高原脱适应与急性高原反应及心脏功能的关系  

Relationship of high altitude de-adaptation with acute high altitude response and cardiac function

作　　者：杨生岳[1] 周其全[2] 冯恩志[1] 闫自强[1] 田忠新[1] 殷和[1] 石自福 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心 [2]第三军医大学高原医学系 [3]68303部队医院

出　　处：《中国应用生理学杂志》2013年第5期395-399,共5页Chinese Journal of Applied Physiology

基　　金：国家科技支撑计划项目(2009BA185B003)

摘　　要：目的:探讨高原脱适应反应(HADAR)与急性高原反应(AHAR)及心脏功能的关系。方法:由低海拔(1 500 m)进入高原(3 700～4 800 m)并从事重体力作业的男性军人96名,年龄18～35岁。在高原上,根据AHAR症状评分分为重度组(A组,24)、轻中度组(B组,47)和无AHAR组(C组,25)。返回低海拔后,根据HADAR症状评分分为重度组(E组,19)、轻中度组(F组,40)和无HADAR组(G组,37)。在该高度停留50 d后下撤前和返回低海拔(1 500 m)后12 h、15 d、30 d分别测平均肺动脉压(mPAP)、右心室内径(RVID)、右心室流出道(RVOT)、左心室内径(LVID)、左心室射血分数(LVEF)、心肌做功指数(Tei指数)、血清肌酸激酶同功酶-MB(CKMB)、乳酸脱氢酶同功酶-1(LDH-1)浓度,并与低海拔(1 500 m)50名健康军人(D组)比较。结果:A组mPAP、RVID、RVOT、RVID/LVID比值、Tei指数、CK-MB、LDH-1水平显著高于,LVEF显著低于B组、C组和D组,B组与C组之间和C组与D组之间亦有显著性差异(P均<0.01),LVID各组之间无统计学差异(P均>0.05)。AHAR总计分与HADAR总计分呈显著正相关(r=0.863,P<0.01)。返回低海拔12 h,E组mPAP、RVID、RVOT、RVID/LVID比值、Tei指数、CK-MB、LDH-1水平显著高于,LVEF显著低于F组、G组和D组,F组与D组之间和G组与D组之间亦有显著性差异(P均<0.01)。返回低海拔15 d,E组mPAP、RVID、RVOT、RVID/LVID比值显著高于F组、G组和D组(P<0.01或P<0.05),F组与G组和D组之间亦有显著性差异(P<0.01或P<0.05),但G组与D组之间差异无显著性(P均>0.05),LVEF、Tei指数、CK-MB、LDH-1各组间差异无显著性(P均>0.05)。返回低海拔30 d,E、F、G组各项指标与D组比较均无显著性差异(P均>0.05)。结论:HADAR程度与AHAR、心脏受损程度密切相关,在高原AHAR和心脏受损越重,返回低海拔HADAR和心脏受损越重,右心形态学受损恢复时间越长。Objective： To assess the relationship of high altitude de-adaptation response（HADAR） with acute high altitude response （AHAR） and cardiac function. Methods： Ninety-six military personnel of rapid entering into high altitude （3 700 to 4 800 m） with strong physical. work were analyzed, all subjects were male, aged 18 - 35 years. According to the symptomatic scores of AHAR were divided into 3 groups： sever AHAR （group A,24） ,mild to moderate AHAR （group B,47） and non-AHAR （group C,25） at high altitude. According to the symptomatic scores of HAD AR were divided into 3 groups： severe HAD AR （group E, 19）, mild to moderate HAD AR （group F, 40） and non-HADAR （group G,37） after retum to lower altitude （ 1 500 m）. Mean pulmonary arterial pressure （mPAP） ,right ventricular intemal dimension （RVID）, outflow tract of fight ventricle （ RVOT）, left ventricular internal dimension （LVID）, left ventricular ejection fraction （LVEF）,cardiac muscle work index （Tei index）, creatine kinase isoenzymes-MB （CK-MB）, lactic dehydrogenase isoenzyme-1 （LDH-1） were measured at high altitude stayed 50 days and after return to lower altitude 12 h, 15 d, and 30 d. Fifty healthy volunteers （group D） at 1 500 m altitude served as control. Results： Level of mPAP, RVID, RVOT, RVID/LVID ratio, Tei index, CK-MB, and LDH- 1 were higher, and LVEF was lower in group A than those in group B, C and D, there were significant differences between group B and C, C and D （all P 〈 0.01）. AHAR scores were positively correlated with HADAR scores （ r =0.863, P 〈 0.01 ）. Twelve hours after return to lower altitude, level of mPAP,RVID,RVOT, RVID/LVID ratio,Tei index, CK-MB, and LDH-1 were higher, and LVEF was lower in group E than those in group F,G and D, there were significant differences between group F and G, G and D （all P 〈 0.01 ）. Fifteen days after return to lower altitude, level of mPAP, RVID,RVOT,RVID/LVID ratio were higher in group E than those in group

关 键 词：高原脱适应 急性高原反应 心脏形态学 心功能 心肌酶 低海拔 

分 类 号：R821.46[医药卫生—临床医学]