高原病分子水平发病机制研究现状

高原病是发生于高原缺氧环境下的一种特发性疾病,当人进入高原地区时,机体因为环境的改变,会发生代谢失调,出现一系列的"高原反应",严重者可发生"高原病",从而危害人类健康甚至威胁生命。全世界有超过14 000万人居住在高原地区,因此对于高原病的发病机制研究极其重要,该文就高原病分子水平发病机制进行初步论述,为高原病的防治提供依据。     

心理行为因素对急进高原救灾官急性高原反应状况的影响

目的了解急进高原抗震救灾官兵的急性高原反应状况,并探讨其心理行为相关影响因素,为进一步研究预防措施提供参考依据。方法整群随机抽取玉树抗震救灾某部162名官兵为研究对象,根据军标GJB1098—9急性高原反应的诊断和处理原则判断官兵的急性高原反应状况,采用一般情况调查表、症状自评量表（SCL-90）和生活事件量表（LES）调查相关因素。结果救灾官兵急性高原反应的检出率为65．4％,其中轻度17．3％、中度31．5％、重度16．7％。临床表现中以气短、心慌、头昏、口唇发绀和头痛等症状最为多见,在救灾官兵中出现比率分别为83．6％、79．1％、73．1％、61．2％和58．2％。急性高原反应总计分与年龄、婚姻、心理创伤史,LES负性事件,SCL-90总分及其躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执、食欲睡眠等因子呈显著正相关（r值为0．188-0．619,P〈0．01或0．05）,与兴趣爱好、社会支持呈显著负相关（r值分别为-0．254,-0．285,P〈0．01）。多元逐步回归分析显示SCL-90的躯体化因子。兴趣爱好、婚姻、社会支持和年龄等因素进入回归方程。结论大部分救灾官兵存在明显的急性高原反应,躯体化症状、兴趣爱好、婚姻、社会支持和年龄等因素对官兵的急性高原反应状况影响较大。     

心理行为因素对急进高原救灾官兵急性高原反应状况的影响

目的 了解急进高原抗震救灾官兵的急性高原反应状况,并探讨其心理行为相关影响因素,为进一步研究预防措施提供参考依据.方法 整群随机抽取玉树抗震救灾某部162名官兵为研究对象,根据军标GJB1098-9急性高原反应的诊断和处理原则判断官兵的急性高原反应状况,采用一般情况调查表、症状自评量表(SCL-90)和生活事件量表(LES)调查相关因素.结果 救灾官兵急性高原反应的检出率为65.4%,其中轻度17.3%、中度31.5%、重度16.7%.临床表现中以气短、心慌、头昏、口唇发绀和头痛等症状最为多见,在救灾官兵中出现比率分别为83.6%、79.1%、73.1%、61.2%和58.2%.急性高原反应总计分与年龄、婚姻、心理创伤史,LES负性事件,SCL-90总分及其躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执、食欲睡眠等因子呈显著正相关(r值为0.188～0.619,P<0.01或0.05),与兴趣爱好、社会支持呈显著负相关(r值分别为-0.254,-0.285,P<0.01).多元逐步回归分析显示SCL-90的躯体化因子,兴趣爱好、婚姻、社会支持和年龄等因素进入回归方程.结论 大部分救灾官兵存在明显的急性高原反应,躯体化症状、兴趣爱好、婚姻、社会支持和年龄等因素对官兵的急性高原反应状况影响较大.

