Article(id=1200024243703477185, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0021.2022.0725, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1641312000000, receivedDateStr=2022-01-05, revisedDate=null, revisedDateStr=null, acceptedDate=1647964800000, acceptedDateStr=2022-03-23, onlineDate=1764037675070, onlineDateStr=2025-11-25, pubDate=1695830400000, pubDateStr=2023-09-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764037675070, onlineIssueDateStr=2025-11-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764037675070, creator=13701087609, updateTime=1764037675070, updator=13701087609, issue=Issue{id=1200024241572770746, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='9', pageStart='993', pageEnd='1112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764037674563, creator=13701087609, updateTime=1764038723302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1200028640353288193, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1200028640353288194, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200024241572770746, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1094, endPage=1099, ext={EN=ArticleExt(id=1200024243997078469, articleId=1200024243703477185, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress on the effects of acute altitude hypoxia on human cognitive function, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

The special environment of low oxygen in the plateau area will have a significant impact on human physiology and psychology, especially in a short period of time to reach the plateau, which can lead to the impairment of attention, memory, executive function, information processing and other types of cognitive functions, and directly affect health and working ability of people in the plateau. To correctly recognize and avoid the damage has become an urgent problem for researchers and clinicians. This paper summarizes the research status of the impact of acute high altitude hypoxia on human cognitive function in recent years, and summarizes the mechanism of high altitude hypoxia affecting brain physiological function, the damage characteristics of acute hypoxia on different types of cognitive function and hypoxia acclimatization strategies, in order to more clearly explain the relationship between high altitude hypoxia and cognitive changes, and better ensure the health and safety of people entering the plateau and Tibet.

, correspAuthors=Hai-Long Dong, authorNote=null, correspAuthorsNote=
E-mail:
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高原地区低氧的特殊环境会对人体的生理和心理产生显著影响,尤其是在短时间内急进高原可导致注意力、记忆力、执行功能、信息处理功能等多种类型的认知功能损害,直接影响急进高原人群的生命健康和作业能力;正确认识和避免这些损害已成为科研工作者和临床医师亟待解决的问题。本文从高原低氧对大脑生理功能的影响、急性高原低氧对不同类型认知功能的损害特点及其防护策略等方面进行综述,以期更清晰地阐述高原低氧与认知功能变化之间的关系,更好地保障急进高原和入藏人群的健康安全。

, correspAuthors=董海龙, authorNote=null, correspAuthorsNote=
董海龙,E-mail:
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许帅,硕士研究生,主要从事低氧对认知功能影响的基础与临床研究

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急性高原低氧对人体认知功能的影响研究进展
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许帅 , 张昊鹏 , 董海龙 *
解放军医学杂志 | 综述 2023,48(9): 1094-1099
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解放军医学杂志 | 综述 2023, 48(9): 1094-1099
急性高原低氧对人体认知功能的影响研究进展
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许帅, 张昊鹏, 董海龙*
作者信息
  • 空军军医大学西京医院麻醉与围术期医学科,陕西西安 710032
  • 许帅,硕士研究生,主要从事低氧对认知功能影响的基础与临床研究

通讯作者:

董海龙,E-mail:
Research progress on the effects of acute altitude hypoxia on human cognitive function
Shuai Xu, Hao-Peng Zhang, Hai-Long Dong*
Affiliations
  • Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, China
出版时间: 2023-09-28 doi: 10.11855/j.issn.0577-7402.0021.2022.0725
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高原地区低氧的特殊环境会对人体的生理和心理产生显著影响,尤其是在短时间内急进高原可导致注意力、记忆力、执行功能、信息处理功能等多种类型的认知功能损害,直接影响急进高原人群的生命健康和作业能力;正确认识和避免这些损害已成为科研工作者和临床医师亟待解决的问题。本文从高原低氧对大脑生理功能的影响、急性高原低氧对不同类型认知功能的损害特点及其防护策略等方面进行综述,以期更清晰地阐述高原低氧与认知功能变化之间的关系,更好地保障急进高原和入藏人群的健康安全。

