高原低流量吸氧时间与血氧饱和度变化的观察

目的:吸氧是预防和治疗高原慢性缺氧损害的主要手段,为了对高原施工人员进行有效的氧疗,对低流量吸氧时间与血氧饱和度变化的关系进行监测,找出科学的吸氧时间,预防和减少缺氧对人体造成的急、慢性损害。方法:通过对高原施工人员在缺氧情况下血氧饱和度的变化和通过一定时间低流量(2L/m in)吸氧后发生的变化进行观察,用最佳的吸氧时间来改善机体的缺氧状态。结果:通过低流量吸氧,能明显改善机体的缺氧程度,在一定时间内机体血氧饱和度变化明显,吸氧30分钟后血氧饱和度的升高到一定程度就停止变化。结论:低流量吸氧能显著改善高原缺氧环境下施工人员机体的缺氧状态,吸氧在30分钟内就能达到最佳效果。     

高原不同吸氧方式对青年人血氧饱和度的影响

目的 探讨高原低氧环境如何方便有效的吸氧,提高资源利用度,为指导高原人群有效地吸氧寻求依据.方法 利用指氧饱和度检测仪对高原守防官兵以不同方式、不同流量吸氧后的血氧饱和度的变化进行检测对比.结果 在同等吸氧浓度（2-4L/min）的情况下,双鼻孔较面罩吸氧可使血氧饱和度平均提高0.4%-0.9%,较单鼻孔吸氧提高0.9%-1.2% 面罩吸氧较单鼻孔吸氧提高血氧饱和度0.3%～0.5%.结论 针对高原保健双鼻孔吸氧更为有效适用.     

高原救生固体化学氧气发生器的研制

目的 研制可用于高原环境、便于携带和使用的固体化学氧气发生器（简称固氧）,供氧量为120 L,供氧流量＞1.5 L/min,供氧时间30 min,使用环境温度为-40～50℃. 方法 根据氯酸盐燃烧分解产氧原理设计高原救生固氧的结构,设计4种不同配方的固氧药柱.配方1：91％产氧剂＋3％金属粉＋2％催化剂＋4％抑氯剂;配方2：91％产氧剂＋5％金属粉＋4％抑氯剂;配方3：前部91％产氧剂＋5％金属粉＋4％抑氯剂,后部91.5％产氧剂＋4.5％金属粉＋4％抑氯剂;配方4：前部88％产氧剂＋5％金属粉＋4％抑氯剂＋3％稳定剂,后部88.5％产氧剂＋4.5％金属粉＋4％抑氯剂＋3％稳定剂.在高、低、常温3种不同状态下对4种配方的供氧时间、流量等性能进行测试,并对固氧所产氧气质量进行净化研究.选取2名健康志愿者作为高原环境实际应用试验对象,观察其在不同高度使用固氧后血氧饱和度的变化. 结果 配方3和配方4的产氧性能均能满足指标要求,配方4供氧性能更稳定,温度敏感系数更低.固氧所产气体成分均能满足标准和规范.2名受试者在4 939m高原使用固氧产品后血氧饱和度均达到了90％以上. 结论-40～50℃环境条件下能正常工作30 min的固氧,可满足高原救生供氧使用要求.降低催化剂含量,提高金属粉用量,药柱中加入稳定剂有助于稳定固氧的产氧速度.1支30 min固氧可同时满足2人吸氧并保证吸氧效果,达到了高原缺氧防护的目的.     

