxia. Among them, HR and MCAv may relate to the mechanism of AMS development, and indirectly reflect the compensation level to oxygen debt, implying that HR and MCAv are helpful in the ass

关 键 词：高原病 每搏输出量 大脑中动脉流速 大脑中动脉阻力单位 

分 类 号：R339.54[医药卫生—人体生理学] R331.36[医药卫生—基础医学]