Abstract：

Objective To investigate the acute mountain sickness of servicemen during"4.14"Yushu earhquake relief work,and analyze the related factors of the sickness at the initial phase of acute plateau exposure.Methods 162 servicemen were sampled randomly and clusteringly from Yushu relief force during.the inidal phase of acute plateau exposure.According to the"Diagnosis and treatment principles of the acute mountain sickness",the prevalence of the acute mountain sickness was judged among the servicemen.The scales of general status invested score(GSIS),the self-rating symptom scale(SCL-90)and the life event scale(LES)were used to investigate the related factors of the acute mountain sickness.Results 65.4% of servicemen in earthquake relief work had acute mountain sickness,including mild 17.3%,moderate 31.5%and severe 16.7%.The occurrences of pant,palpitation,dizziness,lips cyanosis and headache,were higher than other symptoms,accounting for 83.6%,79.1%,73.1%,61.2%and 58.2%.The positive significant correlation was found among the symptoms score of acute mountain sickness and age,marriage,trauma history,negative events,and the most genes(somatization,obsession,depression,anxiety,hostility,fear,paranoia,appetite,sleep)and total score of SCL-90(r=0.188～0.619,P<0.01 or 0.05).There was negative significant correlation among the symptoms score and the personality and social support(r=-0.254,P<0.01;r=-0.285,P<0.01).Regression analysis showed that the somatization,personality,marriage,social support and age were more important than other factors.Conclusion Attention should be paid to the acute mountmn sickness in the relief force during the initial phase of acute plateau exposure,and the morbidity rate of acute mountain sickness were correlated with the somatization,personality,marriage,social support and age.     

Incidence of acute mountain sickness at intermediate altitude

The incidence of acute mountain sickness was determined by questionnaire in 454 individuals who attended week-long continuing medical education programs at ski resorts in the Rocky Mountains with base elevations of about 2000 m. As a control group, 96 individuals who attended continuing medical education programs at sea level in San Francisco completed similar questionnaires. Study subjects were classified as having acute mountain sickness when they reported three or more of the five possible cardinal symptoms: headache, insomnia, dyspnea, anorexia, and fatigue. Only symptoms with an intensity of at least grade 2 (moderate) out of 5 were analyzed. Acute mountain sickness-like symptoms occurred in 25% of subjects at 2000 m compared with 5% of subjects at sea level. The incidence of acute mountain sickness at 2000 m was greatest among subjects who had come from lower altitudes. Half of the subjects with symptoms took medication. The duration of symptoms was short, with 90% of all symptoms that were reported occurring in the first 72 hours. Acute mountain sickness is common at intermediate altitudes, and it is frequently severe enough to prompt self-medication.     

534例高原急进人群肾上腺皮质机能观察

目的：探讨肾上腺皮质激素与急性高原病的关系。方法：分别在低海拔区和高海拔区及高海拔区不同时间抽取同一人群的肘静脉血检测血浆皮质醇（F）、醛固酮（札D）、肾素活性（PRA）、血管紧张素Ⅱ（AⅡ）及睾酮（T）等五项肾上腺皮质激素,进行统计学处理。通过分析找出与急性高原病的相关关系。结果：血浆皮质醇含量随海拔高度的增加而有增高,而ALD、PRA、AⅡ及T无统计学意义;进入高海拔区后,随着时间延长,血浆皮质醇含量明显下降。进入高海拔区后发病组人群血浆皮质醇含量明显低于未发病人群。结论：血浆皮质醇水平与急性高原病的发病明显相关。     

VR技术在急性高原病救援实践演练中的应用

虚拟现实（virtual reality,VR）技术是一种可以进行人机交互的技术手段,已广泛应用于教学。本文在高原医学救援实践演练教学中,通过模拟高原环境、高原病预防和救治环节开展虚实相结合的教学实践,与传统教学模式开展对比研究。选择临床医学专业本科学员为研究对象,对演练效果进行对比分析。结果证明,VR技术使高原病救援实践演练教学手段更加丰富多样,对改善高原病救援实践演练的教学环境,克服设备、场地不足,优化教学设计,实现虚实结合,提高教学质量和考核成绩具有优势。     