高原  /  低氧  /  认知  /  注意力  /  记忆

The special environment of low oxygen in the plateau area will have a significant impact on human physiology and psychology, especially in a short period of time to reach the plateau, which can lead to the impairment of attention, memory, executive function, information processing and other types of cognitive functions, and directly affect health and working ability of people in the plateau. To correctly recognize and avoid the damage has become an urgent problem for researchers and clinicians. This paper summarizes the research status of the impact of acute high altitude hypoxia on human cognitive function in recent years, and summarizes the mechanism of high altitude hypoxia affecting brain physiological function, the damage characteristics of acute hypoxia on different types of cognitive function and hypoxia acclimatization strategies, in order to more clearly explain the relationship between high altitude hypoxia and cognitive changes, and better ensure the health and safety of people entering the plateau and Tibet.

plateau  /  hypoxia  /  cognition  /  attention  /  memory
许帅, 张昊鹏, 董海龙. 急性高原低氧对人体认知功能的影响研究进展. 解放军医学杂志, 2023 , 48 (9) : 1094 -1099 . DOI: 10.11855/j.issn.0577-7402.0021.2022.0725
Shuai Xu, Hao-Peng Zhang, Hai-Long Dong. Research progress on the effects of acute altitude hypoxia on human cognitive function[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (9) : 1094 -1099 . DOI: 10.11855/j.issn.0577-7402.0021.2022.0725
高原地区随着海拔的升高,大气压和氧分压逐渐下降,形成高原独特的低压低氧环境。暴露于海拔3000 m以上数小时便会对机体的生理和心理产生显著影响,严重时可能引发急性高原病、高原肺水肿和高原脑水肿等而危及生命[1-2]。大脑暴露于低压低氧环境下会出现脑部代谢功能障碍、血管调节失常等,从而损伤神经系统结构的完整性和正常功能,其中海马对缺氧最为敏感[3],海马受损后会影响人体的记忆力、注意力等多种认知功能[4-5]。认知功能作为人体大脑的重要功能之一,在日常生活和任务执行中具有至关重要的作用,故高原低氧对认知功能影响的研究受到越来越多的关注。本文就近年来关于高原低氧对大脑生理功能的影响、急性高原低氧对不同类型认知功能的损害特点以及低氧习服策略的研究进展进行总结,以期更清晰地认识急性高原低氧与认知功能改变的关系,更好地保障急进高原和入藏人群的健康安全。
