【作者】 刘园园；

【导师】 俞梦孙； 刘常春；

【作者基本信息】 山东大学 ， 生物医学工程， 2014， 博士

【摘要】 我国约有1/6的领土面积是3000米以上的高原地区,高原地处边陲要地,民族众多,战略地位非常重要。长期以来的中印边界纷争,存在着战争的隐患；达赖“藏独”势力流亡海外,从未停止分裂活动,这些都有可能需要平原驻军急进高原。通过低氧预习服训练研究,保障广大官兵健康入藏,维持部队战斗力,关乎国防安全、边疆稳定,有着重大的战略意义和现实意义。随着高原地区的经济开发、旅游事业的不断发展、登山运动的逐步兴起,高原与内地的联系日益紧密,到达高原地区的平原人数也越来越多。平原居民直接到达高海拔地区,最大的影响就是氧含量的降低,对高原环境的不习服会导致身体各种不适、或者出现临床症状,严重时甚至危及到生命安全。如何避免高原疾病,健康快速地习服高原环境是高原医学的研究的热点之一。所谓习服,是指平原人进入高原后,因低氧等因素刺激机体产生一系列可逆的、非遗传的代偿适应性变化,从而在高原低氧环境中较好工作和生活。而进入高原之前,在平原人工营造低氧环境,预先给予机体低氧刺激,称为预习服训练,它是提高机体低氧耐受能力的有效手段。但目前,国内外的低氧训练并没有统一的标准,方案的设定带有盲目性和随机性。因此,加强这方面的研究,有着重要的实际意义和理论价值。本文在高原健康理论的框架下,研究了渐进型间歇性低氧预习服训练的方法和方案。主要内容包括：1.利用俞梦孙院士提出的高原健康理论为指导,设计并实施了新型的渐进型间歇性低氧预习服(PIHE)训练方案。该理论认为,高原反应的本质是低氧应激反应,产生生理性低氧应激是促进人体健康习服的关键,高原健康出现问题的根本原因是环境中氧浓度的变化速率超出了人体习服环境变化的速率。因此,在新型PIHE方案中,根据人体对环境习服的指数型变化规律,使得模拟环境中高度的上升也按照离散指数的方法变化,从而使得环境变化的速率与人体习服的速率相匹配。2.设置训练前低氧检验和训练后低氧检验环节,通过前后比较,首次验证了PIHE训练能够显著改善4300米高度时人的睡眠质量。睡眠的改善通过睡眠时间的延长、深睡时间的延长、深睡比例的增加、体动和觉醒的减少等多个方面进行具体的量化。验证了PIHE训练能够提高低氧习服能力,包括血氧的提升、心率和呼吸率的下降,充分证明了训练的有效性和高效性。3.提出利用睡眠质量作为重要的预习服指标,系统地评价受试者是否处在生理性应激的范围内。设计选用无负荷的专利技术床垫系统为主、腕表为辅来对自然状态下的睡眠进行监测,尝试通过睡眠和其他日间训练的生理指标,如心率、血氧相结合,辨识受试者是否处在生理性应激的范围内,以评价间歇性低氧刺激量大小是否合适,环境变异量是否已超过人体自然的习服过程,从而保证受试者状态能够得以及时反馈,不会因刺激量过大而造成损伤,也不会过小而影响到习服效率。4.通过样本熵等非线性的方法分析了低氧训练过程中静息状态和运动状态下的心率变异性,发现运动状态的样本熵值要明显高于静止状态的样本熵值。同时还对不同高度,以及同样的高度不同的时期内样本熵值的变化进行了研究,尝试以非线性的方法来评价预习服能力的变化。更多还原

【Abstract】 About1/6of the Chinese territory is plateau with an average altitude above3,000meters. Most of the plateaus locate in the frontier and have many nationalities, they are very important in strategic position. There is a risk of war because of Sino-Indian border dispute for a long time; Dalai Lama "Tibetan separatist" forces are in exile, who never stop separatist activities;"East Turkistan separatist" terrorist forces attack by accident, these are related to national security and border stable. It’s possible for plain garrison to highland acutely. How to ensure the health of soliders and maintain battle effectiveness have great significance.With the development of economy, tourism and mountaineering, more and more people go to plateau area. The worst disadvantage for people going from plain to plateau is the reduction of oxygen content. The unacclimatization will cause sorts of discomfort, clinical symptoms, even life danger. These problems make avoiding plateau diseases and quickly acclimatization become hot issues of plateau medical research.Before enter the plateau, one effective mean to increase the ability of hypoxia acclimatization is building the artificial hypoxia environment in plain, giving hypoxic stimulus and doing preacclimatization training. But till now, the hypoxia exposure training has no unified standard, and individual difference is significant. Therefore, the improvement study in this area has vital theoretical and practical value.This article based on the altitude health theory, focus on the progressive intermittent hypoxia exposure process. The main contents include:1. A new type of progressive intermittent hypoxia exposure (PIHE) is project and implement by the instruction of Altitude Health Theory which is given by NA. Yu Mengsun. This theory explains that the essence of the altitude reaction is hypoxia stress reaction, physiological hypoxia stress is important to acclimatization. The reason of the health problems is that the variation rate of oxygen in the environment exceed people’s own acclimatization rate. In the new PIHE process, the variation rate of simulation environment match for the one of human acclimatization. Both of them are exponent ways. 2. Two hypoxic exposure period:pre-test and post-test are set and compared. It’s the first time to prove that PIHE can improve the hypoxia acclimatization ability at4300m, including the increase of SaO2, the decrease of heart rate and breathing rate, and the improvement of sleep. Among them, the sleep time and deep sleep time are extension, deep sleep time proportion is increased, the body movement and arousal are reduced. All these quantitative indexes demonstrated the effectiveness and efficiency of new PIHE.3. It’s the first time to use sleep as an important indicator to evaluation whether the subject is within the range of physiological stress. The no-load patented mattress system and actigraph were selected to monitor the natural state of sleep. The sleep indexes with other physiological indicators, such as heart rate, blood oxygen, are combined together to identify whether subjects are in the range of physiological stress and evaluate whether the amount of intermittent hypoxic stimulus are appropriate. These give the timely feedback to ensure that the subjects will not be damaged by excessive stimulation. At the same time, the stimulation will not be too small to affect the efficiency of acclimatization.4. Try to make the evaluation of heart rate variability in the hypoxia pre-acclimatization process by nonlinear method. The changes of heart rate signal in motion and resting are analyzed by Sample Entropy. Sample entropy values of motion are higher than the values of resting. The changes of sample entropy in different heights and the same height in different periods are studied. Hypoxia preacclimatization abilitys are attempted to be evaluate by nonlinear methods.The main innovation points of this study are as follows:First, a new type of progressive intermittent hypoxia exposure (PIHE) is project and implement, which makes the variation rate of altitude in simulation environment match for the one in human acclimatization. Both of them are exponent ways. The new PIHE training reflects the guiding of altitude health theory.Second, It’s the first time to improve the PIHE training to improve sleep in4300m, questioned the "intermittent hypoxia exposure can not improve sleep".Third, It’s the first time to monitor and assess whether the stress and environmental stimulation is coordinate by sleep parameters. Through monitoring of sleep time and deep sleep time, combining with subjective feelings, heart rate and SaO2, to evaluate whether the subject is within the range of physiological stress.Forth, this paper discusses a method to evaluate hypoxia acclimatization by nonlinear method, such as Sample Entropy.更多还原