人体在高海拔低氧并重体力劳动时急性高原反应与肺动脉压的关系及其返回低海拔后的变化

目的观察部队官兵在高海拔低氧并重体力劳动时急性高原反应(acute high altitude reaction,AHAR)与肺动脉压(pulmonary arterial pressure,PAP)的关系及其返回低海拔后的变化。方法选择低海拔(1500m)快速进入高海拔(3700m)并从事重体力劳动的男性官兵96名,年龄18~35岁。根据AHAR症状评分,分为重度AHAR组(A组,n=24)、轻中度AHAR组(B组,n=47)和无AHAR组(C组,n=25),在该高度逗留50d后下撤前及返回低海拔(1500m)后12h、15d测定平均肺动脉压(mean pulmonary arterialpressure,mPAP)、血浆内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO),并与低海拔(1500m)50名健康官兵(D组)比较。结果 A组mPAP和血浆ET-1[分别为(34.70±2.94)mm Hg、(68.07±5.33)ng.L-1]显著高于B组[分别为(28.42±1.32)mm Hg、(55.58±2.91)ng.L-1]、C组[分别为(24.23±1.56)mm Hg、(47.27±2.63)ng.L-1]和D组[分别为(18.50±1.30)mm Hg、(33.23±2.86)ng.L-1],(均P0.01),血浆NO(53.76±4.03)μmol.L-1显著低于B组(65.54±2.97)μmol.L-1、C组(72.92±3.20)μmol.L-1和D组(82.43±4.03)μmol.L-1,(均P0.01),B组与C组之间、C组与D组之间亦有显著性差异(均P0.01)。海拔3700m AHAR总计分与mPAP、血浆ET-1呈显著正相关(分别r=0.672、0.712,均P0.01),与血浆NO显著负相关(r=-0.619,P0.01);mPAP与血浆ET-1显著正相关(r=0.712,P0.01),与血浆NO显著负相关(r=-0.686,P0.01)。海拔3700mPAP和血浆ET-1显著高于海拔1500m12h、15d和D组(均P0.01),血浆NO显著低于海拔1500m12h、15d和D组,(均P0.01),海拔1500m12h与15d之间有显著性差异(均P0.01),15d与D组之间差异无显著性(均P0.05)。结论人体在高海拔低氧并重体力时AHAR越重,PAP越高,ET-1与NO比值失衡可能是低氧性肺动脉高压发生发展的重要原因之一。返回低海拔后12h有显著改善,15d恢复到正常水平。

Relationship between acute high altitude reaction and pulmonary arterial pressure in high altitude combined strong physical work in human body and its change after return to lower altitude

Objective To assess the relationship between acute high altitude reaction(AHAR)and pulmonary arterial pressure(PAP)in high altitude combined strong physical work in human body and its change after return to lower altitude.Methods Ninety-six officers and soldiers of rapid into high altitude(3 700 m)combined strong physical work were analyzed,all subjects were male,aged 18-35 years.According to the symptomatic scores of AHAR were divided into 3 groups:severe AHAR(group A,n=24),mild to moderate AHAR(group B,n=...