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Article(id=1322210990792491862, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202412016, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733328000000, receivedDateStr=2024-12-05, revisedDate=1741276800000, revisedDateStr=2025-03-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793169265696, onlineDateStr=2026-10-28, pubDate=1747238400000, pubDateStr=2025-05-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793169265696, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793169265696, creator=13701087609, updateTime=1793169265696, updator=13701087609, issue=Issue{id=1322210968248107603, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='9', pageStart='893', pageEnd='1028', issueExtLink='null', onlineDate='null', pubDate='1747238400000', pubDateStr='2025-05-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793169260321, creator='13701087609', updateTime=1793325292291, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865413818536367, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865413818536368, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210968248107603, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1010, endPage=1017, ext={EN=ArticleExt(id=1322210990993818455, articleId=1322210990792491862, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Efficacies of remote ischemic preconditioning with different pressure modes on acclimatization in male trainees at a simulated altitude of 4 500 m, columnId=1320435151990014650, journalTitle=Journal of Army Medical University, columnName=Military Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To compare the effects of upper limb remote ischemic preconditioning (RIPC) with different pressure modes on enhancing high-altitude acclimatization in healthy adult males rapidly exposed to high-altitude environments.

Methods‍

In May 2024, 86 male adult residents living plain areas planning a high-altitude travel were recruited through advertisements in Chongqing by Department of Anesthesiology at the Second Affiliated Hospital of Army Medical University. The participants were randomly divided into a variable pressure training group (n=29), a constant pressure training group (n=29), and a control group (n=28). The variable pressure training group underwent RIPC training in a variable pressure mode [occlusion pressure was set at systolic blood pressure (SBP) + 40 mmHg], while the constant pressure training group received RIPC training in a constant pressure mode (fixed occlusion pressure of 200 mmHg). Both groups completed a bilateral upper limb RIPC training (twice daily, 5 cycles per time of 10-min occlusion followed by 5-min reperfusion) for 14 d. The control group received no such training. On the 3rd day post-training, all participants entered a simulated 4 500 m altitude chamber for 7 h. The incidence and severity of acute mountain sickness (AMS) were observed and evaluated, and the vital signs and cerebral tissue oxygenation index (CTOI) were recorded.

Results‍

The incidence of AMS was 23.1% in the variable pressure training group (RR=0.4, 95%CI: 0.2~0.8, Chi-square=9.433, P=0.002) and 16.0% in the constant pressure training group (RR=0.2, 95%CI: 0.1~0.6, Chi-square=12.833, P<0.001), and both incidences were significantly lower than that in the control group (65.4%). The AMS symptom score in the variable pressure training group [1.5 (0.8, 3.0) vs (3.1±1.9), P=0.018] and the score in the constant pressure training group [1.0 (1.0, 2.0) vs (3.1±1.9), P=0.001] were significantly lower than that in the control group. The dizziness score was obviously lower in the variable pressure training group [0 (0, 1.0) vs 1.0 (1.0, 1.0), P=0.001] and the constant pressure training group [1.0 (0,1.0) vs 1.0 (1.0,1.0), P=0.003] than the control group, so was the fatigue/weakness score in the variable pressure training group [0 (0, 0.3) vs 1.0 (0,1.0), P=0.006], the constant pressure training group [0 vs 1.0(0,1.0), P<0.001], and the control group. The change of CTOI (ΔCTOI) in the variable pressure training group (P=0.010) and the constant pressure training group (P=0.042) was significantly lower than that in the control group. There were no statistical differences in the 3 groups in terms of SpO2, HR, SBP or DBP (P>0.05). What’s more, no significant differences were observed in the incidence of AMS, AMS score, dizziness score, fatigue/weakness score, or ΔCTOI between the variable pressure training group and the constant pressure training group (P>0.05).

Conclusion‍

Both upper limb RIPC protocols, variable-pressure (SBP+40 mmHg) and fixed-pressure (200 mmHg), can effectively enhance high-altitude acclimatization by reducing AMS incidence, symptom severity, and cerebral oxygen desaturation.

, authors=Xucheng ZHANG1, 2, Yukun REN1, 3, Zhuo WANG1, Jiaxin LI1, Yan LIU1, Hong LI1, authorsList=Xucheng ZHANG, Yukun REN, Zhuo WANG, Jiaxin LI, Yan LIU, Hong LI, authorCompany=null, correspAuthors=Hong LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322210993409737562, articleId=1322210990792491862, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=不同压力模式的远端缺血预适应训练对模拟4 500 m海拔男性受训者高原习服效果影响的对比研究, columnId=1322185581656920707, journalTitle=陆军军医大学学报, columnName=军事医学, runingTitle=null, highlight=null, articleAbstract=
目的

对比不同压力模式的上肢远端缺血预适应（remote ischemic preconditioning，RIPC）训练对急进高海拔环境健康成年男性的促高原习服作用。

