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缺氧對急進(jìn)高原外訓(xùn)官兵睡眠狀況的影響

文章來源:發(fā)布日期:2008-04-04瀏覽次數(shù):68768

【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 JunQiang, YANG JinSheng, WANG WeiMin, DU XuHui, WANG Yan, AN Min, LAI HaiOu

  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 urgently highland (altitude 4500 m) for training. METHODS: Fortysix  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 poorquality 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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 ?。?]Ainslie PN, Burgess K, Subedi P, et al. Alterations in cerebral dynamics at high altitude following partial acclimatization in humans: Wakefulness and sleep[J]. J Appl Physiol, 2007, 102(2): 658-664.

 ?。?]Bosco G, Ionadi A, Panico S, et al. Effects of hypoxia on the circadian patterns in men[J]. High Alt Med Biol, 2003, 4(3): 305-318.

  [4]Przybylowski T, Ashirbaev A, Le Roux J, et al. Sleep and breathing at altitude of 3800 mthe acclimatization effect[J]. Pneumonol Alergol Pol, 2003, 71(56):213-220.

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  [9]Przybylowski T, Ashirbaev A, Le Roux J, et al. Effect of 2000 m descent simulated in a hyperbaric chamber on arterial blood oxygen saturation and sleep quality in workers of a gold mine situated at an altitude of 3800-4200 m above sea level[J]. Pneumonol Alergol Pol, 2003, 71(78):314-319.

 ?。?0]Snyder EM, Stepanek J, Bishop SL, et al. Ventilatory responses to hypoxia and high altitude during sleep in Aconcagua climbers[J]. Wilderness Environ Med, 2007, 18(2):138-145.

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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