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健康青年人高原脱适应心电图及超声心动图的变化规律

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目的 分析健康青年人从高原返回平原过程中心电图及超声心动图的变化规律。方法 采用前瞻性队列研究方法。在青藏高原海拔4800~5500 m移居1年内的健康青年人中招募55名志愿者为高原移居组,从高原返回平原过程中,分别在海拔3700 m(第1次)、返回海拔1300 m第5天(第2次)、返回海拔1300 m第15天(第3次)进行心电图检查;在海拔3700 m及返回海拔1300 m第5天进行超声心动图检查。匹配55名平原(海拔1300 m)健康青年人为平原对照组。比较两组心电图及超声心动图检查结果。结果 对移居高原组进行组内分析发现,与第1次心电图结果比较,第2、3次心电图结果中正常心电图比例降低(P<0。05),窦性心律不齐、窦性心动过缓、U波出现比例增加(P<0。05);第2次与第3次心电图异常结果差异无统计学意义(P>0。05)。与平原对照组比较,移居高原组第1次心电图异常结果差异无统计学意义(P>0。05);第2、3次心电图结果中正常心电图比例降低,窦性心动过缓、窦性心律不齐、U波出现比例增大(P<0。001)。对移居高原组进行组内分析发现,与第1次心电图比较,第2、3次心电图心率降低(P<0。05或P<0。001)。与平原对照组比较,移居高原组第1次心电图PR间期延长,QTc间期缩短,QRS电轴度数增加(P<0。05),第2次心电图心率降低,PR间期延长,QTc缩短(P<0。05),第3次心电图心率降低,PR间期延长,QTc间期缩短,QRS电轴度数增加(P<0。05)。移居高原组第1、2、3次心电图电轴与平原对照组比较差异均有统计学意义(P<0。001)。对移居高原组进行组内分析发现,与第1次超声心动图比较,第2次超声心动图左室收缩末期内径、左室舒张末期内径、左房前后径均明显增大(P<0。001)。与平原对照组比较,移居高原组第1次超声心动图左室舒张末期内径及右心房横径减小,右心室横径增大,左室短轴缩短率(FS)降低(P<0。05),第2次超声心动图左房前后径、右心房横径、右心室横径均增大,FS增高(P<0。05)。结论 健康青年人从高原返回平原过程中,随着海拔降低,心率明显降低,额面QRS电轴右偏人数明显减少,正常心电图明显减少,窦性心动过缓、窦性心律不齐、出现U波的人数明显增多。在高原期间,左心室收缩和舒张功能受到一定的影响。
Electrocardiogram and echocardiogram changes of healthy youngsters during high altitude de-adaptation
Objective To explore the changing patterns of electrocardiogram(ECG)and echocardiography in healthy young people during their descent from high altitude to the plain.Methods A prospective cohort study was carried out.Fifty-five healthy young volunteers who had migrated to an altitude of 4800-5500 m on the Qinghai-Tibet Plateau within one year were recruited as the plateau-migration group.ECG examinations were performed at an altitude of 3700 m(first time),on the 5th day after returning to 1300 m(second time),and on the 15th day after returning to 1300 m(third time).Echocardiography was conducted at 3700 m and on the 5th day after returning to 1300 m.A plain control group of 55 healthy youngsters from the plains(1300 m)was matched.The results of ECG and echocardiography between the two groups were compared.Results Intragroup analysis of the plateau-migration group revealed that compared with the first ECG results,the number of normal ECGs decreased in the second and third ECG results(P<0.05),and the proportions of sinus rhythm irregularity,sinus bradycardia,and U-wave appearance increased(P<0.05).There was no statistically significant difference in abnormal ECG results between the second and third ECGs(P>0.05).Compared with plain control group,there was no significant difference in the abnormal results of the first ECG of plateau-migration group(P>0.05).In the second and third ECG results,the number of normal ECGs was significantly reduced,and the proportions of sinus bradycardia,sinus rhythm irregularity,and U-wave appearance were significantly increased compared with plain control group(P<0.001).Intragroup analysis of plateau-migration group revealed that compared with the first ECG,the heart rate decreased in the second and third ECGs(P<0.05 or<0.001).Compared with plain control group,in the first ECG of plateau-migration group,the PR interval was significantly prolonged,the QTc interval was shortened,and the QRS axis degree was increased(P<0.05).In the second ECG,the heart rate significantly decreased,the PR interval was prolonged,and the QTc interval was shortened(P<0.05).In the third ECG,the heart rate decreased,the PR interval was prolonged,the QTc interval was shortened,and the QRS axis degrees was increased(P<0.05).The QRS axis of the first,second,and third ECGs of plateau-migration group was statistically significantly different from that of plain control group(P<0.001).Intragroup analysis of plateau-migration group showed that compared with the first echocardiogram,the left ventricular end-systole diameter,left ventricular end-diastolic diameter,and left atrial anteroposterior diameter all significantly increased in the second echocardiogram(P<0.001).Compared with plain control group,in the first echocardiogram of plateau-migration group,the left ventricular end-systole diameter and right atrial transection diameter significantly decreased,the right ventricular transection diameter significantly increased,and the left ventricular fractional shortening rate(FS)significantly decreased(P<0.05);In the second echocardiogram,the left atrial anteroposterior diameter,right atrial transverse diameter,and right ventricular transverse diameter all significantly increased,and FS increased(P<0.05).Conclusions In healthy young people returning from high altitude to the plain,as the altitude decreased,the heart rate significantly drops.The number of people with frontal QRS axis right deviation significantly reduces.The number of normal ECGs significantly decreases,while the numbers of people with sinus bradycardia,sinus arrhythmias,and U-wave appearance significantly increase.During high-altitude stay,the left ventricular systolic and diastolic function is affected to some extent.

de-adaptation to high altitudeplateauplainelectrocardiogramechocardiogram

赵鹏、徐朝霞、汤礼军、戴睿武、梁鸿寅、黄竹、孙菲菲、冯健、李福祥

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西南交通大学医学院,四川成都 610031

西部战区总医院重症医学科,四川成都 610083

西部战区总医院急诊医学科,四川成都 610083

西部战区总医院普外科,四川成都 610083

西部战区总医院超声科,四川成都 610083

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高原脱适应 高原 平原 心电图 超声心动图

2024

解放军医学杂志
人民军医出版社

解放军医学杂志

CSTPCD北大核心
影响因子:1.644
ISSN:0577-7402
年,卷(期):2024.49(12)