急进高原后男性官兵心功能的变化及其与AMS的关系

Change of heart function and its relationship with AMS during acute high-altitude exposure at 3658 m in Chongqing soldiers

目的:评价驻平原官兵急进高原前后心功能的变化情况并探讨其与急性高山病(AMS)的关系。方法:采用超声心动图评价42名健康青年男性官兵进入高原前及快速进入高原后(3 658 m,3 d)的心脏功能,同时观察心率、血压和血氧饱和度等生理指标的变化,以及进入高原后AMS的发病情况。结果:与进入高原前相比,青年男性官兵急进高原后,左房收缩末期内径和左室舒张末期内径显著减小,右房收缩末期内径显著减小,右室流出道和肺动脉内径显著增宽,射血分数显著增大,心输出量显著增多,肺动脉收缩压及平均肺动脉压显著增高,二尖瓣E峰流速显著降低(P<0.05)。进入高原后,42人中有15人发生AMS(AMS组),27人未发病(non-AMS组)。比较2组官兵在平原的心功能发现,AMS组的主动脉窦部内径和左室舒张末期内径显著小于non-AMS组,肺动脉收缩压显著高于non-AMS组。比较2组官兵进入高原后的心功能发现,AMS组左房收缩末期内径显著小于nonAMS组(P<0.05)。AMS评分与进入高原前的心输出量呈显著负相关性(r=-0.3814,P<0.05)。结论:青年男性官兵从平原快速进入高原后,右心功能受损合并左心功能代偿;在平原运用超声心动图进行肺动脉收缩压及心输出量的检查有助于AMS易感人群的筛选。

AIM ： To observe the cardiac function during high-altitude exposure in Chongqing soldiers and to discuss its relationship with acute mountain sickness （ AMS） by echocardiography. METHODS ： The changes of heart function were evaluated during acute high-altitude exposure （3 658 m, 3 d） in 42 healthy young male soldiers by echocar-diography. At the same time, the heart rate, blood pressure, blood oxygen saturation, and the incidence of AMS after high- altitude exposure were observed and recorded. RESULTS： Three days after arrival at 3 658 m, the left atrial end-systolic dimension （LADs） , left ventricular end-diastolic dimension （LVDd） and right atrial end-systolic dimension were signifi-cantly decreased, but the right ventricular outflow tract diameter, pulmonary artery dimension, ejection fraction, cardiac output （ CO） , pulmonary arterial systolic pressure （ PASP） and mean pulmonary arterial pressure were significantly in-creased compared with the baseline levels in all subjects. The mitral peak E velocity was significantly reduced （ P 〈 0. 05 ）. A total of 42 healthy young men were recruited and divided into AMS group with 15 subjects and non-AMS group with 27 subjects by Lake Louise scoring after high-altitude exposure. The cardiac function in the plain showed that aortic sinus di-ameter and LVDd in AMS group were significantly smaller, and PASP was significantly higher than those in non-AMS group. After high-altitude exposure, the LADs in AMS group was significantly smaller than that in non-AMS group （P 〈 0. 05）. AMS scores and CO in the plain showed significant negative correlation （ r = - 0 . 3814, P 〈0. 05）. CONCLU- SION： Upon acute high-altitude exposure, right ventricular functions of the young male soldiers are damaged with the com-pensation of the left ventricular functions. Using echocardiography to observe PASP and CO may be helpful for screening the susceptible people of AMS in the plain.