中文摘要

背景  高原环境具有低压低氧、寒冷干燥、强紫外线的气候特点，当平原人快速进入高原后，为适应高原独特的低气压性低氧环境，机体进入习服的过程，很容易发生急性高原反应（Acute Mountain Sickness，AMS）。每个人对低氧的感受和耐受力不同，目前还没有特异性检查能直接筛查出高原病易感人群，但可以采用直接估测的方法来筛选出对低氧易感的人。通过久居平原的人急速进入到高原后，检测分析人体对低氧敏感的重要脏器系统功能的适应性变化，来排除低氧易感人群。人体心血管系统（Card-iovascular System，CVS）及呼吸系统（Respiratory System，RS）对外界氧气的变化十分敏感，在高原低氧环境下，心肺功能的改变对整个机体适应高原气候具有举足轻重的作用。不同海拔高度对心理功能影响不同，从海拔4000m开始，人的情绪状态开始发生改变，其表现特点、严重程度与低氧的严重程度、暴露时间呈现密切的相关关系。在高原负性情绪的改变还与体内的激素水平相关。中国南极昆仑站位于南极大陆内陆高原地区海拔4093米，自然环境恶劣，近年中国南极冰穹A考察将逐步由固定翼飞机替代雪地车从中山站运输人员物资，故研究冰穹A预选队员渐进和急进高原对人体的不同生理心理影响，为选拔合格的队员和制定医学防治措施具有现实意义。

方法  根据昆仑站预选队进入高原的方式，将3支队伍分为火车渐进高原组（简称火车组，N=30）和飞机急进高原组（简称飞机组，N=55）。分别监测两组预选队员海拔4m（上海）、到达海拔3650m（拉萨）和到达海拔4300m（羊八井）24小时内三个标志性时间点的生理心理变化，采用问卷方式评估预选队员情绪和睡眠的变化，利用心电图、心功能仪、肺功能仪等一系列生理监测仪器监测预选队员生理指标改变，无创采集唾液样本，检测唾液中睾酮、皮质醇和免疫球蛋白A（Immunoglobulin A，IgA）的浓度变化并进行分析，此外每天进行脉搏指氧仪监测和AMS问卷评估，对比研究两种方式进入高原对预选队员的生理心理影响的异同。

结果  与平原相比，预选队员乘飞机和火车进入高原后生理心理均有显著改变。与渐进高原火车组相比，急进高原飞机组预选队员的生理心理变化更多，表现为：负性情绪得分显著增加，心电传导异常增加，心肺功能改变显著，在海拔4300m，飞机组预选队员的胸腔液体水平（Thoracic Fluid Content，TFC）显著增加，唾液中的睾酮和IgA水平显著降低；唾液中睾酮浓度变化与AMS得分，情绪总得分（Total mood Disturbance，TMD）、TFC变化以及皮质醇和IgA的浓度均具有相关性，提示睾酮可作为高原低氧环境对人体生理心理影响的观测指标。

结论 预选队员乘飞机和火车进入高原后生理心理均有显著改变。与渐进高原火车组相比，急进高原飞机组预选队员的生理心理变化更多。

关键词  高原，低氧，生理心理，激素，IgA

Abstract

Background  The high altitude environment is characterized with low pressure, hypoxia, coldness, dry, and intense ultraviolet radiation. When lowlanders ascend towards high altitude rapidly, they could easily develop acute mountain sickness (AMS). Everybody has different feelings and tolerances of hypoxia , there is no specific examination can directly screen out the susceptible population of high altitude disease, but can be used to directly estimate the method of screening for hypoxia susceptible people. Through the long-lived plains quickly into the plateau, the detection of human hypoxia-sensitive vital organs of the system to adapt to changes in function, to rule out hypoxia susceptible population.Cardiovascular system and respiratory system are sensitive to the ambient oxygen content, thus, the changes of cardiac and pulmonary function play an important role in human adaptation under high altitude environment. Different altitudes affects mood states differently. Human mood began to change since they arrive 4000 m, and its features and severity are associated with severity and duration of hypoxia. The mood changes are also associated with hormone levels. Chinese Kunlun Station is located at inland plateau with an altitude of 4093 m and harsh natural environmental factors. In recent years, China Antarctic Dome Argus scientific expedition will gradually replace the snowmobile with the fixed-wing aircraft to transport expeditioners and materials from  Zhongshan station to Kunlun station, so for the selection of qualified expeditioners and the development of medical control measures, the researches of different physiological and psychological impacts of the Kunlun station pro-expeditioners progressive and rapid advance of the plateau have practical significance.

Methods  According to their transportation ways towards high altitudes, the subjects were divided into the train crew (N=30) and the airplane crew (N=55). We analyzed the physiological and psychological changes of the two crews at the three time points: the sea level (Shanghai), arriving at 3650 m (Lhasa) in 24 h, arriving at 4300 m (YangBajing) in 24h. We evaluated the mood and sleep via questionnaire and monitored the physiological changes of subjects via electrocardiogram (ECG), cardiac function device, and pulmonary function device. We collected saliva and measured salivary testosterone, cortisol and Immunoglobulin A (IgA). In addition, we monitored oxygen saturation of the subjects and evaluated their AMS symptoms to compare the effects of two transportation ways on physiological and psychological changes.

Results  Compared to the sea level value(4 m), the physiological and psychological parameters of airplane crew and train crew changed significantly. Compared to the train crew, the physiological and psychological parameters of airplane crew changed significantly: the negative mood scores increased, the EEG disorders increased, the cardiac and pulmonary function changed, thoracic fluid content (TFC) increased at 4300 m, salivary testosterone and IgA reduced. For the train crew, the change value of TFC was positively correlated with salivary IgA. It suggesting that testosterone can be used as a plateau hypoxic environment on the physiological and psychological impact of the observed indicators.

Conclusion  The train crew (gradual ascend) and airplane crew (rapid ascend)  both performed significantly changes in physiology and psychology under hypoxia environment,while compared with train crew the airplane crew had more significantly changes.

Key words  Plateau,  Hypoxia, Physiology and Psychology,  Hormone,  IgA