高海拔地区高原习服后缺氧性右心重构情况评价

目的综合评价高海拔地区高原习服后的缺氧性右心重构情况。方法随机选择从内地低海拔地区空运进藏的100名志愿者列为对照组,从低海拔地区移居海拔3000m以上且对高原完全习服的100名驻藏部队官兵列为高原组。后者根据移居高原的海拔高度再分为移居高度Ⅰ组(海拔高度3000~4000m,n=67)和移居高度Ⅱ组(海拔高度4000~5500m,n=33);根据受试者移居高原时间的不同又分为移居时间Ⅰ组(进藏1~2年,n=72)和移居时间Ⅱ组(进藏2年以上,n=28)。应用便携式多功能复合超声心动图技术测量静息状态下的右心结构与功能,综合分析与评价高海拔地区高原习服后的缺氧性右心重构情况。结果与对照组比较,移居高海拔地区后右心重构主要表现为右室、右房增大,右室壁增厚,三尖瓣反流程度增加,肺动脉主干及分支增宽(P<0.01)等。随着海拔高度增加,右心重构更加明显,移居海拔4000m以上受试者的右心重构程度明显高于4000m以下者(P<0.01),4500m以上者尤甚。随着移居时间延长,右心重构亦更加明显,移居时间2年以上的受试者右心重构程度明显高于2年以下者(P<0.01),5年以上者尤甚。结论海拔高度和时间是影响缺氧性右心重构的主要因素,高原习服仅仅是机体对高原低氧环境的一种调节性适应。应用便携式多功能超声技术能早期、及时地评价缺氧性右心重构情况,对保障移居高原部队官兵的身体健康具有重要意义。

Assessment of hypoxia right heart remodeling after acclimatization at high different altitude areas

Objective To assess hypoxic right heart remodeling after acclimatization at high altitude area.Methods One hundred volunteers who came to Tibet from the low-altitude areas by plane were randomly selected to serve as control group,and another 100 servicemen,who were dispatched from low altitude area to a station in Tibet area 3000m above sea level and got acclimatized to serve as altitude group.The altitude group was divided into altitude group 1(3000-4000m above sea level,n=67) and altitude group 2(4000-5500m above sea level,n=33) according to the altitude of the campsite,and also into migration-time group 1(entered and stationed in Xizang for 1-2 years,n=72) and migration-time group 2(entered and stationed in Xizang for over 2 years,n=28).The structure and function of the right heart were measured using a portable multi-functional composite echocardiography in a quiescent state,and hypoxic right heart remodeling after high-altitude acclimatization was comprehensively analyzed and assessed.Results Compared with control group,the main manifestations of the subjects in the altitude group were right ventricular and right atrial enlargement,right ventricular wall thickening,aggravation of tricuspid regurgitation,and broadening of pulmonary trunk and branch(P<0.01).As the altitude increased,the right heart remodeling became more obvious,and the right heart remodeling was significantly more obvious in the subjects who svere stationed in the place >4000m above sea level than in those who were in the area <4000m(P<0.01).The longer the time the subjects stationed in the high-altitude area,the more obvious the right heart remodeling.The right heart remodeling was significantly more obvious in those who lived in high-altitude area for >2 years,particularly in those for >5 years,than those who lived there for <2 years(P<0.01).Conclusions The altitude and living time in high-altitude are main factors for hypoxic right heart remodeling.Altitude acclimatization is only the adjustment of human body to hypoxic environment.A portable multi-functional composite echocardiography can early and timely assess hypoxic right heart remodeling and it is of important significance for ensuring the health of the serviceman in high-altitude area.