【摘要】 目的:研究急進(jìn)高原(海拔4500 m)外訓(xùn)官兵的睡眠狀況以及與血氧的關(guān)系. 方法:對由低海拔地區(qū)(海拔1000 m)急進(jìn)高原(海拔4500 m)進(jìn)行演訓(xùn)的46名官兵進(jìn)行脈搏傳導(dǎo)時(shí)間(PTT)監(jiān)測. 結(jié)果:高海拔地區(qū)與低海拔地區(qū)夜間睡眠時(shí)的平均血氧飽和度、小血氧飽和度、3%血氧飽和度下降指數(shù)、呼吸性事件總指數(shù)及自發(fā)微覺醒總指數(shù)均有明顯改變,二者差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05).變化顯著的為3%血氧飽和度下降指數(shù),高海拔地區(qū)與低海拔地區(qū)分別為13.5±5.4和2.2±0.9,前者是后者的5倍多. 其次為呼吸性事件總指數(shù)和自發(fā)微覺醒總指數(shù),分別為高海拔9.9±4.1和51.5±13.6, 低海拔4.3±2.3和29.6±6.6. 平均血氧飽和度與呼吸性事件指數(shù)和自發(fā)微覺醒指數(shù)之間存在負(fù)相關(guān)(r=-0.713, -0.785, P<0.05),3%血氧飽和度下降指數(shù)與呼吸性事件指數(shù)和自發(fā)微覺醒指數(shù)之間存在正相關(guān)(r=0.717, 0.625, P<0.05). 結(jié)論:高海拔地區(qū)外訓(xùn)官兵的睡眠狀況較差,缺氧可能是主要原因,合理給氧可能是改善睡眠狀況的有效途徑.
【關(guān)鍵詞】 高原; 外訓(xùn); 官兵; 睡眠監(jiān)測; 血氧
Effects of hypoxia on state of sleep in military offices and soldiers who enter urgently highland for training
YAN JunQiang, YANG JinSheng, WANG WeiMin, DU XuHui, WANG Yan, AN Min, LAI HaiOu
Department of Neurology, Lanzhou General Hospital, Lanzhou Military Area Command, Lanzhou 730050, China
【Abstract】 AIM: To investigate the effect of hypoxia on the state of sleep in military officers and soldiers after entering urgently highland (altitude 4500 m) for training. METHODS: Fortysix military officers and soldiers were monitored respectively by PTT (pulse transit time) at low altitude (1000 m) and high altitude (4500 m) for training. RESULTS: There was significant difference between low and high altitudes in the mean or minimal SaO2, index of 3% SaO2 decreasing, index of sleep respiratory events and spontaneous microarousal index (P<0.05). Among these monitoring results, index of 3% SaO2 decreasing changed the most, being 13.5±5.4 at high altitude and 2.2±0.9 at low altitude. Index of sleep respiratory events and microarousal index at high altitude were respectively 9.9±4.1 and 51.5±13.6, while they were 4.3±2.3 and 29.6±6.6 at low altitude. There were negative correlations of mean SaO2 (P<0.05) with index of sleep respiratory events (r=-0.713) and spontaneous microarousal index (r=-0.785), and positive correlations of 3% SaO2 decreasing index (P<0.05) with index of sleep respiratory events (r=0.717) and spontaneous microarousal index (r=0.625). CONCLUSION: Military officers and soldiers after entering urgently highland for training suffers from a poorquality sleep maybe due to hypoxia, so that valid supplying oxygen is an effective method of improving their state of sleep.
【Keywords】 plateau; training outside; officers and soldiers; sleep monitor; blood oxygen
0引言
初進(jìn)高原者會出現(xiàn)睡眠時(shí)間延長、夜間頻繁覺醒、惡夢增多及清晨醒來后感覺頭昏等癥狀,由于睡眠質(zhì)量降低,次日可有嗜睡和疲勞的感覺,作業(yè)中容易出錯,可導(dǎo)致工作能力下降[1]. 為了解急進(jìn)高原進(jìn)行外訓(xùn)官兵在特殊環(huán)境中的睡眠狀況,我們應(yīng)用HYPNO PTT睡眠監(jiān)測儀對某快速反應(yīng)部隊(duì)官兵的睡眠狀況進(jìn)行了監(jiān)測,為改善高原軍人睡眠質(zhì)量、提高作戰(zhàn)能力提供參考依據(jù),使他們能更好的適應(yīng)快速作戰(zhàn)的需要,提高訓(xùn)練的效率.
1對象和方法
1.1對象
由低海拔地區(qū)緊急進(jìn)入高海拔地區(qū)進(jìn)行演訓(xùn)的官兵46名,平均年齡(24.8±4.3)歲. 均為未婚、男性、漢族,無高原居住史,身體健康無不良嗜好.
1.2方法
應(yīng)用HYPNO PTT睡眠監(jiān)測儀(美國美泰公司),采用鼻氣流、手指氧飽和度計(jì)、和兩個(gè)心電圖電極,可以檢測呼吸暫停、低通氣、氣流受限、打鼾、血氧飽和度變化、心電圖、心率和自發(fā)微覺醒. 對46名由低海拔地區(qū)緊急進(jìn)入高海拔地區(qū)進(jìn)行演訓(xùn)的官兵前后兩次進(jìn)行睡眠監(jiān)測,數(shù)據(jù)采集完畢后使用hypnoscan分析軟件自動分析.
