飞行人员模拟急进高原缺氧后脑血管反应性的超声评估  

Ultrasonographic evaluation of cerebrovascular reactivity in flight crew after simulated acute altitude hypoxia

作　　者：阴玮伟 周玉彬 郭华 程洪瑜 丁蔓妮 范校周 王佳 刘禧 Yin Weiwei;Zhou Yubin;Guo Hua;Cheng Hongyu;Ding Manni;Fan Xiaozhou;Wang Jia;Liu Xi(Department of Ultrasound Medicine,Tangdu Hospital,the Air Force Medical University,Xi′an 710038,China;Aeronautical Medical Engineering Research Center,Beijing 100142,China;Department of Ultrasound Medicine,the Air Force Special Medical Center,Beijing 100142,China)

机构地区：[1]空军军医大学唐都医院超声医学科,西安710038 [2]航空医学工程研究中心,北京100142 [3]空军特色医学中心超声科,北京100142

出　　处：《中华超声影像学杂志》2022年第1期25-29,共5页Chinese Journal of Ultrasonography

基　　金：空军军医大学科技攻关项目(2019ZTB05);珠峰工程(2020ZFC001)。

摘　　要：目的应用经颅彩色多普勒(TCCD)对模拟急进高原缺氧暴露初期脑血管血流参数进行监测,评估脑血流动力学及脑血管反应性变化趋势。方法选取2021年参加飞行训练的64名健康志愿者,应用TCCD技术观察受检者快速进入模拟海拔4500 m的低氧环境30 min后大脑中动脉收缩期峰值流速(Vs)、舒张末期流速(Vd)、平均血流速度(Vm)、阻力指数(RI)及搏动指数(PI)等血流参数变化情况;并结合屏气试验,利用屏气指数(BHI)对受检者脑血管反应性(CVR)进行评估,将受检者分为≤30岁和>30岁两个年龄段,比较其缺氧后CVR的变化情况。结果进入缺氧环境初期,与之前相比,受检者脉搏血氧饱和度(SpO2)降低,心率增快,大脑中动脉血流速度(Vs、Vd、Vm)明显升高,BHI降低(均P<0.01);缺氧后,与≤30岁受检者相比,>30岁者BHI变化率减低(P<0.05);屏气后,脑血流速度均明显上升,PI和RI明显降低(均P<0.05)。结论脑血流对缺氧十分敏感,应用TCCD技术可以实时、精准评估快速缺氧环境下脑血流动力学变化趋势和脑血管储备能力,有助于为高原缺氧的防治提供客观依据及研究基础。Objective To monitor the cerebral vascular blood flow parameters in the early stage of simulated acute exposure to high altitude hypoxia by transcranial color Doppler(TCCD),and to evaluate the change trend of cerebral hemodynamics and cerebrovascular reactivity.Methods Sixty-four healthy volunteers were selected to observe the changes of peak systolic flow velocity(Vs),end diastolic flow velocity(Vd),mean flow velocity(Vm),resistance index(RI)and pulsatility index(PI)of middle cerebral artery(MCA)30 minutes after they quickly entered the simulated altitude of 4500 meters.Combined with breath holding test,breath holding index(BHI)was used to evaluate cerebrovascular reactivity(CVR),and subjects were divided into≤30 years old group and>30 years old group,and the changes of CVR after hypoxia of the two groups were compared.Results In the early stage of hypoxic environment,compared with baseline,SpO2 decreased,heart rate increased,and blood flow velocity of middle cerebral artery(Vs,Vd,Vm)increased significantly,BHI showed a decreasing trend(all P<0.01).After hypoxia,the BHI rate of change in>30 years old was lower than that of the subjects≤30 years old(P<0.05).After breath holding,cerebral blood flow velocity increased significantly,PI and RI decreased significantly(all P<0.01).Conclusions Cerebral blood flow is very sensitive to hypoxia.The application of TCCD technology can evaluate the trend of cerebral blood flow dynamics and cerebrovascular reserve capacity in real time and accurately,which is helpful to provide objective basis and research basis for the prevention and treatment of high altitude hypoxia.

关 键 词：彩色多普勒 经颅 缺氧 脑血流动力学 脑血管反应性 屏气试验 

分 类 号：R852.11[医药卫生—航空、航天与航海医学]