目的:探索高原脱适应者不同返回方式对右心室结构及功能变化的影响,为减缓高原脱适应对循环系统的不良反应提供方法.方法:选取驻训于4000 m高原3个月的官兵80例,分为两组:A组(n=40,直接返回平原)和B组(n=40,阶梯式返回).同期选取平原(海拔100m)训练官兵40人作为对照组,身高、体质量、年龄等均与试验组相匹配.于返回平原前(第0天)及返回平原第2天及第15天进行心脏超声检查,测量右心室基底段横径(diameter of the right ventricle,RVD)、右室流出道内径(right ventricular outflow tract,RVOT)评估右心室腔结构;测量右室心肌功能指数(right ventricular tei index,RV-Tei)评估右心功能;应用二维斑点追踪技术分析右心室整体纵向应变(right ventricular global longitudinal strain,RVGLS)、右心室游离壁应变(right ventricular free wall strain,RVFWS)评估右室心肌纵向形变能力.结果:返回第2天:与对照组相比,A组与B组右心室功能显著下降(RV-Tei指数:A组0.42±0.03,对照组0.31±0.02,P＜0.05;B组0.40±0.02,对照组 0.31±0.02,P＜0.05;A 组 0.42±0.03,B 组 0.40±0.02,P＜0.05);心室腔扩大(RVD:A 组 4.47±0.36,对照组 3.61±0.30,P＜0.05;B 组 4.21±0.58,对照组 3.61±0.30,P＜0.05;A组4.47±0.36,B组4.21±0.58,P＜0.05),右室心肌形变能力下降.B组改善更明显.返回第15天:与第2天相比,A、B组心室腔较前缩小,B组改善更明显(RVD:A组4.40±0.37,B组4.12±0.60,P＜0.05);B组的RVOT及A、B组右心功能已恢复至平原水平.结论:从高海拔阶梯式下降返回至平原有助于降低机体氧化应激水平,改善右心结构及功能,降低高原脱适应反应的发生率及严重程度.
Study on the Changes of Right Ventricular Structure and Function in Different Return Modes of Plateau Accommodators during the Period of De-adaptation
Objective:To explore the effects of different return modes on the changes of right ventricular structure and function,and mitigate the adverse effects of high altitudede-adaptationon circulatory system.Methods:A total of 80 soldiers who were stationed in 4000 m plateau for 3 months were divided into two groups:group A(n=40,returned to the plain directly)and group B(n=40,return in steps).During the same period,40 soldiers trained on the plain(100 m above sea level)were selected as the control group,with an average age of(23.89±2.65)years old,and their height and weight were matched with those of the experimental group.Echocardiography was performed before returning to the plain(day 0)and on day 2 and day 15 to evaluate the structure of the right ventricular cavity by measuring the transverse diameter of the right ventricle(RVD)and the inner diameter of the right ventricular outflow tract(RVOT).Right ventricular myocardial function index(RV-Tei)was measured to evaluate right ventricular function.The.right ventricular global longitudinal strain(RVGLS)and the right ventricular free wall strain(RVFWS)were analyzed by two-dimensional speckle tracking imaging technique.Results:On day 2:Compared with the control group,the right heart function of group A and group B decreased(RV-Tei index:group A 0.42±0.03 vs control group 0.31±0.02,P＜0.05;group B 0.40±0.02 vs control group 0.31±0.02,P＜0.05;group A 0.42±0.03 vs group B 0.40±0.02,P＜0.05)and ventricular enlargement(RVD:group A 4.47±0.36 vs control group 3.61±0.30,P＜0.05;group B 4.21±0.58 vs control group 3.61±0.30,P＜0.05;group A 4.47±0.36 vs group B 4.21±0.58,P＜0.05).The right ventricular myocardial deformability decreased.Group B showed more significant improvement.Back on day 15:Compared with day 2,the ventricular cavity of both group A and B was smaller than before,and the improvement was more obvious in group B(RVD:group A 4.40±0.37 vs group B 4.12±0.60,P＜0.05).RVOT in group B and right heart function in groups A and B were restored to plain level.Conclusion:Returning from high altitudes in a stepped descent manner helps reduce the body's oxidative stress levels,improve right ventricular structure and function,and thus reduce the incidence and severity of high-altitude de-adaptation reactions.
high altitude de-adaptationright ventricularechocardiographytwo-dimensional speckle tracking imaging technique
万方数据
维普
