不同干预措施对移居海拔5380m青年睡眠SaO_2的影响  

The Influence of Different Medical Treatments on Sleep SaO_2 of Young Migrants at An Altitude of 5 380m

作　　者：哈振德[1] 朱金银[1] 简新玲[1] 

机构地区：[1]中国人民解放军第18医院,844900

出　　处：《高原医学杂志》2015年第4期12-16,共5页Journal of High Altitude Medicine

基　　金：兰州军区医药卫生科研基金项目(CLZ11JB31)

摘　　要：目的：监测移居海拔5380m不同时间青年睡眠时SaO2变化情况,探讨三种干预措施对移居者睡眠SaO2的改善作用。方法：采用德国耶格公司生产的Sleep Screen睡眠监测仪,对移居5 380m高原1个月、3个月、6个月及1年的青年进行整夜7h睡眠SaO2监测。并将已基本习服特高海拔地区的青年分为对照组、吸氧组[入睡监测前鼻导管吸氧（30-40）min,流量为（2-4）L/min]、乙酰唑胺组（500mg,监测当日分两次口服）及地西泮组（5.0mg,睡前30min顿服）,监测各组睡眠SaO2指标且进行比较。结果：移居海拔5 380m青年清醒静息时SaO2（WSaO2）显著降低（P〈0.001）,但随移居时间的延长仍然维持波动在80%左右（76.73%-84.27%,95%CI）。移居者睡眠时氧合状态很不稳定,氧减饱和度指数（ODI4）显著升高（P〈0.05或P〈0.01）;睡眠期基础SaO2（BSaO2）、平均SaO2（MSaO2）及最低SaO2（LSaO2）显著降低（P〈0.01）,随暴露高原时间的延长,睡眠时SaO2无明显变化。与对照组比较,在改善睡眠SaO2相关指标方面吸氧组和乙酰唑胺组均未显示出统计学差异（P〉0.05）,但地西泮组MSaO2明显降低（72.58%±2.11%和68.21%±5.09%,P=0.016）。结论：移居特高海拔青年长期处于＂低水平、不稳定＂的氧合状态,暂无证据显示睡前短时吸氧或当日服用乙酰唑胺对夜间睡眠。SaO2的改善效用,但地西泮会使睡眠时平均SaO2明显降低,应慎用。Objective： Recording the changes of SaO2 during sleeping in young people at an altitude of 5 380 m and to observe the effects of three intervention measures. Methods： Monitoring,recording and comparing SaO2 changes during seven hours dormancy by Sleep Screen（ Jaeger） from subjects who stayed at 5 380 m for 1 month,3months,6 months and 12 months. In addition,young people who have already acclimatized to high altitude environment were separated into 4 groups： control group,oxygen- taking group（ oxygen inhalation by nasal catheter for30 min - 40 min,flow（ 2 - 4） L / min）,Acetazolamide group（ 250 mg,twice per day） and Diazepam group（ 5mg pill,taken 30 min before sleeping）. Results： At an altitude of 5 380 m,SaO2 of waking（ WSaO2） was decreases significantly（ P〈0. 001） but staying around 80% as time going by（ 76. 73% - 84. 27%,95% CI）. When subjects were sleeping,ODI4（ oxygen desaturation index） increased sharply（ P〈0. 05 or P〈0. 01）; BSaO2,MSaO2 and LSaO2 were decreased（ P〈0. 01）. With the extension of time exposed to the plateau,no significant improvement was observed about SaO2. Compared with the control group,SaO2 index of oxygen- taking and acetazolamide group didn＇t show statistical difference（ P〉0. 05）. However,MSaO2 of diazepam group decreased apparently（ 72. 58%± 2. 11% and 68. 21% ± 5. 09%,P = 0. 016）. Conclusion： Young migrants were suffering from a low level and unstable oxygenation status when sleeping at high altitude. There is no evidence showing that oxygen- taking and acetazolamide could improve SaO2 level,but diazepam may reduce the SaO2 level.

关 键 词：高原 睡眠 动脉血氧饱和度 乙酰唑胺 地西泮 苯二氮卓类 

分 类 号：R740[医药卫生—神经病学与精神病学]