高原暴露人群动脉血压变化与急性高原病的相关性分析  

Correlation analysis of the changes in arterial blood pressure in people with acute mountain sickness when exposed to high altitude

作　　者：刘阳[1] 张继航[1] 武晓静[1] 高旭滨[1] 卢巍[1] 徐柏达 黄岚[1] 

机构地区：[1]重庆第三军医大学新桥医院心血管内科,全军心血管病研究所,400037

出　　处：《解放军医学杂志》2014年第3期226-230,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家卫生部卫生行业科研专项基金(201002012)~~

摘　　要：目的观察平原健康青年男性暴露于不同海拔不同时相时的动脉血压变化及其与急性高原病(AMS)发病之间的关系,探讨高原环境下动脉血压变化的临床风险及评价动脉血压测量在AMS诊断中的作用。方法收集世居平原(海拔500m)、急进高原(海拔3700m)第1、3、5、7天及进入更高海拔地区(海拔4400m)第5天时人群的人口学资料,测量动脉血压[收缩压(SBP)、舒张压(DBP)、平均动脉压(MABP)等],并填写AMS流行病学观察表。另以平原健康青年男性作为对照组。以路易斯湖AMS计分系统(LLS)诊断AMS。分析上述各人群进入高原后的动脉血压变化及其与AMS的关系。结果由平原急进高原(海拔3700m)第1天SBP、DBP、MABP均明显升高,习服约1周后血压稍有下降,但仍高于平原水平(P<0.05),继之进入更高海拔地区(海拔4400m)后SBP、DBP、MABP又升高,但低于急进高原第1天水平。急进高原(海拔3700m)第1天,AMS组MABP高于无AMS组(P<0.05),但两组SBP、DBP和脉压差异无统计学意义(P>0.05),且MABP与LLS呈正相关(r=0.138,P=0.048)。以MABP作为海拔3700m AMS发病的客观评估指标,其诊断AMS的界值为98.5mmHg,灵敏度为32.8%,特异度为73.7%。进入更高海拔地区(海拔4400m)时,AMS组MABP明显高于无AMS组(P<0.05),但两组SBP、DBP和脉压差异无统计学意义(P>0.05),且MABP与LLS也呈正相关(r=0.145,P=0.045)。以MABP作为海拔4400m AMS发病的客观评估指标,其诊断AMS的界值为97.8mmHg,灵敏度为42.4%,特异度为75.5%。结论在急性低氧暴露后MABP对AMS有一定诊断价值,但由于其特异性或敏感性问题,在实际应用中存在一定限制,应当与其他指标(如动脉血氧饱和度)联合以提高诊断AMS的可靠性。Objectives To investigate the changes in arterial blood pressure in the healthy lowlanders when they were exposed to different altitudes and duration, and the relationship of the exposure with the prevalence and susceptibility of acute mountain sickness （AMS）, in order to evaluate the significance of arterial blood pressure changes in the diagnosis of AMS and its clinical risk. Methods Demographic data and blood pressure parameters [systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial BP （MABP）] of healthy lowlanders （inhabitants in 500m） were collected after being exposed to 3700m on day 1, 3, 5 and 7, and also after being exposed to 4400m on day 5, while healthy young men living at low altitude were randomly selected as the control group. Simultaneously the AMS symptoms Questionnaire was filled. The Lake Louise acute mountain sickness scoring system （LLS） was used to diagnose AMS. The changes in arterial blood pressure in people above and its correlation with AMS were analyzed. Results After acute exposure to 3700m （day 1）, SBP, DBP and MABP rose obviously, and then descended moderately after adaptation for about a week, but still higher than that of LA level （P〈0.05）. And then SBP, DBP and MABP rose again at high-altitude of 4400m, but lower than the levels of day 1 at 3700m. MABP at 3700m and 4400m were related to LLS （r=0.138, P=0.048; r=0.145, P=0.045, respectively）. MABP levels for diagnosis of AMS at 3700m showed an cut-offpoint of 98.SmmHg with sensitivity of 32.8% and specificity of 73.7% （P〈0.05）, and MABP levels for diagnosis of AMS at 4400m showed an cut-off point of 97.8mmHg with sensitivity of 42.4% and specificity of 75.5% （P〈0.05）. Conclusions After exposure to acutehypoxia, MABP may serve as a predictive parameter for diagnosis of AMS. However, the clinical application of MABP as a diagnostic criterion is limited because of its poor specificity or sensitivity. The use of MABP as a diagnostic criterion should be combined w

关 键 词：高海拔 缺氧 血压 高原病 敏感性与特异性 

分 类 号：R339.54[医药卫生—人体生理学]