方法

陆军军医大学第二附属医院麻醉科于2024年5月在重庆通过广告招募有高原旅行计划的平原成年男性居民86名，采用随机数字表法将受试者分为变压训练组（n=29），恒压训练组（n=29）和对照组（n=28）。变压训练组以变压模式［阻断压为收缩压（systolic blood pressure，SBP）加40 mmHg］、恒压训练组以恒压模式（阻断压为固定200 mmHg）分别进行14 d的双上肢RIPC训练（2次/d，5个循环/次：缺血10 min后，再灌注5 min），对照组不进行训练。训练结束后第3天进入4 500 m海拔模拟舱，7 h后评估受试者急性高原反应（acute mountain sickness，AMS）的发病率和严重程度，并记录生命体征及脑氧饱和度。

结果

变压训练组AMS发病率为23.1%（RR=0.4，95%CI：0.2~0.8，χ2=9.433，P=0.002）、恒压训练组AMS发病率为16.0%（RR=0.2，95%CI：0.1~0.6，χ2=12.833，P<0.001），均低于对照组AMS发病率65.4%。变压训练组［1.5（0.8，3.0） vs （3.1±1.9），P=0.018］和恒压训练组［1.0（1.0，2.0） vs （3.1±1.9），P=0.001］AMS症状评分均低于对照组。变压训练组［0（0，1.0） vs 1.0（1.0，1.0），P=0.001］和恒压训练组［1.0（0，1.0） vs 1.0（1.0，1.0），P=0.003］头晕评分均低于对照组；变压训练组［0（0，0.3） vs 1.0（0，1.0），P=0.006］和恒压训练组［0 vs 1.0（0，1.0），P<0.001］疲劳/虚弱评分均低于对照组。变压训练组（P=0.010）和恒压训练组（P=0.042）脑氧饱和度下降幅度（Δ cerebral tissue oxygenation index，ΔCTOI）均小于对照组。3组受试者的SpO2、HR、SBP和DBP差异无统计学意义，变压训练组和恒压训练组的AMS发病率、AMS评分、头晕评分、疲劳/虚弱评分及ΔCTOI差异均无统计学意义。

结论

变压（SBP+40 mmHg）和恒压（固定200 mmHg）两种加压模式的上肢RIPC训练均可为急进高原人群提供促高原习服作用，降低AMS发病率，减轻AMS严重程度及减轻脑氧饱和度下降。

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李洪，E-mail：
LI Hong，E-mail：
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J Fourth Mil Med Univ，2008，29（8）：702-704., articleTitle=Survey of prevalence rate and food factors for gastrointestinal stress reaction in military officers and soldiers fleetly coming into high altitude areas, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322210993602675547, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, xref=1, ext=[AuthorCompanyExt(id=1322210993606869852, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993602675547, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Anesthesiology，Second Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing), AuthorCompanyExt(id=1322210993611064157, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993602675547, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第二附属医院麻醉科，重庆)]), AuthorCompany(id=1322210993673978718, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, xref=2, ext=[AuthorCompanyExt(id=1322210993678173023, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993673978718, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Anesthesiology，No.944 Hospital of Joint Logistic Support Force of PLA，Jiuquan，Gansu), AuthorCompanyExt(id=1322210993682367328, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993673978718, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2联勤保障部队第九四四医院麻醉科，甘肃 酒泉)]), AuthorCompany(id=1322210993753670497, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, xref=3, ext=[AuthorCompanyExt(id=1322210993762059106, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993753670497, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Department of Anesthesiology，No.960 Hospital of Joint Logistic Support Force of PLA，Jinan，Shandong，China), AuthorCompanyExt(id=1322210993766253411, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, companyId=1322210993753670497, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3联勤保障部队第九六〇医院麻醉科，山东 济南)])], figs=[ArticleFig(id=1322210995875988364, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=moSumx+RtkF/iCk1c2Y8ag==, figureFileBig=sZiUWYvTbJv76LroTbGmyA==, tableContent=null), ArticleFig(id=1322210995947291533, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=图1, caption=RIPC训练图, figureFileSmall=moSumx+RtkF/iCk1c2Y8ag==, figureFileBig=sZiUWYvTbJv76LroTbGmyA==, tableContent=null), ArticleFig(id=1322210996119257998, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组（n=26）变压训练组（n=26）恒压训练组（n=25）P
年龄/岁20（20，21）20.5±1.420.2±1.40.713
身高/cm176.2±5.8174.0±5.9175.0±6.10.427
体质量/kg72.4±9.467.2±6.169.3±8.40.070
BMI/（kg/m2）23.3±2.522.2±2.022.6±2.50.247
SBP/mmHg117.8±9.7114.0±9.4113.8±7.30.199
DBP/mmHg62.0±9.257.6±7.858.5±6.90.119
HR/bpm70.0±10.068.5±9.067.7±6.70.636
SpO2/%99（98，99）99（98，99）98（97，99）0.121
), ArticleFig(id=1322210997776008079, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=表1, caption=

