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目的:观察高原低氧重体力劳动对部队官兵心脏结构和功能的影响及返回低海拔后恢复变化情况。方法:选择由低海拔(1 500 m)快速进入高原(3 700 m)并从事重体力劳动的男性官兵96名,年龄18～35岁。根据急性高原反应(AHAR)症状评分,分为无AHAR组(n=25)、轻中度AHAR组(n=47)和重度AHAR组(n=24)。在该高度逗留50 d后下撤前及返回低海拔(1 500 m)后12 h、15 d和30 d用超声心动图测定平均肺动脉压(mPAP)、右心室内径(RVID)、右心室流出道(RVOT)、左心室内径(LVID)、心肌做功指数(Tei指数)、左心室射血分数(LVEF),同时选择低海拔(1 500 m)地区的50名健康官兵作为对照组。结果:在高原,无AHAR组mPAP、RVID、RVOT、RVID/LVID比值、Tei指数显著高于对照组,而LVEF显著低于对照组(均P<0.01);且随AHAR加重,各项指标进一步变化,轻中度组与重度组之间两两比较差异均有统计学意义(均P<0.01)。高原50 d时,mPAP与RVID、RVOT、RVID/LVID比值和Tei指数呈显著正相关(分别r=0.613、0.647、0.585、647,均P<0.01),与LVEF显著负相关(r=-0.620,均P<0.01)。与对照组比较,96名官兵在高原地区50 d时,mPAP、RVID、RVOT、RVID/LVID和Tei指数显著升高,LVEF显著降低(均P<0.01),返回低海拔12 h、15 d时mPAP、RVID、RVOT、RVID/LVID比值和Tei指数显著降低,LVEF显著升高(均P<0.01),15 d时mPAP、Tei指数、LVEF与对照组比较均无显著性差异,30 d时RVID、RVOT、RVID/LVID进一步降低,与对照组比较均P>0.05。结论:平原部队快速进入高原低氧环境并从事重体力劳动时,AHAR越重,右心室增大和左心室功能降低越明显,返回低海拔后12 h有显著改善,15 d左心功能恢复正常,30 d右心室增大恢复正常。
Objective: To observe the effect of plateau hypoxic-severe manual labor on the cardiac structure and function of the officers and soldiers and the recovery after the return to low altitude. Methods: A total of 96 male officers and men, aged 18-35 years old, who quickly entered the plateau (3 700 m) and engaged in heavy manual labor from a low altitude (1 500 m). According to the AHAR symptom score, there were no AHAR group (n = 25), mild to moderate AHAR group (n = 47), and severe AHAR group (n = 24). Mean pulmonary arterial pressure (mPAP), RVID, and right ventricular outflow were measured by echocardiography at 12 h, 15 d, and 30 d after this 50-day height stay and 12 h, 15 d, and 30 d after returning to low altitude (1 500 m) RVOT, LVID, Tei index and left ventricular ejection fraction (LVEF). Fifty healthy officers and men at low altitude (1 500 m) were selected as control group. Results: The mPAP, RVID, RVOT, RVID / LVID ratio and Tei index in AHAR group were significantly higher than those in control group, but LVEF was significantly lower than those in control group (all P <0.01) Changes, mild to moderate group and severe group of any pairwise differences were statistically significant (P <0.01). There was a significant positive correlation between mPAP and RVID, RVOT, RVID / LVID and Tei index (r = 0.613,0.647,0.585,647, P <0.01, respectively) and significant negative correlation with LVEF , All P <0.01). Compared with the control group, 96 officers and soldiers in the plateau area at 50 d, mPAP, RVID, RVOT, RVID / LVID and Tei index increased significantly, LVEF significantly decreased (all P <0.01), returned to low altitude 12 h, The mPAP, RVID, RVOT, RVID / LVID ratio and Tei index decreased significantly and LVEF increased significantly (all P <0.01). There was no significant difference in mPAP, Tei index and LVEF between the control group and the 15 d , RVOT, RVID / LVID further reduced, compared with the control group were P> 0.05. Conclusion: When the platoon troops quickly entered the plateau hypoxia environment and engaged in heavy physical labor, AHAR became heavier, the right ventricle increased and the left ventricular function decreased more obviously. After returning to low altitude, the AHAR significantly improved and the left ventricular function returned to normal after 15 days. Right ventricle increased back to normal after 30 days.