大脑是机体能量的主要消耗器官,对氧气高度敏感,其正常的生理功能是产生认知的基础,因此当暴露于高原低氧环境时,大脑的学习、记忆等高级认知功能很容易受到损害[6]。模拟高原环境的低压低氧舱的使用为低氧动物模型的建立及相关机制研究提供了便捷条件,促进了相关研究的发展。
当机体处于急性缺氧状态时,大脑中的葡萄糖无氧糖酵解增加,腺苷三磷酸(adenosine triphosphate,ATP)生成减少,在5 min内便会导致脑内腺苷水平迅速升高,激活的腺苷A1受体可抑制海马突触传递[7],激活的腺苷A2受体则可通过激活小胶质细胞诱导神经炎症的发生[8];无氧酵解产生的大量丙酮酸导致乳酸生成增多,不仅可直接造成组织酸中毒和神经元损伤,还可促进活性氧(reactive oxygen species,ROS)的生成[9]。与此同时,由于缺氧阻断氧化磷酸化而产生的过量超氧阴离子、过氧化氢、羟自由基、一氧化氮等[10]共同导致了体内氧自由基的增加,在生理情况下,氧自由基的生成与清除非常缓慢,并处于动态平衡状态,但在低氧环境中,谷胱甘肽还原酶和谷胱甘肽过氧化物酶等抗氧化酶数量减少[11],可导致体内自由基清除不足,从而引起细胞氧化应激反应。有研究发现,当机体暴露于低氧环境时,肿瘤坏死因子-α等炎性因子分泌增多,在损害淋巴细胞和中性粒细胞的同时,会加重氧化应激反应[12]。大脑作为高耗氧器官,脂质含量丰富,相对缺乏抗氧化酶,对氧自由基的损害更为敏感。过量的一氧化氮、ROS和自由基等可抑制Na+-K+-ATP酶的活性,诱导离子梯度和细胞膜去极化,通过钙泵、Na+/Ca2+交换体、电压依赖性Ca2+通道等导致Ca2+内流增加,当超出细胞的自主调节范围后即出现细胞内钙过载[13],进而通过激活一氧化氮合酶、Ca2+敏感蛋白酶及损伤线粒体而导致神经细胞凋亡[14]。谷氨酸是神经系统中最重要的兴奋性氨基酸,低氧导致抑制性突触的抑制作用增强,细胞膜的兴奋性增加而发生去极化,进而造成大量兴奋性氨基酸释放入突触间隙;谷氨酸的大量合成和释放不仅可竞争性抑制胱氨酸在突触前膜的摄取,导致谷胱甘肽等抗氧化物质生成减少,还可通过过度激活N-甲基-D-天冬氨酸受体引起Ca2+内流而介导神经损伤[15],造成突触可塑性受损[16],最终导致认知缺陷等。
急性低氧环境可通过氧自由基毒性、钙稳态紊乱、线粒体功能障碍、谷氨酸释放增加等多种机制导致突触可塑性降低和特定神经元死亡,从而造成认知功能障碍。然而低氧也可诱导机体产生积极的适应性改变,例如,通过过度表达脑源性神经营养因子以及降低促凋亡和促炎性基因的表达,从而增强神经元群体对缺氧的耐受性等[17]。尽管低氧对大脑生理功能影响的机制尚无定论,但随着研究从整体水平逐步发展到细胞、亚细胞及分子水平,人们对其的理解也逐渐清晰,这对认识、治疗及预防由此引发的认知功能障碍具有重要意义。
在高原相关研究中,研究者通过不同的认知评估任务来分析认知功能受损的类型,主要包括注意力、记忆力、执行功能和信息处理功能的损害等。
注意力是指心理活动或意识对一定对象的指向与集中,具有选择、维持、整合和调节的功能,是人们获得知识、掌握技能、完成操作的重要心理品质,也是信息加工及其他心理活动的基础。注意力障碍会导致决策判断失误、环境感知错误以及注意力涣散,对登山探险、高原任务执行等产生不利影响。
Griva等[18]对198名徒步前往珠穆朗玛峰大本营(5300 m)的健康志愿者进行连线测验、斯楚普测验等多种认知测试,并在海平面设置同步测试的对照组,在控制学习效应后发现,志愿者抵达5300 m后出现注意力等认知功能的下降。Limmer等[19]对登山者攀登不同海拔高度前后认知功能的改变进行研究,发现登山者暴露于5800 m高原后会出现注意力受损,但在3800 m时注意力则无明显变化,该结果与既往研究中高海拔暴露可导致认知功能障碍[20]、但中等海拔暴露不会显著影响认知功能的结果一致[21]。但一项认知测试研究未发现32名登山者攀登至7500 m后发生明显的认知功能改变[22],这可能与机体在缺氧条件下的自适应机制有关。Pun等[5]基于天文台人员独特的工作模式研究了急性、亚急性和重复暴露于高海拔地区后的认知功能变化,结果显示:(1)急性暴露于高海拔地区后出现注意力受损,但经过6 d适应后有所改善;(2)急性暴露会降低机体的精神运动警觉性,然而适应后会对重复暴露的认知损伤产生一定防护作用。