东北某野战医疗队高原驻训生理指标变化动态研究

目的探讨初入高原地区医疗队员生理指标的变化规律,为部队在高原地区演习训练和卫勤保障提供有效的防治对策和科学依据。方法以某野战医疗队参加高原驻训的99名队员为研究对象,分别在不同的海拨高度(40 m、1 000 m、1 500 m、3 000 m、3 600 m、4 600 m)进行血压、心率及血氧饱和度指标的动态监测,并且在最高4 600 m海拨高度下,给予低流量吸氧30 min,观察吸氧前后上述生理指标的变化。结果医疗队员从平原进入高原后,在海拨3 000m以上地区血压、心率和血氧饱和度发生显著变化(P<0.05),并且随着海拔高度的增加,变化越显著;在低流量吸氧30 min后,血压、心率及血氧饱和度均得到改善(P<0.05)。结论在3 000 m以上高海拨地区,医疗队员生理指标变化显著,应采取相应的干预措施,给予一定的氧疗是有必要的,对于本身有高血压、心动过速或肺通气功能异常者应谨慎进入高海拔地区。     

持续性高空缺氧对心率和血氧饱和度的影响

目的　为保障进驻高原地区人员的身体健康而寻求一种缺氧耐力检查方法。　方法　 2 0名受试者依次进入低压舱 ,先后暴露于模拟 4 0 0 0m、5 0 0 0m、6 0 0 0m、710 0m高度 ,每一高度停留 10min。在每一高度的即刻、5min、10min分别测定受试者各项生理指标。结果　随缺氧高度升高 ,人体心率增加 ,血氧饱和度逐渐下降。 2 0名受试者中 ,3名未能通过缺氧耐力检查 ,提前终止实验 ,吸氧后即恢复正常。其余 17名受试者全部通过 4 0 0 0～ 710 0m的缺氧耐力检查 ,认知能力、意识、体征全部正常。　结论　心率和血氧饱和度的变化反映了持续性高空缺氧对人体的影响 ,综合心电监测指标能够对受试者的缺氧耐力作出客观的评价。     

急性一氧化碳中毒患者高压氧治疗减压后肺水肿反跳一例

临床资料:患者男,19岁,既往体健,某工厂车工,因意识不清5h入院.患者入院前2d宿于隔壁生有煤炉的约10 m2的房间,门窗紧闭,约3～4h后被工友发现昏迷在床上.入院查体:体温36.7℃,脉搏90次/min,呼吸24次/min,血压102/64 mm Hg,昏睡状态,呼之能睁眼,颈软,瞳孔对光反射存在,无咳嗽、咳痰,双肺底呼吸音略减低,未闻及干湿性哕音,四肢可见活动,双侧巴氏征阳性,查碳氧血红蛋白为5％.初步诊断:急性一氧化碳中毒.入院后以5 L/min流量鼻导管吸氧,血氧饱和度波动在85％ ～98％,改用面罩吸氧后稳定在96％以上.之后患者在医生陪同下行高压氧治疗,治疗压力0.25 MPa,加压时间25 min,吸氧1h(中间间歇5 min),吸氧结束后减压13 min至0.16 MPa,停留5min,继续减压8 min至常压出舱,吸氧过程中患者意识好转,自主睁眼.减压过程中患者呼吸急促,30次/min,双肺底偶可闻及细湿哕音.出舱5 min后返回病房,患者呼吸36次/min,以5 L/min流量鼻导管吸氧,监护仪显示血氧饱和度波动在65％ ～85％之间,提高吸氧流量至7 L/min后无改善,双肺呼吸音粗,双肺底可闻及细湿哕音,较减压时增多,未闻及哮鸣音.查血气分析:PaO2 46.8 mm Hg,PaCO225.6 mm Hg;肺CT显示:双侧支气管血管束增粗、紊乱,脊柱旁双下肺野可见对称性斑片状高密度影,约占肺野1/4～1/3,初步考虑:急性呼吸窘迫综合征;肺水肿.立即行气管插管,呼吸机辅助呼吸,同步间歇指令通气模式,设定频率12 次/min,吸入气氧浓度100％,并给予抗生素、激素治疗,患者呼吸逐渐平稳,呼吸频率22次/min,血氧饱和度升至98％,约3h后逐渐调低吸入气氧浓度至50％,血氧饱和度维持在97％以上.患者次日意识恢复,脱呼吸机自主呼吸.     