受试者的基线资料［x¯±s，M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组（n=26）变压训练组（n=26）恒压训练组（n=25）P
年龄/岁20（20，21）20.5±1.420.2±1.40.713
身高/cm176.2±5.8174.0±5.9175.0±6.10.427
体质量/kg72.4±9.467.2±6.169.3±8.40.070
BMI/（kg/m2）23.3±2.522.2±2.022.6±2.50.247
SBP/mmHg117.8±9.7114.0±9.4113.8±7.30.199
DBP/mmHg62.0±9.257.6±7.858.5±6.90.119
HR/bpm70.0±10.068.5±9.067.7±6.70.636
SpO2/%99（98，99）99（98，99）98（97，99）0.121
), ArticleFig(id=1322210997876671376, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
症状评分项目对照组（n=26）变压训练组（n=26）恒压训练组（n=25）P1P2P3
AMS症状评分3.1±1.91.5（0.8，3.0）1.0（1.0，2.0）0.0180.0011.000
头痛评分1.0（0，1.3）1.0（0，1.0）1.0（0，1.0）---
消化道症状评分0（0，1.0）0（0，0.3）0---
头晕评分1.0（1.0，1.0）0（0，1.0）1.0（0，1.0）0.0010.0031.000
疲劳/虚弱评分1.0（0，1.0）0（0，0.3）00.006<0.0010.813
), ArticleFig(id=1322210997947974545, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=表2, caption=

模拟海拔4 500 m暴露7 h后受试者AMS症状评分［x¯±s，M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
症状评分项目对照组（n=26）变压训练组（n=26）恒压训练组（n=25）P1P2P3
AMS症状评分3.1±1.91.5（0.8，3.0）1.0（1.0，2.0）0.0180.0011.000
头痛评分1.0（0，1.3）1.0（0，1.0）1.0（0，1.0）---
消化道症状评分0（0，1.0）0（0，0.3）0---
头晕评分1.0（1.0，1.0）0（0，1.0）1.0（0，1.0）0.0010.0031.000
疲劳/虚弱评分1.0（0，1.0）0（0，0.3）00.006<0.0010.813
), ArticleFig(id=1322210998015083410, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别0分1分2分3分4分5分≥6分
对照组（n=26）2（7.7）3（11.5）4（15.4）8（30.8）5（19.2）2（7.7）2（7.7）
变压训练组（n=26）6（23.1）7（26.9）5（19.2）5（19.2）2（7.7）1（3.8）0
恒压训练组（n=25）5（20.0）11（44.0）5（20.0）3（12.0）01（4.0）0
), ArticleFig(id=1322210998115746707, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=表3, caption=

模拟海拔4 500 m暴露7 h后受试者AMS症状评分分布［例（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
组别0分1分2分3分4分5分≥6分
对照组（n=26）2（7.7）3（11.5）4（15.4）8（30.8）5（19.2）2（7.7）2（7.7）
变压训练组（n=26）6（23.1）7（26.9）5（19.2）5（19.2）2（7.7）1（3.8）0
恒压训练组（n=25）5（20.0）11（44.0）5（20.0）3（12.0）01（4.0）0
), ArticleFig(id=1322210998216410004, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组（n=26）变压训练组（n=26）恒压训练组（n=25）
平原高原P平原高原P平原高原P
SBP/mmHg117.8±9.7117.6±11.30.909114.0±9.4113.5±9.40.817113.8±7.3118.2±9.60.078
DBP/mmHg62.0±9.264.0±8.90.38057.6±7.860.2±8.50.19458.5±6.961.1±9.30.240
HR/bpm70.0±10.080.7±9.7<0.00168.5±9.082.1±12.6<0.00167.7±6.780.1±8.9<0.001
SpO2/%99（98，99）76.1±5.0<0.00199（98，99）75.4±6.2<0.00198（97，99）73.6±7.3<0.001
), ArticleFig(id=1322210998308684693, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=表4, caption=

模拟海拔4 500 m暴露7 h后受试者生命体征变化情况［x¯±s，M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组（n=26）变压训练组（n=26）恒压训练组（n=25）
平原高原P平原高原P平原高原P
SBP/mmHg117.8±9.7117.6±11.30.909114.0±9.4113.5±9.40.817113.8±7.3118.2±9.60.078
DBP/mmHg62.0±9.264.0±8.90.38057.6±7.860.2±8.50.19458.5±6.961.1±9.30.240
HR/bpm70.0±10.080.7±9.7<0.00168.5±9.082.1±12.6<0.00167.7±6.780.1±8.9<0.001
SpO2/%99（98，99）76.1±5.0<0.00199（98，99）75.4±6.2<0.00198（97，99）73.6±7.3<0.001
), ArticleFig(id=1322210998379987862, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组
（n=26）		变压训练组
（n=26）		恒压训练组
（n=25）		P
基线CTOI/%63.7±4.162.1±4.262.6±3.30.304
高原CTOI/%52.4±3.9b53.7±4.5b53.6±2.4b0.393
ΔCTOI/%11.3±4.28.4±4.6a9.0±3.1a0.025
a： P<0.05，与对照组比较；b： P<0.001，与基线CTOI比较
), ArticleFig(id=1322210998451291031, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210990792491862, language=CN, label=表5, caption=

