【摘要】 目的:研究急进高原(海拔4500 m)外训官兵的睡眠状况以及与血氧的关系. 方法:对由低海拔地区(海拔1000 m)急进高原(海拔4500 m)进行演训的46名官兵进行脉搏传导时间(PTT)监测. 结果:高海拔地区与低海拔地区夜间睡眠时的平均血氧饱和度、小血氧饱和度、3%血氧饱和度下降指数、呼吸性事件总指数及自发微觉醒总指数均有明显改变,二者差异均具有统计学意义(P<0.05).变化显著的为3%血氧饱和度下降指数,高海拔地区与低海拔地区分别为13.5±5.4和2.2±0.9,前者是后者的5倍多. 其次为呼吸性事件总指数和自发微觉醒总指数,分别为高海拔9.9±4.1和51.5±13.6, 低海拔4.3±2.3和29.6±6.6. 平均血氧饱和度与呼吸性事件指数和自发微觉醒指数之间存在负相关(r=-0.713, -0.785, P<0.05),3%血氧饱和度下降指数与呼吸性事件指数和自发微觉醒指数之间存在正相关(r=0.717, 0.625, P<0.05). 结论:高海拔地区外训官兵的睡眠状况较差,缺氧可能是主要原因,合理给氧可能是改善睡眠状况的有效途径.
【关键词】 高原; 外训; 官兵; 睡眠监测; 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
初进高原者会出现睡眠时间延长、夜间频繁觉醒、恶梦增多及清晨醒来后感觉头昏等症状,由于睡眠质量降低,次日可有嗜睡和疲劳的感觉,作业中容易出错,可导致工作能力下降[1]. 为了解急进高原进行外训官兵在特殊环境中的睡眠状况,我们应用HYPNO PTT睡眠监测仪对某快速反应部队官兵的睡眠状况进行了监测,为改善高原军人睡眠质量、提高作战能力提供参考依据,使他们能更好的适应快速作战的需要,提高训练的效率.
1对象和方法
1.1对象
由低海拔地区紧急进入高海拔地区进行演训的官兵46名,平均年龄(24.8±4.3)岁. 均为未婚、男性、汉族,无高原居住史,身体健康无不良嗜好.
1.2方法
应用HYPNO PTT睡眠监测仪(美国美泰公司),采用鼻气流、手指氧饱和度计、和两个心电图电极,可以检测呼吸暂停、低通气、气流受限、打鼾、血氧饱和度变化、心电图、心率和自发微觉醒. 对46名由低海拔地区紧急进入高海拔地区进行演训的官兵前后两次进行睡眠监测,数据采集完毕后使用hypnoscan分析软件自动分析.
统计学处理: 采用SPSS10.0对资料进行数据录入和统计分析,所用统计方法为配对t检验和pearson相关分析(r).
2结果
高海拔地区与低海拔地区夜间睡眠时的平均血氧饱和度、小血氧饱和度、3%血氧饱和度下降指数、呼吸性事件总指数及自发微觉醒总指数均有明显差异(P<0.05). 各项指标中变化显著的为3%血氧饱和度下降指数,其次为呼吸性事件总指数和自发微觉醒总指数. 高海拔地区与低海拔地区各项指标相比均有统计学意义(P<0.05, 表1).表1睡眠监测结果比较(略)
3讨论
高原特殊的自然环境对人生理、心理及电生理等方面的影响既往已有较多的报道,高原环境下睡眠的研究,国外有相关报道[2],但国内的研究较少. 我们应用PTT睡眠监测仪对急进高原外训官兵的睡眠状况监测结果显示:3%血氧饱和度下降指数、呼吸性事件总指数和自发微觉醒总指数均增高,说明高原外训官兵的睡眠质量下降,高原缺氧可能是主要原因. 睡眠过程受内稳态系统、24 h生物节律和夜间睡眠生物节律的调控. 缺氧能扰乱人的生物节律[3],影响睡眠调控,从而引起睡眠障碍. Przybylowski等[4]也发现,高海拔作业人群睡眠时快速动眼期时间减少,周期性呼吸(由反复的呼吸暂停、中枢性呼吸阻塞和较多的深快呼吸组成)明显增加. 相关研究[5]也表明在海拔高于4500 m地区时,夜间睡眠时伴有呼吸障碍的周期性呼吸在整个睡眠过程中均可发现. 而高海拔地区,富氧室内睡眠和室外睡眠相比,睡眠明显加深,周期性呼吸减少,慢波睡眠时间明显增加[6],这些研究结果表明周期性呼吸增加、睡眠紊乱是由于缺氧引起的. Hanson等[7]还发现在低氧环境中肌肉交感神经发放冲动明显增多. 这可能导致睡眠时肌肉仍处于轻度紧张状态,从而产生不舒服的感觉,结果是自发微觉醒次数增加,睡眠质量下降. 而睡眠质量下降可产生心情不愉快,白天精力不够,生活兴趣缺乏,注意力不集中等症状[8],这可能是高原状态下焦虑恐惧产生的原因之一.
Przybylowski等[9]对在海拔3800~4200 m工作的金矿工人回到海拔2000 m时的睡眠研究时发现,他们的血氧含量升高后,睡眠时出现的周期性呼吸减少,睡眠质量明显改善. 这也从另一方面说明高原低氧是睡眠呼吸紊乱的主要原因.
本试验表明,在急进高原外训时睡眠异常是存在的,主要特征是呼吸性事件和自发性微觉醒次数增多. 相关研究表明,海拔4900 m和5300 m的血氧饱和度分别为(70±8)%, (60±2)%[10],睡眠异常可能更严重,因此高原外训时提高睡眠质量是必要的. 针对3%血氧饱和度下降指数得分较高的官兵,夜间集中间断供氧可能是一个有效的改善途径. 对有严重睡眠问题的可给予羟基安定,在高海拔地区,它是安全有效的,能改善睡眠质量而不影响第二天的工作能力[11]. 分析可能与增加睡眠深度和快速眼动期时间有关. 总之,采取有效措施改善睡眠质量可以改善生存质量,提高其自我效能,增强外训官兵对高原低压缺氧环境的适应能力,使其有好的精神情绪,对提高急进高原部队官兵的战斗能力是有价值的.
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作者:闫俊强, 杨金升, 王为民, 杜旭辉, 王艳, 安敏, 来海鸥
作者单位:兰州军区兰州总医院神经内科, 甘肃 兰州 730050