野战增压帐篷对高原缺氧的防治作用

 目的 观察高原野战增压帐篷对健康武警官兵急进性高原缺氧的防治作用.方法 选择低海拔地区急进高原的武警官兵12名,采用自身对照方法,在海拔3700 m,4200 m,5200 m高度,分别监测增压组与未增压组23:00时至次日6:00共7 h的睡眠状况和脉搏氧饱和度,并应用匹茨堡睡眠质量指数(PSQI)进行测评.结果 在3个海拔高度,增压组与未增压组睡眠的平均脉搏氧饱和度、最低脉搏氧饱和度、呼吸性事件总指数、自发微觉醒总指数及PSQI总分比较,差异均有统计学意义(P<0.05).结论 高原野战增压帐篷能有效纠正高原低压性缺氧,提高血氧浓度,改善睡眠质量,具有防治急进性高原缺氧作用.     

模拟7500m高空缺氧训练时的血氧饱和度测定

目的 测定飞行员缺氧耐力训练时的血氧饱和度,以作为监护指标使用。方法 用低氧混合仪配制7500m高空氧浓度,对23例飞行人员进行缺氧体验训练。当缺氧症状出现时和不能维持书写(有效意识时间)时用经皮血氧仪测血氧饱和度。结果 模拟高空缺氧训练中血氧饱和度呈进行性下降。训练开始至血氧饱和度下降的时间为(62.7±5.2)s。症状出现时的血氧饱和度为(86.0±3.2)％,有效意识时间末血氧饱和度为(74.0±5.0)％。结论 血氧饱和度可作为缺氧训练时评定机体缺氧程度,把握缺氧训练终止时机的定量指标。     

动脉血氧饱和度的不同测量方法对测值的影响

目的 探讨耳血氧计和指端血氧计测定血氧饱和度的差异。方法 观察11名男性健康青年受试者,吸氧浓度为18％及0.8％两种氧氮混合气,用两种测定方法测定血氧饱和度的变化。结果 吸入18％的氧氮混合气5min。两种测定方法的血氧饱和度无显著差异。突然改吸0.8％氧氮气体10s之后耳血氧饱和度迅速下降,25s时耳血氧饱和度下降到最低值;指血氧饱和度在15s时方开始下降,30s指血氧饱和度下降到最低值。结论 在急性缺氧试验中作为指示体内缺氧程度生理指标之一的血氧饱和度的测量,最好使用耳血氧计。在缺氧程度不太严重的试验中,两者均可使用。     

一种临床供氧面罩的节氧效果观察

目的 观察一种供临床使用的节氧型供氧面罩的供氧效果。方法 10名健康男性受试者,在人体低压舱内模拟4500m高空缺氧10min后,分别采用3种不同供氧方法给氧,记录指端血氧饱和度,进行供氧效果的比较。结果 相同供氧流量下节氧型供氧面罩的供氧效果优于普通面罩,两者之间的差异有非常显著性意义(P<0.01);而较低流量下节氧供氧面罩的供氧效果与较高流量的鼻管供氧之间差异无显著性意义(P>0.05)。结论 节氧供氧面罩在节省氧气的情况下保证了供氧效果。     

Decrement in postural control during mild hypobaric hypoxia

The effects of mild hypoxia on the postural control system of 39 naive subjects were examined by measuring the postural sway with a Kistler force platform, at ground level and at one of four simulated altitudes: 1,521 m (5,000 ft), 2,438 m (8,000 ft), 3,048 m (10,000 ft), or 3,658 m (12,000 ft). The total sway increased above the ground level controls for the 1,521 m, 2,438 m, and 3,048 m exposures (p less than or equal to 0.005) as did the sway at the lowest measurable frequency (p less than or equal to 0.002), but no change in sway was seen in those subjects exposed to 3,658 m as compared to ground level values. Significant interaction between altitude and exposure was observed at p less than or equal to 0.04, reflecting the definite effect at the lower altitudes and the lack of an effect at the higher altitude. The multiple comparison test indicated no difference between the responses at 1,524 m, 2,438 m, and 3,048 m. Both arterial oxygen saturation, SaO2, and the end-tidal oxygen partial pressure, PetO2, decreased in relation to the test altitudes with a statistically significant interaction between altitude and PetO2 (p less than or equal to 0.02), and SaO2 (p less than or equal to 0.005). There was no significant interaction between altitude and end-tidal carbon dioxide partial pressure (p = 0.4853). The postural control mechanisms, as an intergrative functional unit, are very sensitive to acute mild hypoxia. Arguments are advanced to indicate that intervention of compensatory mechanisms at higher altitudes may explain the recovery of postural stability at 3,658 m.     