考虑到高原实地研究的实施难度大、混杂因素多,低压低氧舱凭借其便捷可控等优势逐渐兴起。de Aquino Lemos等[23]将10名男性受试者置于模拟4500 m海拔高度的常压低氧舱内24 h,并在暴露前后分别进行数字跨度测试等认知测试,结果发现受试者的注意力和心理控制得分等出现明显下降。另有研究发现,受试者暴露于模拟2438 m或3658 m海拔高度30 min后,包括注意力在内的复杂认知能力并未出现明显损伤[24],分析原因可能为模拟的海拔高度过低、暴露时间过短等。由此可见,无论是高原实地研究还是模拟研究,急性暴露于高海拔均可降低受试者的注意力,而中等海拔对注意力的影响较弱,同时随着暴露时间的延长,受损的注意力会逐步改善。
记忆力是指记住事情发生过程或事物所存在形象的能力,是认知功能的重要组成部分,在生活、学习、工作等活动中具有重要作用。记忆力在急性高原低氧环境下的损害有以下特点:(1)对高海拔敏感,易受损。有研究报道,健康成年受试者急性暴露于6096 m海拔15 min后,会出现学习和记忆功能损害,包括记忆的编码、检索和保留能力受损等[25];Lefferts等[26]跟踪18名受试者攀登至5160 m高峰的过程发现,工作记忆准确性在4240 m以上时开始出现下降,这与在4000 m以下认知功能可能不会明显受损的观点一致[27],但注意力等认知功能未受到显著影响,表明工作记忆等高级认知过程可能对高海拔更为敏感。(2)记忆力的不同方面受低氧损害的程度不同。Turner等[28]研究发现,急性低氧暴露严重损伤认知和学习任务,特别是复合记忆(-30%)、语言记忆(-34%)及视觉记忆(-23%)。(3)随着海拔高度增加、缺氧程度加重,受试者会表现出不同程度的记忆损害,从记忆力下降直至记忆力完全丧失,主要影响短时记忆,一般不影响长时记忆。(4)种族可能是低氧暴露后记忆力功能恢复的影响因素。一项比较印度士兵和吉尔吉斯斯坦士兵暴露于4111 m高原后认知功能变化的研究发现,暴露后第1天,双方的图形记忆、空间记忆功能等均出现明显受损,然而印度士兵在停留7 d后记忆功能基本恢复至平原水平,但吉尔吉斯斯坦士兵则经历了21 d的适应期[29]。(5)儿童的记忆力同样受高原低氧环境的影响。Rimoldi等[30]开展了一项儿童暴露于3450 m海拔24 h后记忆力变化的研究,发现受试儿童的语言短期记忆力和长期情景记忆力均受损。值得注意的是,在高海拔情景记忆任务中,儿童在语义线索的提示下仍然不能唤起记忆,表明儿童的记忆力受损主要是由于初级编码障碍,且在儿童中参与情景记忆的海马结构对缺氧更为敏感[31]。(6)低氧舱模拟研究得到与实地研究相同的结论。当急性暴露于6000 m低压低氧模拟舱15 min后,飞机机组受试者即出现学习和记忆功能障碍,主要表现为记忆编码、保留和检索缺陷等[25];健康受试者暴露于模拟海拔4500 m的低氧舱24 h后同样出现工作记忆、注意力及执行功能的全面下降[23]
以上关于高原低氧对记忆力影响的研究提示,暴露于高海拔低氧环境短时间内即产生了记忆力损伤,然而记忆力的不同方面对于低氧的敏感性不同,成人与儿童的记忆力受损机制存在差异,不同种族对于低氧的敏感性及习服过程也各有特点,这仍需通过进一步的研究进行细化与明确。
执行功能是指在完成复杂认知任务的过程中,对其他认知活动进行有意识控制和调节的高级认知过程,良好的执行功能有助于人们更好地进行计划、推理、判断以及做出决定。
Ray等[29]对40名成年士兵进行高原低氧对于认知功能损害的研究,发现暴露于4111 m海拔7 d内,受试士兵均出现了明显的执行功能下降。这一结论同样适用于儿童[30]。在模拟研究中,Chroboczek等[32]通过使用常压低氧空气发生器控制吸入气氧浓度(fractional concentration of inspired oxygen,FiO2)来模拟不同海拔高度,利用斯楚普测验检测执行功能,结果显示,在FiO2=13%的条件下呼吸30 min后,受试者出现了执行功能下降,此结果也在同类模拟试验中得到了验证[28];Komiyama等[33]则从运动对执行功能影响的角度出发,使受试者分别在低氧环境(FiO2=15%)中维持静息状态及运动状态,之后在第5、23分钟对两组受试者进行执行功能测试,结果发现运动时间对执行功能具有明显的增益效果。
