Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (1): 13-19.doi: 10.24920/003552

• 论著 • 上一篇    下一篇

生理学指标和无创心血管指标对急性高原反应的早期预警作用

李宗斌,刘春伟,郭军,石亚君,李泱,王晋丽,王晶,陈韵岱()   

  1. 解放军总医院第一医学中心心血管内科
  • 收稿日期:2019-04-29 出版日期:2020-03-31 发布日期:2020-01-20
  • 通讯作者: 陈韵岱 E-mail:cyundai@vip.163.com

Early Warning of Acute Altitude Sickness by Physiological Variables and Noninvasive Cardiovascular Indicators

Li Zongbin,Liu Chunwei,Guo Jun,Shi Yajun,Li Yang,Wang Jinli,Wang Jing,Chen Yundai()   

  1. Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2019-04-29 Published:2020-03-31 Online:2020-01-20
  • Contact: Chen Yundai E-mail:cyundai@vip.163.com

摘要:

目的 探讨平原生理学指标和无创心血管指标的变化能否预测急进高原后急性高原反应的发生。
方法 招募106名汉族男性志愿者,分别在平原和急进高原后行24小时动态心电图、平板运动试验、心脏超声、血常规、血生化等检查。以Louise湖评分为因变量,进行多元回归分析,建立多元线性回归方程,以平原生理学指标和无创心血管指标预测急性高原反应发生的风险。
结果 急进高原后约49.05%的志愿者发生急性高原反应。与未发生急性高原反应的志愿者相比,发生急性高原反应的志愿者的部分平原指标的差异存在统计学意义,如三尖瓣环平面收缩偏移较低(22.0±2.66比23.2±3.19 mm,t=1.998,P=0.048),嗜酸性粒细胞计数较高[(0.264±0.393)×109/L比(0.126±0.084)×109/L,t=-2.040,P=0.045],相邻正常间隔数之间超过50 ms的差异百分比较高(PNN50,9.66%±5.40%比6.98%±5.66%,t=-2.229,P=0.028),心率变异三角指数较高(57.1±16.1比50.6±12.7,t=-2.271,P=0.025)。急进高原后,发生急性高原反应的志愿者C反应蛋白偏高(0.098±0.103比0.062±0.045 g/L,t=-2.132,P=0.037),天冬氨酸转氨酶偏高(19.7±6.72比17.3±3.95 U/L,t=-2.231,P=0.028),肌酐偏高(85.1±12.9比77.7±11.2 mmol/L,t=-3.162,P=0.002),碱性磷酸酶偏低(71.7±18.2比80.6±20.2 U/L,t=2.389,P=0.019),全部窦性心搏RR间期的标准差偏低(126.5±35.9比143.3±36.4 ms,t=2.320,P=0.022),心脏射血时间偏低(276.9±50.8比313.8±48.9 ms,t=3.641,P=0.001),心率变异三角指数偏低(37.1±12.9比41.9±11.1,t=2.020,P=0.047)。以Louise湖评分为因变量,建立多元线性回归方程:路易斯湖得分=3.783+0.281×嗜酸性粒细胞计数-0.219×碱性磷酸酶+0.032×PNN50。
结论 本研究阐明了急进高原后生理学指标和无创心血管指标的差异,根据平原生理学指标和无创心血管指标建立了急进高原后急性高原反应预警方程。

关键词: 急性高原反应, 生理学指标, 无创心血管指标, 急进高原, 早期预警

Abstract:

Objective To examine if the variations at sea level would be able to predict subsequent susceptibility to acute altitude sickness in subjects upon a rapid ascent to high altitude.
Methods One hundred and six Han nationality male individuals were recruited to this research. Dynamic electrocardiogram, treadmill exercise test, echocardiography, routine blood examination and biochemical analysis were performed when subjects at sea level and entering the plateau respectively. Then multiple regression analysis was performed to construct a multiple linear regression equation using the Lake Louise Score as dependent variable to predict the risk factors at sea level related to acute mountain sickness (AMS).
Results Approximately 49.05% of the individuals developed AMS. The tricuspid annular plane systolic excursion (22.0±2.66 vs. 23.2±3.19 mm, t=1.998, P=0.048) was significantly lower in the AMS group at sea level, while count of eosinophil [(0.264±0.393)×109/L vs. (0.126±0.084)×109/L, t=-2.040, P=0.045], percentage of differences exceeding 50 ms between adjacent normal number of intervals (PNN50, 9.66%±5.40% vs. 6.98%±5.66%, t=-2.229, P=0.028) and heart rate variability triangle index (57.1±16.1 vs. 50.6±12.7, t=-2.271, P=0.025) were significantly higher. After acute exposure to high altitude, C-reactive protein (0.098±0.103 vs. 0.062±0.045 g/L, t=-2.132, P=0.037), aspartate aminotransferase (19.7±6.72 vs. 17.3±3.95 U/L, t=-2.231, P=0.028) and creatinine (85.1±12.9 vs. 77.7±11.2 mmol/L, t=-3.162, P=0.002) were significantly higher in the AMS group, while alkaline phosphatase (71.7±18.2 vs. 80.6±20.2 U/L, t=2.389, P=0.019), standard deviation of normal-to-normal RR intervals (126.5±35.9 vs. 143.3±36.4 ms, t=2.320, P=0.022), ejection time (276.9±50.8 vs. 313.8±48.9 ms, t=3.641, P=0.001) and heart rate variability triangle index (37.1±12.9 vs. 41.9±11.1, t=2.020, P=0.047) were significantly lower. Using the Lake Louise Score as the dependent variable, prediction equation were established to estimate AMS: Lake Louise Score=3.783+0.281×eosinophil-0.219×alkaline phosphatase+0.032×PNN50.
Conclusions We elucidated the differences of physiological variables as well as noninvasive cardiovascular indicators for subjects after high altitude exposure compared with those at sea level. We also created an acute high altitude reaction early warning equation based on the physiological variables and noninvasive cardiovascular indicators at sea level.

Key words: acute altitude sickness, physiological variables, noninvasive cardiovascular indicators, acute high altitude exposure, early warning

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