Preliminary study of calculating cerebral arterial blood oxygen saturation using MRI

To assess whether cerebral arterial blood oxygen saturation (SaO2) can be calculated by EPI, we examined the relationship between peripheral SaO2 and T2+ signal intensity (SI) changes in the brain in three normal subjects, using 1.5 Tesla MRI. To decrease SaO2, hypoxia was induced by 100% helium-gas inhalation (60 sec). SI declined as SaO2 decreased during helium inhalation, while rapid recovery of SI to the baseline was noted with recovery from hypoxia. The differential effective transverse relaxation rate was closely correlated with SaO2 (r > 0.94). Consequently, using MRI, we were able to calculate arterial SaO2.     

Short-term intermittent normobaric hypoxia-haematological, physiological and mental effects

Effects on erythropoiesis and blood pressure as well as physical performance and mental effects were studied in 15 healthy subjects during intermittent exposure to normobaric hypoxia corresponding to either 2000 m (6 persons) or 2700 m (9 persons) above sea level; another group (5 persons) also served as controls at normoxia. The concept "live hightrain low" was used for 10 d consecutively and the exposure to hypoxia was 12 h/d. Blood pO₂ and oxygen saturation were significantly decreased during the 10 d at hypoxia. [Hb] and Hct decreased significantly after 2 d in hypoxia and then returned to pre-study levels. Erythropoietin was significantly elevated in both hypoxia groups during the initial 3–5 d. Reticulocytes were significantly increased during 7 d of hypoxia. Submaximal and maximal oxygen uptake, blood pressure at rest and during exercise and the profile of mood states (POMS test) did not change during the study. In conclusion, intermittent normobaric hypoxia for 10 d resulted in a significant stimulation of erythropoiesis. Staying at normobaric hypoxia may serve as a complement to an ordinary altitude level sojourn.     

两种不同方式供氧对新入高原某部官兵血气的影响

目的：观察医用氧气瓶和高原移动式制氧站两种不同方式供氧对新入高原官兵血气的影响。方法按随机抽取原则将40名新入高原1周内的官兵分为A组（医用氧气瓶供氧,氧浓度≧99.5%）和B组（制氧站供氧,氧浓度≧90%）,每组20人,各吸氧40min。在吸氧前和吸氧后30min内抽取动脉血进行血气分析比较。结果（1）A、B两组人员在吸氧前血气指标不具有统计学差异（P＞0.05）,吸氧后两组人员的氧分压（PO2）和氧饱和度（SO2%）均高于吸氧前（P＜0.05）。（2）A、B两组人员吸氧后血气差异无统计学意义（P＞0.05）。结论高原移动式制氧站和医用氧气瓶供氧一样,都能明显提高新入高原人员的氧分压和氧饱和度,提高部队战斗力。     

膈肌导引与腹式呼吸对高原作业人员血氧饱和度及心率影响的比较

目的 比较膈肌导引与腹式呼吸改善高原作业人员血氧饱和度和心率的效果,为高原作业人员提供一种更有效的呼吸方法.方法 在海拔4000 m的高原随机抽取进驻高原满1个月且不足3个月的作业人员50名,采用随机数字表法分为两组,运用交叉对照研究方法分别测量受试者膈肌导引和腹式呼吸各5 min前后的血氧饱和度与心率,比较膈肌导引和...     