受试者基线和模拟海拔4 500 m暴露7 h后CTOI参数（x¯±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
指标对照组
（n=26）		变压训练组
（n=26）		恒压训练组
（n=25）		P
基线CTOI/%63.7±4.162.1±4.262.6±3.30.304
高原CTOI/%52.4±3.9b53.7±4.5b53.6±2.4b0.393
ΔCTOI/%11.3±4.28.4±4.6a9.0±3.1a0.025
a： P<0.05，与对照组比较；b： P<0.001，与基线CTOI比较
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不同压力模式的远端缺血预适应训练对模拟4 500 m海拔男性受训者高原习服效果影响的对比研究
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张旭程 1, 2 , 任玉琨 1, 3 , 王卓 1 , 李加欣 1 , 刘燕 1 , 李洪 1
陆军军医大学学报 | 军事医学 2025,47(9): 1010-1017
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陆军军医大学学报 |军事医学 2025 , 47 (9) : 1010 -1017
不同压力模式的远端缺血预适应训练对模拟4 500 m海拔男性受训者高原习服效果影响的对比研究
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张旭程1, 2, 任玉琨1, 3, 王卓1, 李加欣1, 刘燕1, 李洪1
作者信息
  • 1陆军军医大学（第三军医大学）第二附属医院麻醉科，重庆
  • 2联勤保障部队第九四四医院麻醉科，甘肃 酒泉
  • 3联勤保障部队第九六〇医院麻醉科，山东 济南
通讯作者:
李洪，E-mail：
LI Hong，E-mail：
Efficacies of remote ischemic preconditioning with different pressure modes on acclimatization in male trainees at a simulated altitude of 4 500 m
Xucheng ZHANG1, 2, Yukun REN1, 3, Zhuo WANG1, Jiaxin LI1, Yan LIU1, Hong LI1
Affiliations
  • 1Department of Anesthesiology，Second Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing
  • 2Department of Anesthesiology，No.944 Hospital of Joint Logistic Support Force of PLA，Jiuquan，Gansu
  • 3Department of Anesthesiology，No.960 Hospital of Joint Logistic Support Force of PLA，Jinan，Shandong，China
出版时间: 2025-05-15 doi: 10.16016/j.2097-0927.202412016
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摘要
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目的

对比不同压力模式的上肢远端缺血预适应（remote ischemic preconditioning，RIPC）训练对急进高海拔环境健康成年男性的促高原习服作用。

方法

陆军军医大学第二附属医院麻醉科于2024年5月在重庆通过广告招募有高原旅行计划的平原成年男性居民86名，采用随机数字表法将受试者分为变压训练组（n=29），恒压训练组（n=29）和对照组（n=28）。变压训练组以变压模式［阻断压为收缩压（systolic blood pressure，SBP）加40 mmHg］、恒压训练组以恒压模式（阻断压为固定200 mmHg）分别进行14 d的双上肢RIPC训练（2次/d，5个循环/次：缺血10 min后，再灌注5 min），对照组不进行训练。训练结束后第3天进入4 500 m海拔模拟舱，7 h后评估受试者急性高原反应（acute mountain sickness，AMS）的发病率和严重程度，并记录生命体征及脑氧饱和度。

结果

变压训练组AMS发病率为23.1%（RR=0.4，95%CI：0.2~0.8，χ2=9.433，P=0.002）、恒压训练组AMS发病率为16.0%（RR=0.2，95%CI：0.1~0.6，χ2=12.833，P<0.001），均低于对照组AMS发病率65.4%。变压训练组［1.5（0.8，3.0） vs （3.1±1.9），P=0.018］和恒压训练组［1.0（1.0，2.0） vs （3.1±1.9），P=0.001］AMS症状评分均低于对照组。变压训练组［0（0，1.0） vs 1.0（1.0，1.0），P=0.001］和恒压训练组［1.0（0，1.0） vs 1.0（1.0，1.0），P=0.003］头晕评分均低于对照组；变压训练组［0（0，0.3） vs 1.0（0，1.0），P=0.006］和恒压训练组［0 vs 1.0（0，1.0），P<0.001］疲劳/虚弱评分均低于对照组。变压训练组（P=0.010）和恒压训练组（P=0.042）脑氧饱和度下降幅度（Δ cerebral tissue oxygenation index，ΔCTOI）均小于对照组。3组受试者的SpO2、HR、SBP和DBP差异无统计学意义，变压训练组和恒压训练组的AMS发病率、AMS评分、头晕评分、疲劳/虚弱评分及ΔCTOI差异均无统计学意义。

结论

变压（SBP+40 mmHg）和恒压（固定200 mmHg）两种加压模式的上肢RIPC训练均可为急进高原人群提供促高原习服作用，降低AMS发病率，减轻AMS严重程度及减轻脑氧饱和度下降。

远端缺血预适应  /  急性高原反应  /  高原习服  /  脑氧饱和度
Objective‍

To compare the effects of upper limb remote ischemic preconditioning (RIPC) with different pressure modes on enhancing high-altitude acclimatization in healthy adult males rapidly exposed to high-altitude environments.

