健康青年男性急进高原初期肺动脉压力动态波动变化的研究  

Dynamic change of pulmonary artery pressure in healthy young males at acute high-altitude exposure

作　　者：孙书红[1] 段炜[1] 孟宏涛[1] 惠增骞[1] 江水根 高钊[1] 胡建库[1] 

机构地区：[1]武警陕西总队医院,西安710054 [2]武警西藏总队医院特诊科

出　　处：《公共卫生与预防医学》2016年第2期38-41,共4页Journal of Public Health and Preventive Medicine

基　　金：武警部队后勤部2012年科研项目(WJWSB2012-11)

摘　　要：目的探讨急进高原适应过程中肺动脉压力的动态变化及可能机制及对右室功能的影响。方法 62名健康汉族男性青年,分别在平原(海拔390m)空运至西藏拉萨(海拔3 658m)后第1 d、第7 d、第60 d接受了多普勒超声测量主肺动脉血流加速时间(ACT)、右心室射血时间(RVET)、右室射血前期(RVPEP)、右室流出道宽度(ROVT)、主肺动脉内径(MPAD)、右室舒张末期内径(RVD)。硝酸还原法测定相同时间点的血清一氧化氮(NO),放射免疫法检测血清内皮素(ET-1)的水平。结果与平原比较,急进高原第1 d收缩期肺动脉压(SPAP)、平均肺动脉压(m PAP)和E/A值明显升高(P<0.05),ROVT明显降低(P<0.05),ET-1明显升高(P<0.05)。急进高原第7 d SPAP、m PAP和ROVT明显降低(P<0.05),NO和E/A明显增高(P<0.05),急进高原第60 d SPAP、m PAP、ROVT和E/A值明显升高,差异有统计学意义(P<0.05),急进高原第60 d NO及ET-1差异均无统计学意义。与急进高原第1 d比较,急进高原第7 d SPAP、MPAP,ET-1明显增高(P<0.05),NO明显降低(P<0.05),急进高原60 d SPAP、MPAP、POVT和E/A明显升高(P<0.05),ET-1、NO变化不显著。与急进高原第7 d比较,急进高原60 d SPAP、MPAP明显升高(P<0.05),ET-1、NO变化不显著。结论缺氧、低压的高原环境导致了肺动脉压力增高,但在急进高原初期适应过程中,肺动脉压力出现一过性降低(急进高原第7 d)、右心舒张功能增强的波动,这一变化可能与NO及ET-1在不同时向交替占优势、调节肺血管的收缩舒张有关。Objective To explore the dynamic change of pulmonary arterial pressure and the effect of right ventricle in healthy young males on the first day,seventh day and sixtieth day after they first arrived at acute high-altitude. Methods Sixty-two healthy recruits from plain area were transported from 390 m to 3658 m altitude of the Tibet Plateau by airplane. Echo Doppler measurements of pulmonary blood flow acceleration time（ AT）,ejection time（ ET）,right ventricular pre-ejection period（ RVPEP）,right ventricular outflow tract（ RVOT）,main pulmonary artery diameter（ MPAD）,right ventricular end diastolic dimension（ RVD）,nitric acid reduction method were applied to measure NO level,and radioimmunoassay method was applied to measure ET-1 level. Results The systolic pulmonary artery pressure（ SPAP） and mean pulmonary artery pressure（ m PAP） were significantly higher at the 1st,60 th day after the arrival at highlands（ P 0. 05）,but lower at the 7thday after the arrival（ P 0. 05）. ET-1 obviously increased（ P 0. 05） at the 1stday after the arrival,and NO obviously increased（ P 0. 05） at the 7thday after the arrival. SPAP,m PAP and ET-1significantly decreased,while NO significantly increased at the 7thday after the arrival,higher than that at the 1st day after the arrival（ P 0. 05）. The SPAP and m PAP were significantly higher at the 60 th day after the arrival,higher than that at the 1st day after the arrival（ P 0. 05）. The SPAP and m PAP were significantly higher at the 60 th day after the arrival,higher than that at the 7thday after the arrival（ P 0. 05）. The difference of ET-1 and NO were not statistically significant. Conclusion Dynamic Changes of pulmonary artery pressure occurred in healthy young males at acute high-altitude exposure. Alternating dominance between ET-1 and NO might play a role at different time phase.

关 键 词：高海拔 超声心动描记术 肺动脉压 动态变化 

分 类 号：R82[医药卫生—临床医学]