马拉松赛对运动员心脏电生理相关指标的影响

The effects of full marathon on hemodynamics related to cardiac electrophysiology of marathon amateurs

目的观察并评估马拉松全程赛对赛后无症状运动员血流动力学和心脏电生理的影响。方法共入选51名全程马拉松业余选手，分别于赛前静息状态下和完成赛程后（15～30）min内测量血压、心率、体表心电图等，并留取足量外周静脉血及桡动脉血标本。外周静脉血用于检测肌损伤标志物和N末端脑钠肽前体（N．terminal pro brain natriuretic peptide，NT-pro BNP）等生化指标，桡动脉血检测血气分析。记录12导联心电图报告的校正后Q-T（corrected Q-T，QTc）间期、QRS、PR间期及QT间期离散度（QT dispersion，QTdo结果与赛前静息状态下相比，赛后15～30min内受试者的收缩压、舒张压、平均动脉压和心率均显著升高（P〈0．05），比较受试者赛前静息状态下与赛后即刻的横纹肌损伤标记物，肌酸激酶（creatine kinase，CK）、心肌肌钙蛋白I（cardiac troponin I，cTNI）、乳酸脱氢酶（1acticdehydrogenase，LDH）、肌红蛋白均较赛前明显升高（P〈0．05），且受试者QTd水平亦较赛前显著升高（P〈0．05）；比较受试者赛前静息状态下与赛后即刻的动脉血气分析，赛后PH值较赛前显著降低（P〈0．05），赛后乳酸较赛前显著升高（P〈0．05），赛后PC02、标准的剩余碱（standard base excess，SBE）和标准HCO3-较赛前显著降低（P〈0．05）；赛后QTc间期、QTd间期均较赛前显著延长，但所有受试者赛前和赛后QTc间期和QTd间期均在正常范围内。结论全程马拉松赛显著影响无慢性疾病的健康业余选手的心肌电生理指标，但正常范围内波动。

Objective To observe and assess the effects of full marathon on hemodynamics and cardiac electrophysiology of marathon amateurs without adverse event after the race. Methods Fifty- one subjects were included in the final analysis of the study, blood pressure, heart rate, body surface electrocardiogram （ECG） of all subjects under static status before the race and within （15-30） rain after the race were detected, and sufficient amounts of the peripheral blood and the radial arterial blood specimens of all subjects under static status before the race and within （15-30） rain after the race were collected instantly. The peripheral blood was used for measuring markers of muscle injury and NT-proBNP, and the radial arterial blood was taken for blood gas analysis. The QTc interval, QRS, PR interval, and QTd interval were recorded from the 12-lead ECG report. Results Compared with those under static status before the race, the systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate of all the subjects within （15-30） min after the race were significantly higher （P〈0.05）. When the markers of striated muscle injury were compared before and after the competition, levels of CK, cTNI, LDH, and myoglobin after the race were significantly increased compared with them under static status before the race （P 〈0.05）, and the level of NT-proBNP after the race was also significantly increased compared with it before the race （P〈0.05）. When blood gas analysis before the race was compared with that after the race, the PH values after race were significantly lower than it before race （P〈0.05）. The level of lactic acid after the race was significantly higher than it before race （P〈0.05）. After the race, the levels of PCO2, SBE and HCO3- decreased significantly compared with those before race （P〈0.05）, and the QTc and QTd intervals after the race increased significantly compared with those before the race, however, the QTc interval and QTd interval for all subjects before and after the competition were within the normal range. Conclusions Full marathon significantly affect the myocardial electrophysiological markers of healthy amateur athletes without chronic diseases, but those markers fluctuate within the normal range.