模拟飞行缺氧与吸氧对小鼠脏器自由基代谢的影响

目的 观察了两种模拟飞行条件（１５００ｍ轻度低压缺氧和５５００ｍ中度低压吸氧重复暴露下小鼠多脏器自由基代谢变化的特点。方法 昆明种小鼠６０只,随机分为６组（ｎ＝１０）进行缺氧与吸氧实验,实验完毕后,取小鼠尾血做血常规检查。次日,将小鼠断头处死,取脑、心、肺、肝、肾制备匀浆,测定丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＳＯＤ）活性。结果 １５００ｍ轻度低压缺氧重复暴露８ｗｋ使肺ＭＤＡ含量显著增高,提示     

间歇性低氧训练对高性能战斗机飞行员脑电复杂度及血氧饱和度的影响

目的 通过动态观察间歇性低氧训练前后高性能战斗机飞行员EEG复杂度和血氧饱和度(arterial oxygen saturation,Sa()2)的变化特征,为低氧适应性训练效果评价提供量化指标.方法 对32名高性能战斗机飞行员进行15 d的间歇性低氧训练(模拟高度3500 m),1次/d,每次25 min.于训练前后,分别检测受试者在模拟7500 m高空环境下的EEG、SaO2、红细胞数及血红蛋白含量,并对受试者低氧训练前后的检测数据进行t检验.结果 间歇性低氧训练后,受试者在模拟7500 m高空环境下的EEG复杂度较训练前显著降低,差异有统计学意义(P＜0.01),Sa()2升高,差异有统计学意义(P＜0.01),红细胞和血红蛋白含量则无明显变化(P＞0.05).结论 模拟3500 m间歇性低氧训练可提高机体高空缺氧耐力水平,EEG复杂度和SaO2可作为评价高性能战斗机飞行员间歇性低氧训练的定量生理指标. Abstract： Objective To explore the quantitative index for evaluating the intermittent hypoxia training effects by analyzing the characteristic changes of electroencephalogram (EEG) complexity and saturation of blood oxygen (SaO2) of high performance fighter pilots. Methods Thirty-two pilots were selected as subjects and undertook a 25 min-training (simulated hypoxia at 3500 m-oxygen concentration 13.1%) with Type DY-84 hypoxia training device once a day for 15 d. Before and after training the subjects were put in simulated 7500 m hypoxia condition (oxygen concentration 7.1%,ventilation volume 15L/min) and their EEG, SaO2, number of red blood cell and hemoglobin level were recorded and analyzed by t-test. Results Training effects showed that the subjects' 7500m EE(G complexity was significantly decreased (P＜0.01), but SaO2 was significantly increased (P＜0.01).Number of red blood cell and hemoglobin level had no obvious change (P＞0.05).Conclusions The simulated 3500 m intermittent hypoxia training could improve pilot's hypoxia tolerance. EEG complexity and SaO2, which are measured under simulated 7500 m hypoxia condition,would be the quantitative indices for evaluating the effects of intermittent hypoxia training for pilot.The results application would be hopefully expanded to the population who work at high altitude or in anoxic environment.     

久居高原地区缺氧环境对红细胞膜蛋白结构和血液流变学的影响

目的：探讨高原缺氧环境对高原地区老年人红细胞膜蛋白结构的影响;方法：运用薄层色谱扫描等方法对长期居住在高原地区的46例老人进行了红细胞膜磷脂蛋白和血液流变学等测定;结果：高原组红细胞膜神经磷脂和磷脂酰胆碱等指标较平原组有显著升高（P＜0．05或P＜0．01）,血液粘度也有一定升高,以低切为明显;结论：红细胞膜蛋白结构改变与高原缺氧有一定的关系。     

