部队官兵急性高原反应的影响因素分析

Associated factors of acute mountain sickness in army officers and soldiers

背景急性高原反应(acute mountain sickness,AMS)是部队急进高原后最主要的非战斗减员因素,AMS的发病存在较多的影响因素,AMS不同症状随海拔增加的变化及影响因素相关研究仍显不足。目的分析不同海拔区域AMS各不适症状发生情况,探讨急进高原后AMS的影响因素。方法2020年9月利用自编调查问卷,对某部184名急进高原官兵在2780 m、4200 m海拔区域的自觉症状进行跟踪调查,并分析急进高原后官兵AMS症状及其变化和影响因素。结果171例纳入统计的受试对象中,女性47例,男性124例,年龄20~49(31.95±6.85)岁,在海拔约2780 m及4200 m区域分别有63.74%和90.64%的人员出现不同程度的AMS症状。急进高原后AMS发生风险显著高于急进高原前(OR=5.838,95%CI:3.162~10.778,P=0.000);性别对AMS有显著影响,女性发生AMS症状的风险显著高于男性(OR=0.335,95%CI:0.151~0.743,P=0.007);年龄、民族、体质量指数(body mass index,BMI)、吸烟史、继往高原暴露史与AMS总体发生风险无显著相关性(P>0.05)。对AMS各症状进一步分析发现,随着年龄的增加,类似"感冒"症状发生率降低(OR=0.638,95%CI:0.463~0.878,P=0.006),而呼吸困难、心慌等症状的发生率及严重程度呈现出随年龄加重的趋势(P<0.05);随着BMI的增加,AMS腹泻症状的风险增加(OR=1.639,95%CI:1.083~2.480,P=0.019);此外,吸烟人群的心慌、乏力或疲倦、失眠、记忆力减退、思考问题速度变慢等症状发生率显著低于不吸烟人群(P<0.05)。结论在海拔约4200 m区域AMS症状发生率达到90.64%;性别、海拔高度等因素对AMS有显著影响,年龄、BMI、吸烟史对AMS部分症状有显著影响。上述研究发现将为降低官兵AMS发生率提供科学依据。

Background Acute mountain sickness(AMS)is the most important non-combat attrition factor after troops enter the plateau rapidly.There are many factors affect the incidence of AMS,while researches on influencing factors and symptom changes of AMS with the increase in altitude are still insufficient.Objective To analyze the occurrence of various discomfort symptoms of AMS in different altitude areas,explore the influencing factors of AMS after rushing to the plateau,and predict the occurrence of AMS.Methods A follow-up survey of conscious symptoms from 184 officers and soldiers was made in September 2020 by selfcompiled questionnaires during their advancing to the plateau at altitudes of 2780 meters and 4200 meters.A logistic regression model was established to explore the changes and influencing factors of AMS symptoms in officers and soldiers who were rapidly advancing to different altitudes.Results The average age of the 171 subjects(47 females and 124 males)included in the study was31.95±6.85 years.The incidences of AMS symptoms at an altitude of 2780 m and 4200 m were 63.74%and 90.64%,respectively.The risk of AMS significantly increased after rapid entry into the plateau(OR=5.838,95%CI:3.162-10.778,P=0.000).Gender was an independent influencing factor for AMS,and the incidence of AMS symptoms in women was significantly higher than that in men(OR=0.335,95%CI:0.151-0.743,P=0.007),while age,ethnicity,BMI,smoking history,and history of exposure to high altitude were not correlated with AMS(P>0.05).Analysis on the symptoms of AMS found that the incidence of symptoms similar to"cold"decreased(OR=0.638,95%CI:0.463-0.878,P=0.006)with the increase of age,while the incidence and severity of symptoms such as dyspnea and palpitation showed a trend of getting more serious with the increase of age(P<0.05),and the risk of diarrhea increased with the increase of BMI(OR=1.639,95%CI:1.083-2.480,P=0.019).In addition,symptoms including palpitation,feeble or fatigue,insomnia,memory loss,and thinking problems in smokers were significantly milder than that of nonsmokers(P<0.05).Conclusion The incidence of AMS reaches 90.64%at an altitude of 4200 meters.Gender and altitude have a significant impact on the occurrence of AMS,and age,BMI and smoking history affect some symptoms of AMS,which provide scientific evidences for reducing the occurrence of AMS in officers and soldiers.