Methods‍

In May 2024, 86 male adult residents living plain areas planning a high-altitude travel were recruited through advertisements in Chongqing by Department of Anesthesiology at the Second Affiliated Hospital of Army Medical University. The participants were randomly divided into a variable pressure training group (n=29), a constant pressure training group (n=29), and a control group (n=28). The variable pressure training group underwent RIPC training in a variable pressure mode [occlusion pressure was set at systolic blood pressure (SBP) + 40 mmHg], while the constant pressure training group received RIPC training in a constant pressure mode (fixed occlusion pressure of 200 mmHg). Both groups completed a bilateral upper limb RIPC training (twice daily, 5 cycles per time of 10-min occlusion followed by 5-min reperfusion) for 14 d. The control group received no such training. On the 3rd day post-training, all participants entered a simulated 4 500 m altitude chamber for 7 h. The incidence and severity of acute mountain sickness (AMS) were observed and evaluated, and the vital signs and cerebral tissue oxygenation index (CTOI) were recorded.

Results‍

The incidence of AMS was 23.1% in the variable pressure training group (RR=0.4, 95%CI: 0.2~0.8, Chi-square=9.433, P=0.002) and 16.0% in the constant pressure training group (RR=0.2, 95%CI: 0.1~0.6, Chi-square=12.833, P<0.001), and both incidences were significantly lower than that in the control group (65.4%). The AMS symptom score in the variable pressure training group [1.5 (0.8, 3.0) vs (3.1±1.9), P=0.018] and the score in the constant pressure training group [1.0 (1.0, 2.0) vs (3.1±1.9), P=0.001] were significantly lower than that in the control group. The dizziness score was obviously lower in the variable pressure training group [0 (0, 1.0) vs 1.0 (1.0, 1.0), P=0.001] and the constant pressure training group [1.0 (0,1.0) vs 1.0 (1.0,1.0), P=0.003] than the control group, so was the fatigue/weakness score in the variable pressure training group [0 (0, 0.3) vs 1.0 (0,1.0), P=0.006], the constant pressure training group [0 vs 1.0(0,1.0), P<0.001], and the control group. The change of CTOI (ΔCTOI) in the variable pressure training group (P=0.010) and the constant pressure training group (P=0.042) was significantly lower than that in the control group. There were no statistical differences in the 3 groups in terms of SpO2, HR, SBP or DBP (P>0.05). What’s more, no significant differences were observed in the incidence of AMS, AMS score, dizziness score, fatigue/weakness score, or ΔCTOI between the variable pressure training group and the constant pressure training group (P>0.05).

Conclusion‍

Both upper limb RIPC protocols, variable-pressure (SBP+40 mmHg) and fixed-pressure (200 mmHg), can effectively enhance high-altitude acclimatization by reducing AMS incidence, symptom severity, and cerebral oxygen desaturation.