人工富氧环境改善急进高原人员睡眠效果的研究

目的 通过研究高原人工富氧环境(简称富氧室)对急进高原人员睡眠的作用,探讨富氧室的抗缺氧效果及其与高原习服的关系. 方法 利用分子筛制氧机在海拔3500 m高原建立富氧室.将18名世居平原人员随机分为富氧组、缺氧组和平原组,每组各6人.平原组不进入高原,富氧组和缺氧组人员乘飞机到达高原后,在未供氧情况下记录2组受试人员的心率和血氧饱和度(arterial oxygen saturation,SaO2).当晚22:00两组人员分别进入富氧室和普通房间,休息至次日上午9:00通过睡眠呼吸记录分析系统,对受试人员进行监测,在同一时间对平原组也进行监测.数据采集完毕后利用系统自带分析软件进行分析. 结果 ①富氧组供氧后SaO2为92.3%.±1.0%,高于供氧前的82.9%±4.2%和缺氧组的79.3%±5.9%(P<0.01),但低于平原组的97.3%±0.8%(P<0.05),且差异均有统计学意义.心率值在富氧组供氧前后及与缺氧组间差异无统计学意义,但均高于平原组,且差异有统计学意义(P<0.01).②睡眠结构富氧组与缺氧组差异无统计学意义,与平原组比较浅睡眠偏多,深睡眠偏少,且差异有统计学意义(P<0.01).低通气次数和呼吸紊乱指数平原组低于缺氧组和富氧组(P<0.01);富氧组呼吸紊乱指数低于缺氧组,两组分别为28.1±11.9和53.2±23.4,且差异有统计学意义(P<0.05).③睡眠期间,富氧组和缺氧组的归一化低频功率和低频与高频的比值分别为89.3±2.9、9.4±2.8和90.2±1.8、9.9±1.9,组间差异无统计学意义,但均高于平原组的85.8±2.9和6.4±1.4,且差异有统计学意义(P<0.05);平原组的归一化高频功率则高于富氧组和缺氧组,且差异有统计学意义(P<0.05). 结论 高原富氧室可以有效改善急进高原人员睡眠情况,但对睡眠期间心率变异性未见显著影响,且与高原习服的关系尚待深入研究. Abstract： Objective To study the effects of the artificial oxygen-enriched environment (is called "oxygen-enriched room" in short) on sleep efficiency of the people who participate in the mission on plateau with hurry-up entry,and to investigate the anti-hypoxia effect of oxygen-enriched room to plateau acclimatization. Methods Eighteen subjects were randomly and averagety allocated into plain group,oxygen-enriched group and hypoxia group.Only the later two groups were dispatched to plateau by air.Molecular sieve oxygenerator was used to supply the room with oxygen on 3500 m plateau.The oxygen-enriched group and hypoxia group got into the oxygen-enriched rooms and normal rooms respectively at 22 o' clock and took rest till to 9 o' clock next morning.The changes of heart rate (HR) and the saturation of blood oxygen (SaO2) of three groups were recorded and compared between the states of with and without oxygen enrichment.The subjects were monitored by sleep respiration recording and analysis system. Results ①The SaO2 of the oxygen-enriched group was 92.3%±1.0%,and it was significant higher than the state before oxygen enrichment (82.9%±4.2%) and than that of hypoxia group (79.3%±5.9%,P<0.01),but lower than that of plain group (97.3%±0.8%,P<0.05).②There were less deep sleep and more slight sleep in hypoxia group and oxygen-enriched group than in plain group.The hypopnea and apnea hypopnea index (AHI) of plain group was significant lower than that of hypoxia group and oxygen-enriched group (P<0.05).The AHI of the oxygen-enriched group was 28.1±11.9,and it was significant lower than that of hypoxia group (53.2±23.4)(P<0.05).③The normalized low-frequency (Ln) and the ratio of low-frequency to high-frequency (LF/HF) measured in sleep was respectively 89.3±2.9 and 6.4±1.4 in oxygen-enriched group comparing to 90.2±1.8 and 9.9±1.9 in hypoxia group but without statistical difference.The corresponding Ln and LF/HF of plain group was 85.8±2.9 and 6.4±1.4 respectively,significantly higher than those of other two groups (P<0.05).Plain group also showed higher normalized high-frequency than others(P<0.05). Conclusions Oxygen-enriched environment can effectively improve the sleep quality but significantly change heart rate variation (HRV) of the people who participate in the mission with hurry-up entry to plateau.Further studies are still needed to reveal the quantitative effectiveness of oxygen-enriched room to plateau acclimatization.