不同压力模式的远端缺血预适应训练对模拟4500 m海拔男性受训者高原习服效果影响的对比研究  

Efficacies of remote ischemic preconditioning with different pressure modes on acclimatization in male trainees at a simulated altitude of 4500 m

作　　者：张旭程 任玉琨 王卓 李加欣 刘燕 李洪 ZHANG Xucheng;REN Yukun;WANG Zhuo;LI Jiaxin;LIU Yan;LI Hong(Department of Anesthesiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing;Department of Anesthesiology,No.944 Hospital of Joint Logistic Support Force of PLA,Jiuquan,Gansu;Department of Anesthesiology,No.960 Hospital of Joint Logistic Support Force of PLA,Jinan,Shandong,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院麻醉科,重庆 [2]联勤保障部队第九四四医院麻醉科,甘肃酒泉 [3]联勤保障部队第九六〇医院麻醉科,山东济南

出　　处：《陆军军医大学学报》2025年第9期1010-1017,共8页Journal of Army Medical University

基　　金：重庆市技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0179);陆军军医大学第二附属医院青年博士人才孵化计划项目(2022YQB079)。

摘　　要：目的 对比不同压力模式的上肢远端缺血预适应(remote ischemic preconditioning,RIPC)训练对急进高海拔环境健康成年男性的促高原习服作用。方法 陆军军医大学第二附属医院麻醉科于2024年5月在重庆通过广告招募有高原旅行计划的平原成年男性居民86名,采用随机数字表法将受试者分为变压训练组(n=29),恒压训练组(n=29)和对照组(n=28)。变压训练组以变压模式[阻断压为收缩压(systolic blood pressure,SBP)加40 mmHg]、恒压训练组以恒压模式(阻断压为固定200 mmHg)分别进行14 d的双上肢RIPC训练(2次/d,5个循环/次:缺血10 min后,再灌注5 min),对照组不进行训练。训练结束后第3天进入4 500 m海拔模拟舱,7 h后评估受试者急性高原反应(acute mountain sickness,AMS)的发病率和严重程度,并记录生命体征及脑氧饱和度。结果 变压训练组AMS发病率为23.1%(RR=0.4,95%CI:0.2~0.8,χ^(2)=9.433,P=0.002)、恒压训练组AMS发病率为16.0%(RR=0.2,95%CI:0.1~0.6,χ^(2)=12.833,P<0.001),均低于对照组AMS发病率65.4%。变压训练组[1.5(0.8,3.0) vs(3.1±1.9),P=0.018]和恒压训练组[1.0(1.0,2.0) vs (3.1±1.9),P=0.001]AMS症状评分均低于对照组。变压训练组[0(0,1.0) vs 1.0(1.0,1.0),P=0.001]和恒压训练组[1.0(0,1.0) vs 1.0(1.0,1.0),P=0.003]头晕评分均低于对照组;变压训练组[0(0,0.3) vs 1.0(0,1.0),P=0.006]和恒压训练组[0 vs 1.0(0,1.0),P<0.001]疲劳/虚弱评分均低于对照组。变压训练组(P=0.010)和恒压训练组(P=0.042)脑氧饱和度下降幅度(Δcerebral tissue oxygenation index,ΔCTOI)均小于对照组。3组受试者的SpO_(2)、HR、SBP和DBP差异无统计学意义,变压训练组和恒压训练组的AMS发病率、AMS评分、头晕评分、疲劳/虚弱评分及ΔCTOI差异均无统计学意义。结论 变压(SBP+40 mmHg)和恒压(固定200 mmHg)两种加压模式的上肢RIPC训练均可为急进高原人群提供促高原习服作用,降低AMS发病率,减轻AMS严重程度及减轻脑氧饱和�Objective To compare the effects of upper limb remote ischemic preconditioning(RIPC) with different pressure modes on enhancing high-altitude acclimatization in healthy adult males rapidly exposed to high-altitude environments. Methods In May 2024, 86 male adult residents living plain areas planning a high-altitude travel were recruited through advertisements in Chongqing by Department of Anesthesiology at the Second Affiliated Hospital of Army Medical University. The participants were randomly divided into a variable pressure training group(n=29), a constant pressure training group(n=29), and a control group(n=28). The variable pressure training group underwent RIPC training in a variable pressure mode [occlusion pressure was set at systolic blood pressure(SBP) + 40 mmHg], while the constant pressure training group received RIPC training in a constant pressure mode(fixed occlusion pressure of 200 mmHg). Both groups completed a bilateral upper limb RIPC training(twice daily, 5 cycles per time of 10-min occlusion followed by 5-min reperfusion) for 14 d. The control group received no such training. On the 3rd day posttraining, all participants entered a simulated 4 500 m altitude chamber for 7 h. The incidence and severity of acute mountain sickness(AMS) were observed and evaluated, and the vital signs and cerebral tissue oxygenation index(CTOI) were recorded. Results The incidence of AMS was 23. 1% in the variable pressure training group(RR=0. 4, 95%CI: 0. 2~0. 8, Chi-square=9. 433, P=0. 002) and 16. 0% in the constant pressure training group(RR=0. 2, 95%CI: 0. 1~0. 6, Chi-square=12. 833, P<0. 001), and both incidences were significantly lower than that in the control group(65. 4%). The AMS symptom score in the variable pressure training group [1. 5(0. 8, 3. 0) vs(3. 1±1. 9), P=0. 018] and the score in the constant pressure training group [1. 0(1. 0, 2. 0) vs(3. 1±1. 9), P=0. 001] were significantly lower than that in the control group. The dizziness score was obviously lower in the variable pressure training gr

关 键 词：远端缺血预适应 急性高原反应 高原习服 脑氧饱和度 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学] R459.9[医药卫生—基础医学] R594.3