remote ischemic preconditioning  /  acute mountain sickness  /  high-altitude acclimatization  /  cerebral oxygen saturation
张旭程, 任玉琨, 王卓, 李加欣, 刘燕, 李洪. 不同压力模式的远端缺血预适应训练对模拟4 500 m海拔男性受训者高原习服效果影响的对比研究. 陆军军医大学学报, 2025 , 47 (9) : 1010 -1017 . DOI: 10.16016/j.2097-0927.202412016
Xucheng ZHANG, Yukun REN, Zhuo WANG, Jiaxin LI, Yan LIU, Hong LI. Efficacies of remote ischemic preconditioning with different pressure modes on acclimatization in male trainees at a simulated altitude of 4 500 m[J]. Journal of Army Medical University, 2025 , 47 (9) : 1010 -1017 . DOI: 10.16016/j.2097-0927.202412016
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高原低氧环境对人体生理功能的挑战已成为高原医学研究的重点领域。随着海拔升高，大气氧分压的急剧下降会引发机体一系列代偿性反应，未习服人群进入海拔2 500 m以上区域时，人体即可能出现急性高原反应（acute mountain sickness，AMS），当海拔超过4 500 m时，AMS发病率为40%~90%［1-3］。这种病理状态不仅表现为头痛、恶心、厌食等躯体症状［4-6］，更伴随显著的神经认知功能损害，表现为复杂决策能力下降，工作记忆容量缩减［1，7］，严重制约高原作业人员的执行效能。AMS引发的睡眠结构改变可进一步导致情绪调节障碍，表现为焦虑加重、抑郁倾向增加［7］，形成“低氧-睡眠障碍-情绪失调”的恶性循环。我国高海拔地区面积辽阔，青藏高原及其周边区域涉及6省区、总面积达257万km2，年流动人口数量庞大。传统习服策略常难以满足在军事部署、工程建设、旅游开发等急进高原场景的需求。因此，开发高效、便捷的促习服方法，构建基于个体生理反应的精准干预方案，对保障急进高原人群健康、提升作业效能具有重要战略意义。
远端缺血预适应（remote ischemic preconditioning，RIPC）是一种对机体远端器官或组织进行短暂、可逆性的缺血缺氧刺激，诱导缺血器官以外的其他脏器对可能发生的严重或致命性缺血缺氧性损伤产生保护作用的方法［8-9］。虽有研究表明，RIPC训练可减轻AMS，但由于训练方案的不同（如干预部位、训练周期等），其有效性在不同研究中结论尚不一致［10-13］。此前的研究主要探究不同时长RIPC训练的促高原习服效果，结果显示：延长训练周期可能会产生较好的训练效果［13］。由于在RIPC实施过程中需要对肢体施加压力，以阻断血流从而引发缺血缺氧效果。因此，除训练周期外，训练时阻断血流的压力、加压时长和循环次数均可能影响RIPC的训练效果，但目前尚无最优训练方案。RIPC的加压过程可导致肢体的局部疼痛或不适，虽然在压力解除后症状得到缓解，但在目前的训练方案中上肢RIPC多采用恒压模式（阻断压为固定200 mmHg）进行训练［13-15］，一方面，针对正常血压的受训者200 mmHg的阻断压力可能偏高，在长期的重复训练中可降低RIPC的使用体验，而针对高血压患者，200 mmHg的阻断压力可能出现阻断不全的情况，影响训练效果。因此，探索阻断压个性化的训练方案对提高RIPC训练的舒适度和训练效果，具有重要意义。有研究报道，在较低压力下进行上肢RIPC训练可降低受训者的疼痛评分［16］，以收缩压（systolic blood pressure，SBP）加40 mmHg的压力进行RIPC训练可提供心脏保护作用［17］。然而，关于不同阻断压的RIPC训练对高原习服效果的研究尚缺乏报道。因此，本研究以阻断压为SBP加40 mmHg的变压模式和以阻断压为固定200 mmHg的恒压模式为双上肢RIPC训练方案来进行高原习服训练，并通过观察两种压力模式下的RIPC训练对健康成年男性急性暴露于模拟高海拔环境后的影响，旨在探究两种不同的RIPC训练方案对高原习服能力的提升效果。
1　资料与方法
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1.1　研究对象
本试验为随机对照研究，经陆军军医大学第二附属医院医学伦理委员会批准（2024-研第016-03），临床试验注册号为ChiCTR2500095628。陆军军医大学第二附属医院麻醉科于2024年5月在重庆通过广告招募有高原旅行计划的平原成年男性居民进行试验，所有受试者签署知情同意书。
纳入标准：①年龄18~25岁；②常住地海拔<2 500 m；③30 d内未进入海拔>2 500 m地区；④受试期间未服用任何药物；⑤均自愿参与本研究且3个月内未参与其他研究。排除标准：①有高血压、冠心病、哮喘、贫血、减压病史、慢性头痛史者；②6个月内上肢外伤或有上肢手术史无法接受RIPC训练者。
1.2　样本量计算
利用软件PASS 2021计算样本量，设置显著性水平α=0.05、检验效能（power=1-β）为90%。以受试者的AMS发病率为观测的结局指标，根据既往研究［13，18］，预计对照组的发病率为75%，各训练组发病率为30%，每组至少需要招募25例，考虑失访以及拒访的情况按10%计算，至少需要招募受试者84例。最终本研究共招募受试者86名。
1.3　方法
1.3.1　分组
