急进4000米海拔高原对健康青年男性长时程心率变异性的影响  

Effects of rapidly entering 4 000 m high altitude on long-term heart rate variability in healthy young men

作　　者：石亚君[1] 宋小武 王晋丽[1] 郭军[1] 李宗斌[1] 郜玲[1] 王小鹏[1] 赵成辉[1] 陈韵岱[1] Shi Yajun;Song Xiaowu;Wang Jinli;Guo Jun;Li Zongbin;Gao Ling;Wang Xiaopeng;Zhao Chenghui;Chen Yundai(Department of Cardiology,First Medical Center,PLA General Hospital,Beijing 100853,China;Outpatient Department of Organ Service Center,Ministry of Agriculture and Rural Affairs of the People's Republic of China,Beijing 100125,China)

机构地区：[1]解放军总医院第一医学中心心血管内科,北京100853 [2]中华人民共和国农业农村部机关服务局门诊部,北京100125

出　　处：《中国心血管杂志》2020年第4期312-316,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家重大新药创制科技重大专项(2014ZX09J14102-02A)。

摘　　要：目的研究急进4 000 m海拔高原的健康青年男性长时程心率变异性(HRV)的变化,为急进高原对自主神经系统活动的影响提供理论依据。方法 2014年8月至2015年12月整群抽样兰州驻军某部队服役1年以上急进海拔4 000 m高原、年龄≤35岁的健康青年男性100名作为急进高原组,整群抽样敦煌海拔1 700 m驻军某部队服役1年以上体检健康青年男性100名作为高原组和北京海拔43.5 m驻军某部队服役1年以上体检健康青年男性42名作为平原组。急进高原组在急进4 000 m高原后驻扎高原,24 h内行动态心电图检查,对比3组心电参数。结果研究最终入选急进高原组91名,高原组98名和平原组40名。急进高原组总心搏数、平均心率、最高心率、最低心率、窦性心搏总数、最高窦性心率、最低窦性心率和平均窦性心率均明显高于高原组和平原组(均为P<0.05)。3组心律失常的发生率比较无显著性差异(均为P>0.05),而HRV指标比较差异均有统计学意义(均为P<0.01)。与平原组比较,高原组代表总频率24 h全部窦性RR间期的标准差(SDNN)和代表交感神经张力的超低频指标24 h内每5 min节段窦性RR间期平均值的标准差(SDANN)明显降低[(186.3±43.8)ms比(214.2±42.0)ms,t=3.239,P<0.01;(172.5±44.6)ms比(206.0±47.5)ms,t=4.004,P<0.01];与高原组比较,急进高原组代表迷走神经张力的高频指标24 h内相邻两个正常窦性RR间期差值大于20 ms的个数所占百分比(PNN50)、24 h内全部窦性RR间期差值的均方根(RMSSD)和代表总频率的HRV三角指数均明显降低[6.45%±3.5%比12.7%±5.1%,t=6.466;(47.6±23.3)ms比(62.4±22.9)ms,t=2.853;43.9±9.9比50.9±13.5,t=2.246,均为P<0.01]。所有HRV指标急进高原组均低于平原组(均为P<0.05)。结论健康青年男性急进高原后所有频率水平的HRV指数均降低,可能是自主神经逐步调节所致;高原环境习服后交感神经首先调节,在进一步急进高海拔地区后迷走神经�Objective To investigate the change of long-term heart rate variability(HRV)of healthy young men who are rushing to the 4000 m altitude plateau,and to provide of a theoretical basis of automatic nervous system reaction after acute exposure to high altitude.Methods A total of 242 healthy young men(≤35y)were cluster sampling enrolled from August 2014 to December 2015.The 100 cases exposed to 4000-meter altitude in Lanzhou were enrolled as acute exposure high altitude group.The 100 cases were selected from Dunhuang with 1700-meter altitude as high altitude group,while 42 cases were enrolled from Beijing with 43.5-meter altitude as plain group.All subjects were undergone 24-hour Holter monitoring.In high altitude group,Holter monitoring were tested within 24-hour after exposure to high altitude.Electrocardiographic parameters were compared among three groups.Results There were 91,98,40 participants finally enrolled in acute exposure high altitude group,high altitude group and plain group,respectively.The total heart rate(HR),average HR,maximum HR,minimum HR,total sinus HR,highest sinus HR,lowest sinus HR,and average sinus HR were significantly higher in the acute exposure high altitude group than those in the plain group and the high altitude group(all P<0.05).There was no significant difference in the incidence of arrhythmias among the three groups(all P>0.05).HRV was significantly different in the three groups(all P<0.01).Compared with the plain group,standard deviation of NN intervals(SDNN)and five-minute R-R interval means(SDANN)were significantly lower in the high altitude group[(186.3±43.8)ms vs.(214.2±42.0)ms,t=3.239,P<0.01;(172.5±44.6)ms vs.(206.0±47.5)ms,t=4.004,P<0.01].Compared with the high altitude group,percentage of adjacent NN intervals differing by more than 50 milliseconds(PNN50),root mean square successive difference(RMSSD)and HRV trigonometric index(HRVTI)were significantly lower in acute exposure high altitude group[6.45%±3.5%vs.12.7%±5.1%,t=6.466;(47.6±23.3)ms vs.(62.4±22.9)ms,t=2.853;4

关 键 词：高原病 高海拔 急进 心率变异性 长时程 

分 类 号：R339.5[医药卫生—人体生理学]