統(tǒng)計(jì)學(xué)處理: 采用SPSS10.0對資料進(jìn)行數(shù)據(jù)錄入和統(tǒng)計(jì)分析,所用統(tǒng)計(jì)方法為配對t檢驗(yàn)和pearson相關(guān)分析(r).
2結(jié)果
高海拔地區(qū)與低海拔地區(qū)夜間睡眠時(shí)的平均血氧飽和度、小血氧飽和度、3%血氧飽和度下降指數(shù)、呼吸性事件總指數(shù)及自發(fā)微覺醒總指數(shù)均有明顯差異(P<0.05). 各項(xiàng)指標(biāo)中變化顯著的為3%血氧飽和度下降指數(shù),其次為呼吸性事件總指數(shù)和自發(fā)微覺醒總指數(shù). 高海拔地區(qū)與低海拔地區(qū)各項(xiàng)指標(biāo)相比均有統(tǒng)計(jì)學(xué)意義(P<0.05, 表1).表1睡眠監(jiān)測結(jié)果比較(略)
3討論
高原特殊的自然環(huán)境對人生理、心理及電生理等方面的影響既往已有較多的報(bào)道,高原環(huán)境下睡眠的研究,國外有相關(guān)報(bào)道[2],但國內(nèi)的研究較少. 我們應(yīng)用PTT睡眠監(jiān)測儀對急進(jìn)高原外訓(xùn)官兵的睡眠狀況監(jiān)測結(jié)果顯示:3%血氧飽和度下降指數(shù)、呼吸性事件總指數(shù)和自發(fā)微覺醒總指數(shù)均增高,說明高原外訓(xùn)官兵的睡眠質(zhì)量下降,高原缺氧可能是主要原因. 睡眠過程受內(nèi)穩(wěn)態(tài)系統(tǒng)、24 h生物節(jié)律和夜間睡眠生物節(jié)律的調(diào)控. 缺氧能擾亂人的生物節(jié)律[3],影響睡眠調(diào)控,從而引起睡眠障礙. Przybylowski等[4]也發(fā)現(xiàn),高海拔作業(yè)人群睡眠時(shí)快速動眼期時(shí)間減少,周期性呼吸(由反復(fù)的呼吸暫停、中樞性呼吸阻塞和較多的深快呼吸組成)明顯增加. 相關(guān)研究[5]也表明在海拔高于4500 m地區(qū)時(shí),夜間睡眠時(shí)伴有呼吸障礙的周期性呼吸在整個(gè)睡眠過程中均可發(fā)現(xiàn). 而高海拔地區(qū),富氧室內(nèi)睡眠和室外睡眠相比,睡眠明顯加深,周期性呼吸減少,慢波睡眠時(shí)間明顯增加[6],這些研究結(jié)果表明周期性呼吸增加、睡眠紊亂是由于缺氧引起的. Hanson等[7]還發(fā)現(xiàn)在低氧環(huán)境中肌肉交感神經(jīng)發(fā)放沖動明顯增多. 這可能導(dǎo)致睡眠時(shí)肌肉仍處于輕度緊張狀態(tài),從而產(chǎn)生不舒服的感覺,結(jié)果是自發(fā)微覺醒次數(shù)增加,睡眠質(zhì)量下降. 而睡眠質(zhì)量下降可產(chǎn)生心情不愉快,白天精力不夠,生活興趣缺乏,注意力不集中等癥狀[8],這可能是高原狀態(tài)下焦慮恐懼產(chǎn)生的原因之一.
Przybylowski等[9]對在海拔3800~4200 m工作的金礦工人回到海拔2000 m時(shí)的睡眠研究時(shí)發(fā)現(xiàn),他們的血氧含量升高后,睡眠時(shí)出現(xiàn)的周期性呼吸減少,睡眠質(zhì)量明顯改善. 這也從另一方面說明高原低氧是睡眠呼吸紊亂的主要原因.
本試驗(yàn)表明,在急進(jìn)高原外訓(xùn)時(shí)睡眠異常是存在的,主要特征是呼吸性事件和自發(fā)性微覺醒次數(shù)增多. 相關(guān)研究表明,海拔4900 m和5300 m的血氧飽和度分別為(70±8)%, (60±2)%[10],睡眠異??赡芨鼑?yán)重,因此高原外訓(xùn)時(shí)提高睡眠質(zhì)量是必要的. 針對3%血氧飽和度下降指數(shù)得分較高的官兵,夜間集中間斷供氧可能是一個(gè)有效的改善途徑. 對有嚴(yán)重睡眠問題的可給予羥基安定,在高海拔地區(qū),它是安全有效的,能改善睡眠質(zhì)量而不影響第二天的工作能力[11]. 分析可能與增加睡眠深度和快速眼動期時(shí)間有關(guān). 總之,采取有效措施改善睡眠質(zhì)量可以改善生存質(zhì)量,提高其自我效能,增強(qiáng)外訓(xùn)官兵對高原低壓缺氧環(huán)境的適應(yīng)能力,使其有好的精神情緒,對提高急進(jìn)高原部隊(duì)官兵的戰(zhàn)斗能力是有價(jià)值的.
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作者:閆俊強(qiáng), 楊金升, 王為民, 杜旭輝, 王艷, 安敏, 來海鷗
作者單位:蘭州軍區(qū)蘭州總醫(yī)院神經(jīng)內(nèi)科, 甘肅 蘭州 730050