利用随机数字表法将研究对象分为3组：变压训练组（n=29）、恒压训练组（n=29）和对照组（n=28）。
1.3.2　试验方案
训练开始前采集受试者基线数据。采集完成后变压训练组和恒压训练组进行14 d的RIPC训练，对照组未进行RIPC训练。RIPC训练结束后的第3天，受试者进入高原环境模拟舱，以3~4 m/s的速度将模拟海拔高度由400 m上升至4 500 m，停留7 h后评估AMS的发病率和严重程度，同时监测生命体征和脑氧饱和度。
1.3.3　RIPC训练方法
RIPC训练仪的气囊放置在双侧上肢肘横纹上方2 cm处，训练时以维持阻断压力10 min、恢复灌注5 min为1个循环，每次5个循环，每天2次（上、下午各1次），连续训练14 d（图1）。变压训练组每次训练前先测量血压，其阻断压力设置为SBP+40 mmHg，恒压训练组的阻断压力设置为恒定的200 mmHg。
1.4　观察指标
1.4.1　症状评分
本研究以AMS发病率为主要结局指标，并采用路易斯湖AMS评分（Lake Louise acute mountain sickness score，LLS）2018年版［19］对AMS症状进行评估，评估项目包括：头痛、消化道症状（厌食、恶心、呕吐）、头晕和疲劳/虚弱，每个症状由轻到重分别评为0~3分。AMS诊断标准：头痛评分≥1分且AMS评分≥3分；总分3~5分为轻度AMS，6~9分为中度AMS，10~12分为重度AMS。
1.4.2　生命体征
采用mindray PM9000 ExPress监护仪（深圳迈瑞生物医疗电子股份有限公司）采集心率（heart rate，HR）、SBP、舒张压（diastolic blood pressure，DBP）和脉搏氧饱和度（peripheral oxygen saturation，SpO2）数据。
1.4.3　脑氧饱和度监测
采用ENGINMED-ECO-N17-C25L组织血氧饱和度监测仪（苏州爱琴生物医疗电子有限公司）监测脑组织氧合指数（cerebral tissue oxygenation index，CTOI）。将检测探头固定在左前额，数值稳定后，每30 s记录1次，共记录3次，计算平均值作为最终的CTOI。
1.4.4　人口学资料收集
收集受试者年龄、身高、体质量、体质量指数（body mass index，BMI）等人口学资料。
1.5　统计学分析
采用 SPSS 26.0软件进行统计分析，采用Shapiro-Wilktest检验数据正态性，服从正态分布的计量资料以x¯±s表示，采用单因素方差分析进行组内比较，并采用LSD法进行两两比较，不服从正态分布的计量资料以M（P25，P75）表示，并采用Kruskal-Wallis检验进行两两比较；组内比较采用配对样本t检验或Wilcoxon秩和检验进行分析；计数资料采用例（%）表示，AMS发病率通过组内发病人数除以组内总人数计算，并采用χ2检验进行比较；采用Spearman秩相关系数对脑氧饱和度与AMS症状评分的相关性进行分析。P<0.05为差异具有统计学意义。
2　结果
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2.1　受试者资料
本研究共招募受试者86名，最终共77人完成训练和模拟舱内的评估和检测项目，其中4人未完成训练，5人未参加评估，最终对对照组26人、变压训练组26人、恒压训练组25人的数据进行了分析。3组受试者基线资料差异无统计学意义（表1）。
2.2　AMS发病率评估结果
模拟海拔4 500 m暴露7 h后，对照组有17人（65.4%）发生AMS，其中15人（57.7%）为轻度AMS，2人（7.7%）为中度AMS；变压训练组有6人（23.1%）发生AMS，均为轻度；恒压训练组有4人发生AMS（16.0%），均为轻度；3组数据AMS发病率存在统计学差异（χ2=16.129，P<0.001）。变压训练组（RR=0.4，95%CI：0.2~0.8，χ2=9.433）和恒压训练组（RR=0.2，95%CI：0.1~0.6，χ2=12.833）AMS发病率均低于对照组（P=0.002，P<0.001），变压训练组和恒压训练组间差异无统计学意义（RR=1.4，95%CI：0.5~4.5，χ2=0.080，P=0.777）。
2.3　AMS严重程度评估结果
模拟海拔4 500 m暴露7 h后，变压训练组和恒压训练组受试者的AMS症状评分均低于对照组AMS症状评分（P=0.018，P=0.001），而变压训练组和恒压训练组受试者的AMS评分差异无统计学意义。同时，LLS评分中头痛、消化道症状、疲劳/虚弱、头晕4种症状的评分结果显示：变压训练组和恒压训练组受试者的头晕评分均低于对照组受试者的头晕评分（P=0.001，P=0.003），但2个RIPC训练组间差异无统计学意义；变压训练组和恒压训练组受试者的疲劳/虚弱评分均低于对照组受试者的疲劳/虚弱评分（P=0.006，P<0.001），但2个RIPC训练组间差异无统计学意义；3组间头痛评分和消化道症状评分差异无统计学意义（表2）。变压训练组和恒压训练组AMS评分≤1分的比例分别为50.0%（P=0.020）和64.0%（P=0.001）均高于对照组（19.2%），但2组间差异无统计学意义（表3）。
2.4　生命体征变化情况
模拟海拔4 500 m暴露7 h后，对照组、变压训练组和恒压训练组受试者的HR均较平原时显著增高（P<0.001），SpO2均较平原时显著降低（P<0.001）；各组受试者的SBP和DBP较平原训练前无显著变化。3组间SBP、DBP、HR和SpO2差异均无统计学意义（表4）。
2.5　脑组织氧合情况