Pun等[34]进行的不同海拔高度对执行功能影响的实地研究未观察到急性暴露于5050 m与2900 m的受试者在执行功能等方面存在差异,然而在试验设计相似的低压低氧舱模拟研究中,暴露于7620 m模拟高度的受试者相较于暴露于5334 m的受试者执行功能出现了明显下降[35],分析原因可能是由于实地研究的受试者均有多年的高空工作经验、大多接受过高等教育且比较的海拔高度较低。另外,该项研究还发现,受试者暴露于5050 m时的认知表现与个体经皮动脉血氧饱和度(percutaneous arterial oxygen saturation,SpO2)具有很强的相关性,特别是在执行功能领域,即SpO2较高者具有更好的执行功能表现。一项低压低氧舱模拟研究同样发现了急性暴露于严重缺氧条件下会降低执行功能,且降低程度与SpO2相关[36],这些发现与Moraga等[37]报道的对高海拔地区工作人员补充氧气有益于提升认知领域表现的结果一致。
以上关于高原低氧对执行功能影响的研究提示,受试者无论是暴露于高原实地还是模拟舱内,在短至30 min、长至7 d的时间范围内,均可能出现执行功能的损害,且损害的严重程度与SpO2具有很强的相关性。
信息处理功能损伤是正常衰老、创伤性脑老化、抑郁症和帕金森病等认知功能障碍的核心过程,可介导更为广泛的认知功能障碍。信息处理功能受损通常包括信息处理的速度减慢与准确度下降。
Davranche等[38]将11名男性受试者通过直升机运送至4350 m海拔处展开为期4 d的认知研究,发现受试者暴露数小时后即在Simon task一致性试验中表现出错误率增高及处理速度减慢,其中高错误率在整个暴露期间持续存在,而处理速度在2 d后有所改善,考虑是适应过程缓解了急性高原暴露对于处理速度的损害。另有研究发现,儿童在暴露于3450 m海拔24 h后同样出现了信息处理功能的损害[30]
Dykiert等[39]利用10名前往5565 m海拔高度受试者的认知测试结果建立了混合线性模型,发现暴露于4000 m阈值以上时受试者的反应时间明显延长。一项模拟3500 m和5500 m海拔的常压低氧试验同样发现,随着海拔升高,受试者的认知反应时间显著延长[40]。目前通常认为,处理速度降低、反应时间延长可能是一种以牺牲速度来提高测试准确性的补偿机制,然而也有研究表明,暴露于5050 m海拔后受试者的反应时间没有明显变化[41],与既往研究结果不一致的原因可能是该研究纳入的样本量较小,且参与者每天只暴露在5050 m 6~8 h,其余时间生活在较低海拔(2900 m),低海拔地区相对较高的氧气浓度等可能在一定程度上抵消了急性高海拔暴露的负面影响。
以上关于高原低氧对信息处理功能影响的研究提示,暴露于4000 m左右海拔地区数小时即可能出现信息处理速度下降及反应时间延长,然而该功能在短期适应后便可迅速恢复,高错误率的表现则可能长期存在。
总之,关于急进高原低氧环境对认知功能影响的研究较多,包括针对不同人群、不同高度、不同暴露方式、不同认知功能亚类等,虽然大多提示受试者在进入高原数日甚至数小时后即出现认知功能的损害,仍有研究得出急进高原并不会损害认知的结果,其差异可能与不同研究的异质性及混杂因素的控制等有关,仍需进一步完善及规范此类研究的研究方案。
针对高原低氧对人体认知功能的损害可采取多种防护策略,其中高原习服是预防和缓解高原低氧危害的重要途径。高原习服是指居住在相对低海拔的个体进入海拔相对较高的地区后,机体的各种组织器官发生一系列的形态结构和功能变化来适应高原低氧环境。由于直接关系到急进高原人群的生存和生命健康,促进低氧习服成为高原医学研究的焦点和热点,目前的策略主要有阶梯习服、低氧预适应、适应性运动锻炼以及药物治疗等。
阶梯习服是指从低海拔地区到达高海拔目的地的过程中,每上升一定的高度就停留一段时间,待机体对环境习服之后再继续上升,直至目标海拔,该方法对急进高原损害认知功能的预防效果已得到实地研究的证实[34]。低氧预适应是一种机体通过自身保护机制提高缺氧耐力的方法,一般采用低压舱内间歇性低氧的方式,通过一次或多次的低氧刺激,使机体获得对继发低氧性损伤的耐受性,从而改善严重缺氧条件下的运动耐量和中枢疲劳[42]。适应性运动锻炼是指在进入高原之前进行长距离跑步、负重拉练等训练,改善机体对氧的摄取和利用能力,提高低氧环境下的适应力,已被多项研究证实可提升认知表现,预防认知功能紊乱[43-45]。