慢性高原病发病机制研究进展

慢性高原病是高原地区危害人体健康的常见慢性病。是长期生活在海拔2500m以上并对缺氧不完全适应的表现,其发病机制普遍认为与高原低氧所引起的高原习服失衡、呼吸驱动减弱、炎性因素,血红蛋白与氧气亲和力下降、促红细胞生成素的合成与释放调节机制紊乱、血清p53和Bcl-xL蛋白的表达等有关系,但其发病机制是多样复杂的,现在尚未阐明。本文对慢性高原病的发病机制研究进展予以综述。     

急性高原病发病机制的研究进展

急性高原病是人由平原进驻高原时最常发生的问题,高原的低氧环境无法改变,但通过寻找提高氧利用效率的抗缺氧药物,从而提高机体的抵抗能力是一条有效的途径。中药凭借其自身的优势在抗缺氧方面发挥着独特的作用,具有不良反应少、应用历史悠久等特点。现对急性高原反应的发病机制及红景天抗高原反应作用机制进行综述,从而为研制有效的抗缺氧新药奠定理论基础。     

Mountain sickness

Acute mountain sickness (AMS) is a failure to adapt to high altitude. Although some people may be at increased risk, most cases are unpredictable. Much can be done, however, to prevent AMS or limit its severity. Staging ascent, sleeping low, and avoiding overexertion and respiratory depressants are all helpful. For some, drug prophylaxis should be considered. Treatment is based on clinical severity, with descent remaining the primary treatment for severe cases.     

玉树灾区高原病及其预防

本文结合玉树地震灾区的特点,概述了赴灾区救援与灾后重建工作者中可能出现的各种急性高原病,便于医务人员等做好宣传、防治工作。     

急性重症高原病患者脑功能损伤与多器官功能障碍

目的 探讨急性重症高原病患者脑损伤与多脏器功能障碍的关系。方法 回顾性调查了50年间住院治疗的3184例急性重症高原病患者，对其脑损伤与多脏器功能障碍之间的关系进行了统计分析。结果 急性高原病患者中5．4％有不同程度昏迷，5％有精神异常，4％有嗜睡，1％有感觉异常，1.48％有眼底出血或水肿，1％有颅内CT异常；在这部分病人中高原脑水肿占总病例数的10％，在高原脑水肿病例中脑功能障碍比例明显增高，其中精神行为异常者占51％．有不同程度昏迷者占51．5％。脑功能障碍者中有15％伴其它脏器功能损伤，明显高于其它脏器损伤所伴有的并发症。结论 高原病患者脑损伤更易并发其它多脏器功能障碍，是引起高原多脏器功能障碍综合征的一个重要原因。     

Birmingham Medical Research Expeditionary Society 1977 Expedition: cardiopulmonary function before, during and after a twenty-one-day Himalayan trek.

The heart rate response to exercise was studied in 17 normal subjects before, during and after a 21-day Himalayan trek to 5490 m. The group were fitter before the trek when compared to normal subjects of a similar age (P less than 0.001) having a lower heart rate response to exercise for their lean body mass. The trek significantly increased the ''fitness'' of the group as a whole (P less than 0.025) but this was not seen in the 5 members of the group who had severe acute mountain sickness. Similar changes were noted within the first 8 days of the trek before symptoms of mountain sickness occurred. The group had normal pulmonary function before the trek but peak expiratory flow rate and vital capacity decreased with altitude. The effect was more marked in the subjects with acute mountain sickness.     

急性高原病高原环境下现场教学法的实践与评价

目的 探讨高原环境现场教学模式在急性高原病教学中的应用效果。方法 选择2018、2019级临床医学专业的在院医学生作为教学对象,分为常规教学组（20人）和现场教学组（20人）。常规教学组学生接受单纯课堂授课方式教学,现场教学组学员在接受理论授课后继续进驻高原,接受高原现场模式教学。课程完成后比较两组学员的急性高原病理论知识、实习质量评分和急性高原病救治操作成绩,并在学员和教员中开展问卷反馈和课后讨论,评价高原现场教学模式。采用SPSS 19.0进行卡方检验和t检验。结果 现场教学组学员的急性高原病理论知识成绩高于常规教学组[（91.72±4.34） vs. （86.10±5.15）分],现场教学组学员的实习质量评分成绩高于常规教学组[（89.64±5.21） vs. （83.51±2.38）分],现场教学组学员的急性高原病救治操作成绩高于常规教学组[94.05（89.54,94.87） vs. 87.01（84.33,90.82）分],差异均具有统计学意义（P<0.001）。结论 高原环境下的现场教学模式可以提高急性高原病教学的效果,培养学生的兴趣和学习积极性,值得推广应用。     

