不同海拔汉族健康人大循环及微循环特征的对比

目的: 观察青海不同海拔高度的果洛(4 100 m)和互助(2 600 m)与平原地区上海(4 m)汉族健康人大循环及微循环特征。方法: 将青海果洛28名年龄(45.62±10.15)岁、青海互助27名年龄(47.25±8.43)岁、上海20名年龄(43.12±8.28)岁的三地区汉族健康人分为:果洛组(GL)、互助组(HZ)和上海组(SH);抽取静脉血分别行血常规:红细胞(RBC)、血红蛋白(HGB)、红细胞压积(HCT)、血小板(PLT)的检测;凝血功能:凝血酶原时间(PT)、国际标准化比值(INR)、纤维蛋白原(Fib)、部分凝血活酶(APTT)、凝血酶时间(TT)的检测,应用连续无创血流动力学监测仪(CNAP)连续测定连续心排量(CO)、每搏输出量(SV)、平均动脉压(MAP)、心率(HR)、脉压差变异率(PPV)、血管外周阻力指数(SVRI),应用脉氧监测仪测得指脉氧(SPO₂),用旁流暗视野成像(SDF)监测技术观察舌下微循环指标:总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI)。结果: 与上海组比较,互助组和果洛组的RBC、HGB明显升高(P＜0.05),而PLT明显降低(P＜0.05);互助组的PT、Fib、APTT、TT、CO、HR、SV、MAP、SPO₂均明显降低(P＜0.05),而TVD、PVD、PPV、MFI均明显升高(P＜0.05);果洛组的HCT、 Fib、CO、SV、PPV、MAP、TVD、PVD均明显升高(P＜0.05),而PT、INR、TT、SPO₂均明显降低(P＜ 0.05)。与互助组比较,果洛在组的RBC、HGB、HCT、 Fib、APTT均明显升高(P＜0.05);而SPO₂、TVD、PVD、INR、TT均明显降低(P＜0.05)。结论: 不同海拔地区的健康人微循环具有较明显的差异,高海拔地区健康人群微循环密度较平原地区明显增加,特别是在中度海拔地区更为明显,其特殊的生理意义,对救治高原地区感染性休克及慢性高原病有指导意义。

Characteristics of circulation and microcirculation in healthy people of Han nationality at different altitudes

Objective: To observe the circulation and microcirculation characteristics of healthy han people in Qinghai at different Guoluo (4 100 m) and Huzhu (2 600 m) and in Shanghai in plain area (4 m). Methods: The 28 healthy han people aged (45.62±10.15) from Guoluo in Qinghai, 27 healthy han people aged (47.25±8.43) from Huzhu in Qinghai and 20 healthy han people aged (43.12±8.28) from Shanghai were divided into three groups: Guoluo group (GL), Huzhu group (HZ) and Shanghai group (SH); Venous blood was collected for routine blood test: red blood cells count(RBC), hemoglobin(HGB), hematocrit(HCT), platelet(PLT); and coagulation index: prothrombin time(PT), interntionl normlized ratio(INR), fibrin(Fib), activated partial thromboplastin time (APTT), thrombin time(TT), continuous non - invasive hemodynamic monitor (CNAP) was used for continuous measurement: cardiac output (CO), heart rate (HR), stroke volume (SV), pulse pressure variation rate (PPV), systemic vascular resistance index (SVRI), mean arterial pressure (MAP); pulse oxygen monitoring instrument is used for monitoring SPO₂ (pulse oxygen); the total vascular density (TVD), perfusion vascular density (PVD), proportion of perfused vascular(PPV), and microvascular flow index (MFI) of sublingual microcirculation were observed by using peripheral dark field imaging (SDF) monitoring technique. Results: Compared with the Shanghai group, the RBC and HGB levels in the Huzhu group and the Guoluo group were significantly increased (P＜0.05), while PLT levels were significantly decreased (P＜0.05); The levels of PT, Fib, APTT, TT, CO, HR, SV, MAP and SPO₂ in the Huzhu group were significantly decreased (P＜0.05), while the levels of TVD, PVD, PPV and MFI were significantly increased (P＜0.05). In Guoluo group, the levels of HCT, Fib, CO, SV, PPV, MAP, TVD and PVD were significantly increased (P＜0.05), while the levels of PT, INR, TT and SPO₂ were significantly decreased (P＜0.05). Compared with the Huzhu group, the levels of RBC, HGB, HCT, Fib and APTT of Guoluo group were significantly increased (P＜0.05); while the levels of SPO₂, TVD, PVD, INR and TT were significantly decreased (P＜0.05). Conclusion: The microcirculation of healthy people in different altitude areas is significantly different, and the microcirculation density of healthy people in high altitude areas is significantly higher than that in plain areas, especially in moderate altitude areas. Its special physiological significance is of guiding significance for the treatment of infectious shock and chronic altitude disease in plateau areas.