缓慢阶梯间断性缺氧复合运动锻炼可显著改善机体的心肺功能,提高劳动能力,但这些促习服的方式存在适应周期长、低氧舱设备昂贵等缺点,所以并不适用于高原救援、高原紧急军事行动等突发情况。促进低氧习服的药物主要包括西药和中草药两类。西药中的乙酰唑胺、地塞米松、缓释茶碱、地西泮等均可缓解血氧饱和度的急性改变,从而有效治疗高原病[46];中草药如红景天、银杏内酯、丹参等具有抗辐射、抗疲劳等作用,对高原反应也有一定的预防及治疗效果。另外可通过补充维生素E、维生素C等抗氧化药品抵抗机体暴露于高原环境后的氧化损伤,补充硫酸亚铁、氯化钾等微量元素制剂也可提高机体对急性缺氧的耐受力。促习服药物和营养剂的服用可增加血氧饱和度,改善机体抗氧化能力,且简便易行,对于提高急进高原人群的适应能力具有重要意义。
另外随着研究的进展,发现了一些可用于预防和治疗急进高原后认知功能损害的药物与技术。一项探讨奥拉西坦与顶核刺激技术对急进4000 m海拔后认知功能改善作用的研究发现,二者均可降低事件相关电位(P300和N200)的延长潜伏期,并增强4000 m海拔高度的脑电图功率谱熵,预防急进高海拔后的认知能力下降[47]。另一项关于远程缺血处理(remote ischemic preconditioning,RIPC)的研究发现,暴露于高海拔的受试者经过1周的RIPC治疗后,其注意力-预警功能得到显著改善[48]。尽管RIPC用于脑保护的机制尚未明确,但其仍不失为一种针对认知功能障碍的有前途的治疗策略。
海拔高度的升高和大气压的降低,会导致吸入气体中氧浓度下降,从而影响大脑的供氧与功能,通常表现为暴露于高海拔地区人群的认知功能受损[49]。总结前期研究发现,急性高原低氧可对注意力、记忆力、执行功能、信息处理功能等产生损害[18],然而也有研究指出高海拔缺氧对认知并无负面影响[50]。针对相关研究结果并不一致的现状,可从以下方面进行规范和探索:(1)鼓励进行高原实地研究。受限于高原实地研究的复杂性、不确定性及人群招募难度大等问题,目前许多高原相关研究依托于低压低氧舱等展开,虽可在一定程度上反映低氧对认知的短期损害,但模拟环境与高原实际的低压低氧、高辐射、高寒等环境仍存在差异,并不能完整体现睡眠、情绪、体力劳动等可能影响认知功能的因素,故与实际情况仍存在差异。(2)开展连续追踪研究。前期研究提示受损的认知功能可能在急进期内即出现改善,所以在短期内多次进行追踪测试可更完整地展现急进过程中认知功能的变化趋势。(3)开展大样本研究。考虑到实地研究招募志愿者相对困难,目前的研究样本量普遍较少,应鼓励并支持开展大样本研究,从而更好地发现认知功能的差异性变化。(4)建立统一规范的研究方案。在高原实地研究中有很多混杂因素可能影响最终的结果,如纳入人群的基本情况、到达的海拔高度、海拔攀升的速度、高原暴露的时间、是否补充氧气、重复测试的学习效应、评估的认知领域、认知评估采用的是纸笔还是计算机等,这些信息的差异或者缺失导致不同研究结果之间无法很好地进行类比与总结。相信随着研究设计的规范、研究内容的完善及样本量的扩大,人们对急性高原低氧与认知功能变化之间关系的认识会进一步加深,对急进高原后认知功能的防护也将迈入新阶段。
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2023年第48卷第9期
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doi: 10.11855/j.issn.0577-7402.0021.2022.0725
  • 接收时间:2022-01-05
  • 首发时间:2025-11-25
  • 出版时间:2023-09-28
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  • 收稿日期:2022-01-05
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    空军军医大学西京医院麻醉与围术期医学科,陕西西安 710032

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2种不同金属材料的力学参数

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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