Severe acute mountain sickness.

The experiences of acute mountain sickness (AMS) as it has presented to a physician working in a general hospital at 1370 m in Kathmandu, nepal, are described. The features of 39 cases are analysed. It is suggested that AMS should be classified into benign and malignant forms.     

Acute mountain sickness: medical problems associated with acute and subacute exposure to hypobaric hypoxia

This article summarises the medical problems of travel to altitudes above 3000 m. These are caused by chronic hypoxia. Acute mountain sickness (AMS), a self limiting common illness is almost part of normal acclimatisation--a transient condition lasting for several days. However, in <2% of people staying above 4000 m, serious illnesses related to hypoxia develop--high altitude pulmonary oedema and cerebral oedema. These are potentially fatal but can be largely avoided by gradual ascent. Short vacations, pressure from travel companies and peer groups often encourage ascent to 4000 m more rapidly than is prudent. Sensible guidelines for ascent are outlined, clinical features, management and treatment of these conditions.     

模拟6000m高原大白鼠脑皮层含水量及其电解质变化

大白鼠在模拟6000m高原,经受缺氧48h,发生了大脑水肿,皮层组织中钠和水含量均增高,是细胞毒性水肿的特点,支持急性高山病是由于高原缺氧导致大脑水肿而引起的假说。     

Birmingham Medical Research Expeditionary Society 1977 Expedition: signs and symptoms.

The BMRES group of 17 persons is described and details are given of the trek to 5400 m. The research programme is outlined. Moderately severe acute mountain sickness (AMS) was observed in 5 subjects. All subjects were rated according to their symptoms related to AMS by interview, peer review and self-assessment, and the results compared.     

Introductory address: lessons to be learned from high altitude.

A historical account of the important landmarks in man''s experience with the high altitude environment is followed by comments on the important stages in the understanding of its physiological effects. The work of The Mount Logan High Altitude Physiology Study on acute mountain sickness is reviewed from its inception in 1967 until the present.     

血红蛋白在高原低氧适应中的机制研究进展

低氧分压是造成急性高山病的主要原因。机体中血红蛋白在氧的结合、利用、运输、释放中起着重要作用,增加血红蛋白的氧气结合量或者在组织中的供氧量有助于缓解高原病。但增加血红蛋白含量有一定的局限性,研究人员利用分子生物学的技术,寻找可调节血红蛋白构象的内源性或外源性物质,提高肺泡中的摄氧量或肺泡氧在组织中的利用率。目前有关变构调节剂改善血红蛋白亲和力的研究已取得一定进展,将这一机制运用到高原低氧的研究也正在展开。本文从血红蛋白与高原低氧的关系入手,阐述了血红蛋白的结构以及各种变构调节剂在低氧中发挥的作用,希望为寻找新的调节血红蛋白构象的物质提供理论依据。     

急性高原病的病理生理表现及机制研究进展

急性高原病(AMS)是人快速进入2500 m以上高原、暴露于低氧环境后产生的具有一系列病理生理学变化、功能紊乱及相应的各种临床症状的疾病。随着高原地区经济建设的迅速发展,进入高原的人逐年增多,高原病的发病率也逐渐增高,已成为制约高原经济发展和影响驻地军民身体健康的主要因素。研究AMS病理生理表现及其发病机制,对积极有效地预防和治疗AMS有重要意义。