急进高原自主神经功能变化与急性高原反应的关系

RELATIONSHIP BETWEEN THE CHANGE IN FUNCTION OF AUTONOMIC NERVOUS SYSTEM AND ACUTE MOUNTAIN SICKNESS AFTER URGENT ENTERING INTO HIGH ALTITUDE

目的研究急进高原前、后心血管自主神经（autonomic nervous system, ANS）功能变化及其与急性高原反应（acute mountain sickness, AMS）之间关系，揭示ANS在AMS发病中的作用，探求预防AMS的可能途径。方法对99名健康男性青年在海拔450m平原和空运急进3700m高原后2～4d内进行心率变异性（ heart rate variability, HRV）和冷加压试验（cold pressor test ,CPT）检测；在急进高原后l～5d接受AMS发病情况调查。结果急进高原后第1天AMS发病率92％，其中，中重度AMS占10％、轻度占36％、基本无反应占54％。LF/HFn随AMS程度减轻而减少，HFn随AMS程度加重而增加。中重度、轻度、基本无AMS反应组平原时收缩压（SBP）分别为（123．42±7．14）mmHg、（120．6±11．22）mmHg、（122．58±10．92）mmHg，均显著高于无反应纽（111．31±9．48）mmHg，（P〈0．05）；中重度AMS组在平原CPT后心率（tm）变化幅度[（7．57±8．22）b/min]显著低于基本无反应组[（25．47±19．26）b/min，（P〈0．05）]。急进高原后，中重度、轻度、基本无AMS反应纽CPT后SBP变化幅度分别为（8．14±4．95）mmHg、（9．56±7．77）mmHg、（9．97±6．80）mmHg，均显著低于无反应组[（17．00±12．75）mmHg，（P〈0．05）]；HR变化幅度分别为（11．13±6．08）b/min、（10±7．5）b/min、（12．25±8．14）b/min，均显著低于无反应组（[19．71±9．35）b/min，P〈0．05]。AMS症状积分与平原时LF/HF正相关（r=0．437，P〈0．01），与平原时CVF后HR变化幅度呈负相关（r=-0．35，P=0．01）。结论平原交感神经活动较高者其ANS的应激调节能力相对较小，对AMS易感性较高。改善ANS功能可能有助于预防AMS。

Objective To study the relationship between the functional change of autonomic nervous system （ANS） and acute mountain sickness（AMS） after urgent entering into the altitude, so as to explore the effect of ANS on the onset of AMS and to seek possible path to prevent AMS. Methods Heart rate variability（HRV） and cold pressor test （CPT） in 99 healthy young male were examined at plain and in 2 - 4 d after urgent exposure to an altitude of 3 700 m. Their AMS scores were investigated in successive 5 days after exposure. Results The total incidence of AMS was 92% on the first exposed day, in which moderate to severe AMS was 10%, mild AMS 36%, very little response 54%. The trend of LF/HF, LFn was decreased with the decrease in AMS level, and HFn was increased with the increase in AMS level. At plain, SBP were higher in .moderate to severe AMS group[（ 123.42 ± 7.14） mmHg], mild AMS group[（ 120.6 ± 11. 22） mmHg] and very little response group[ （122.58 ±10.92）mmHg] than in non-AMS group[ （111.31 ±9.48）mmHg, P 〈 0.05） ]. The increase in HR was less in moderate to severe AMS group [ （7.57 ± 8.22）b/min] than in very little response group [（25.47±19.26）b/min] after CPT （P 〈0.05）. At high altitude,the variation of SBP in moderate to severe AMS group [ （8.14 ± 4.95） mmHg], mild AMS group [ （9.56 ±7.77） mmHg], and very little response group [ （9.97 ± 6.80）mmHg] were lower than that in non-AMS group [ （17 ± 12.75）mmHg, P 〈 0.05 ]. The increase in HR [ （11.13 ± 6.08） b/min, （ 10 ± 7.5） b/min, and （ 12.25 ± 8.14） b/min respectively] were also lower than that in non-AMS （ 19.71±9.35） b/min, P 〈 0.05]. AMS was positively correlated with LF/HF（ r=0.437, P 〈 0.01 ） and negatively correlated with the variation of HR （ r = -0.35, P = 0.01 ） after CPT at plain. Conclusion The man with higher sympathetic activity at plain has lower modulating ability of ANS in stress, and is susceptible to AMS. Improving the function of ANS may conduce to prevention of AMS.