远端肢体缺血预处理缓解急进高原导致的血循环改变

李悦; 向伦理; 段家翔; 顾健腾; 易斌; 鲁开智; 陈卡; 糜漫天; 李鹏; 甯交琳

doi:10.16016/j.2097-0927.202106033

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远端肢体缺血预处理缓解急进高原导致的血循环改变

军事医学 | 更新时间：2026-01-09

- 远端肢体缺血预处理缓解急进高原导致的血循环改变
- Remote ischemic preconditioning alleviates hemodynamic changes induced by acute altitude exposure
- 陆军军医大学学报 2022年44卷第3期页码：203-209
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
  2.400038 重庆，陆军军医大学(第三军医大学)军事预防医学系营养与食品安全研究中心
  3.400038 重庆，陆军军医大学(第三军医大学)高原军事医学系高原作业医学教研室
- 作者简介：
  
  [ 甯交琳，E-mail: NJiaolin1976@126.com NING Jiaolin, E-mail: NJiaolin1976@126.com
- 基金信息：
  
  全军后勤科研重大项目(AWS17J014)
- DOI：10.16016/j.2097-0927.202106033
  中图分类号： R181.34;R364.12;R594.3
- 收稿：2021-06-07，
  
  修回：2021-09-08，
  
  纸质出版：2022-02-15
- 稿件说明：
移动端阅览
李悦, 向伦理, 段家翔, 等. 远端肢体缺血预处理缓解急进高原导致的血循环改变[J]. 陆军军医大学学报, 2022,44(3):203-209.

Yue LI, Lunli XIANG, Jiaxiang DUAN, et al. Remote ischemic preconditioning alleviates hemodynamic changes induced by acute altitude exposure[J]. Journal of Army Medical University, 2022, 44(3): 203-209.
李悦, 向伦理, 段家翔, 等. 远端肢体缺血预处理缓解急进高原导致的血循环改变[J]. 陆军军医大学学报, 2022,44(3):203-209. DOI： 10.16016/j.2097-0927.202106033.

Yue LI, Lunli XIANG, Jiaxiang DUAN, et al. Remote ischemic preconditioning alleviates hemodynamic changes induced by acute altitude exposure[J]. Journal of Army Medical University, 2022, 44(3): 203-209. DOI： 10.16016/j.2097-0927.202106033.

摘要

目的

观察远端肢体缺血预处理(remote ischemic preconditioning，RIPC)对急进高原的健康成年人血循环及脑氧饱和度的影响。

方法

于2020年3-7月招募陆军军医大学在校男性学员24名，年龄(24.0±1.7)岁，随机分为对照组和缺血预处理(RIPC)组，每组12人，测量被试者循环动力学指标与脑氧饱和度的基线值后，RIPC组利用气压式血压计接受连续7 d的上肢缺血预处理，对照组接受相同的步骤，但未给予缺血处理。采用低压舱模拟4 000 m高原的氧分压和大气压力。观察两组被试者在进入模拟舱后减压前和减压至海拔4 000 m 2 h后上述指标的变化，并留取血液标本，测定去甲肾上腺素、内皮素-1水平。

结果

两组被试者各项指标基线值及减压前数值，组间比较均无统计学差异。到达海拔4 000 m处2 h后，对照组收缩压、舒张压、平均动脉压、外周血管阻力均降低，RIPC组每搏输出量、每搏指数、收缩压均降低(

0.05)；其中RIPC组外周血管阻力(1 172.8/1 130.9 dyn·s·cm

-5

1 225.8/993.0 dyn·s·cm

-5

)降低的幅度(3.6%

19.8%，

=0.009)显著小于对照组，RIPC组每搏输出量(99.3/84.3 mL

82.9/78.8 mL)降低的幅度(17.8%

4.1%，

=0.032)高于对照组。两组被试者心率均增加，脉搏血氧饱和度、左侧和右侧脑氧饱和度均降低，组内自身前后比较差异均具有统计学意义(

0.01)；RIPC组左侧脑氧饱和度下降幅度低于对照组(-6.0±3.5%

-8.6±2.4%，

=0.049)。RIPC组循环去甲肾上腺素水平显著高于对照组(7 233±1 175 pmol·L

-1

5 995±1 079 pmol·L

-1

，

0.05)。

结论

RIPC可通过缓解低压低氧引起的外周循环阻力下降，有效维持组织的氧供，缓解急进高原引起的心血管代偿性反应，提高急进高原人体早期的适应能力。

Abstract

Objective

To observe the effects of remote ischemic preconditioning (RIPC) on hemodynamic parameters and cerebral oxygen saturation in healthy adults under acute exposure to altitude.

Methods

Twenty-four healthy male cadets (24.0±1.7 years old) were recruited from Army Medical University during March and July

2020

and equally and randomly divided into control and RIPC groups. After the hemodynamic parameters and cerebral oxygen saturation were measured at baseline for all participants

those of the RIPC group were subjected to 7 consecutive days of upper limb ischemic preconditioning with a pneumatic sphygmomanometer

while those of the control group underwent the same procedure but without ischemic treatment. A hypobaric chamber was used to simulate the oxygen partial pressure and atmospheric pressure at an altitude of 4 000 m. The changes of mentioned indexes were observed and compared between the 2 groups

before decompression and 2 h after reaching the simulated altitude. Moreover

blood samples of the participants were collected to determine the levels of norepinephrine and endothelin-1.

Results

There were no signif

icant differences in the baseline values and the values before decompression between the 2 groups. At 2 h after reaching simulated altitude of 4 000 m

systolic blood pressure (SBP)

diastolic blood pressure (DBP)

mean arterial pressure (MAP)

and systemic vascular resistance (SVR) were all decreased in the control group; while stroke volume (SV)

stroke index (SI)

and SBP were declined in the RIPC group (

0.05). Among these changes

the reduction of SVR was remarkably lower in the RIPC group (1 172.8/1 130.9 dyn·s·cm

-5

3.6%) than the control group (1 225.8/993.0 dyn·s·cm

-5

19.8%) (

=0.009)

whereas the decrease of SV in the RIPC group (99.3/84.3 mL

17.8%) was higher than that in the control group (82.9/78.8

4.1%) (

=0.032). All the subjects showed elevated heart rate and reduced pulse oxygen saturation and left and right cerebral oxygen saturations

with significant differences before and after decompression in both groups (

0.01). However

the RIPC group presented smaller reduction of left cerebral oxygen saturation than the control group. Meanwhile

the RIPC group had raised level of norepinephrine when compared with the control group (7 233±1 175

5 995±1 079 pmol·L

-1

0.05).

Conclusion

Remote ischemic preconditioning can effectively maintain tissue oxygen supply by relieving the decrease of SVR caused by hypobaric hypoxia

which alleviates the cardiovascular compensatory response to hypobaric hypoxia

and thus improves the early acclimatization in human under acute altitude exposure.

关键词

Keywords

references

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