模拟海拔4 500 m暴露7 h后，3组受试者CTOI均较基线显著降低（P<0.001）；变压训练组和恒压训练组CTOI均高于对照组，但差异无统计学意义。变压训练组和恒压训练组脑氧饱和度下降幅度（Δ cerebral tissue oxygenation index，ΔCTOI）均低于对照组（P=0.010，P=0.042），但2组间ΔCTOI的差异无统计学意义（表5）。对所有受试者的CTOI值和AMS症状评分进行相关性分析，结果显示出负相关性（r=-0.254，P=0.026）。
3　讨论
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3.1　RIPC对AMS的改善作用及潜在机制
本研究结果显示，经过14 d的RIPC训练后，两种模式训练组的AMS发病率及评分均显著低于对照组，尤其是头晕、疲劳/虚弱等典型症状的缓解更为明显。这一结果与既往研究相似［12-13］，表明RIPC可能通过多重机制增强机体对高原低氧暴露的耐受能力。RIPC的生理保护效应可能涉及缺血再灌注触发的内源性保护通路，如腺苷释放、抗氧化应激增强、线粒体功能调节以及炎症反应抑制等［20-22］，这些机制可能协同作用于心血管和神经系统，改善微循环灌注，减少氧化损伤，从而缓解AMS相关症状［23-25］。此外，本研究结果表明，进入4 500 m模拟高原环境后脑组织氧合显著降低，而2种压力模式的双上肢RIPC训练均可减缓这种因高原暴露引起的CTOI下降，这与李悦等［26］在模拟4 000 m海拔暴露2 h后的检测结果一致。RIPC训练可改善脑血管的调节功能［27］，TOI下降幅度的减少提示RIPC可能通过改善脑血流，维持脑组织氧供需平衡，减轻低氧对中枢神经系统的直接影响。同时大脑氧饱和度下降与肌力的下降显著相关［28］，RIPC训练可以通过减轻脑组织氧合下降，改善肌力，改善高原活动能力，减轻头晕和疲劳感，进而降低AMS的发生风险。
3.2　两种不同压力模式上肢RIPC训练的效果对比
变压模式（基于个体SBP+40 mmHg）与恒压模式（固定200 mmHg）在阻断压力设定上存在差异，但2组在AMS发病率、症状评分、评分分布及ΔCTOI方面均无显著差异。这可能提示两种模式均达到了有效的缺血刺激阈值。以往的训练中上肢RIPC训练常以固定压力进行［29］，然而，个体血压差异可能影响恒压模式的实际效果，例如低血压或高血压人群可能因固定压力导致刺激不足或过度。以变压模式进行双上肢RIPC训练，其在提供有效训练效果的同时，降低了训练压力，减轻训练者的不适感［16］，减轻其对高阻断压力的畏惧心理，避免形成过度压迫或无效阻断，使训练更具个性化。
AMS是进入高原人群的常见反应，是人体无法适应高原低压低氧环境所致。高原低压低氧环境对身体的病理生理影响，通常可以通过下降高度或减缓上升速度来减轻［30-31］，而在飞机作为主要交通工具的今天，在急进高原前的快速习服显得非常重要。但目前的促高原习服方法中，化学药物治疗存在副作用大、起效时间缓慢等问题［32］，通过模拟舱和实验室进行低氧习服存在场地、设备等条件要求高的缺点［32-33］，且在模拟舱内进行习服训练时，若出现严重不适，则存在急救保障难的问题［34］。本研究表明，短期RIPC训练作为一种非侵入性、低成本的干预手段，能够显著提升高原习服能力。同时两种压力模式的等效性提高了RIPC训练实际应用的灵活性：恒压模式操作简便［26］，适合大规模推广；而变压模式可能更适应个体血压差异，尤其在血压波动较大的人群中更具优势。出行者可结合高原旅行的任务特点，选择适宜模式进行训练。
本研究的不足之处在于：①由于较低和较高阻断压力的气囊膨胀程度和缺血效果明显不同，在2周的训练期间很难对受试者设盲，对照组未进行假RIPC训练，因此，不能排除安慰剂效应对结果的影响。但是3组间头痛、消化道症状和生命体征等指标无显著不同，表明安慰剂效应很小；②本研究样本量较小且仅纳入男性受试者，结果外推至女性或特殊人群需谨慎；③本研究在训练和模拟高海拔环境的评估期间未严格控制受试者的饮食，而不同的饮食习惯可影响急进高原人员消化道症状［35］，这可能影响RIPC对高原胃肠道症状作用的评估；④模拟高原环境与真实高原在气候、运动负荷等方面存在差异，需后续实地验证。未来研究需进一步探讨基于个体化血压调整的RIPC方案是否更具普适性。
综上所述，本研究通过对比两种不同压力模式的双上肢RIPC训练对急进模拟4 500 m海拔成年男性AMS的影响，发现变压模式与恒压模式的RIPC训练均能显著降低AMS发病率，减轻AMS严重程度，并有效缓解脑氧饱和度的下降。这一结果为急进高原人群的适应性训练提供了灵活有效的促习服方法选择，同时也为RIPC在高原习服中的应用拓展了研究方向。

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2025年第47卷第9期
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doi: 10.16016/j.2097-0927.202412016
  • 接收时间：2024-12-05
  • 首发时间：2026-10-28
  • 出版时间：2025-05-15
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  • 收稿日期：2024-12-05
  • 修回日期：2025-03-07
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    1陆军军医大学（第三军医大学）第二附属医院麻醉科，重庆
    2联勤保障部队第九四四医院麻醉科，甘肃 酒泉
    3联勤保障部队第九六〇医院麻醉科，山东 济南

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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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