Article(id=1322934460462805810, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322934434474885947, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202409111, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726675200000, receivedDateStr=2024-09-19, revisedDate=1727798400000, revisedDateStr=2024-10-02, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341754308, onlineDateStr=2026-10-30, pubDate=1736870400000, pubDateStr=2025-01-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341754308, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341754308, creator=13701087609, updateTime=1793341754308, updator=13701087609, issue=Issue{id=1322934434474885947, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='1', pageStart='1', pageEnd='99', issueExtLink='null', onlineDate='null', pubDate='1736870400000', pubDateStr='2025-01-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341748111, creator='13701087609', updateTime=1793341748111, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1, endPage=9, ext={EN=ArticleExt(id=1322934460697686835, articleId=1322934460462805810, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Training methods for high-altitude acclimatization and its applications in military, columnId=1320434417353470541, journalTitle=Journal of Army Medical University, columnName=Expert Review, runingTitle=null, highlight=null, articleAbstract=

The unique geography,climate,and natural conditions of plateaus pose significant challenges to the physical health and combat effectiveness of stationed troops. In high-altitude regions,maladaptation can lead to acute mountain sickness,such as high-altitude pulmonary edema and high-altitude cerebral edema. Previous studies have shown that gradual acclimatization is an effective strategy for preventing and mitigating altitude sickness. Additionally,non-pharmacological strategies such as intermittent hypoxia and pre-simulated altitude training have also been proven to effectively promote altitude acclimatization. Conventional acclimatization strategies take longer time and are not conducive to rapid deployment of military personnel. In this article,we review various acclimatization training for individuals entering high-altitude areas,in order to provide a reference for the research and application of scientific and efficient altitude acclimatization training strategies.

, authors=Yongchun WANG, Jiaxiang LI, authorsList=Yongchun WANG, Jiaxiang LI, authorCompany=null, correspAuthors=Yongchun WANG, 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=1322934461255529270, articleId=1322934460462805810, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=高原习服的训练方法及其在军事中的应用, columnId=1320434417496076879, journalTitle=陆军军医大学学报, columnName=专家述评, runingTitle=null, highlight=null, articleAbstract=

高原特殊的地理、气候、自然条件给驻训官兵的生理健康和作战效能带来极大挑战。在高海拔地区,适应不良会导致机体出现高原肺水肿、脑水肿等急性高原病。既往研究表明,阶梯习服是预防和减轻高原反应的有效策略。此外,间歇性低氧和预先模拟海拔训练等非药物预防措施也被证明可以有效促进高原习服。传统的习服策略需要较长时间,不利于军事人员快速进入高原。本文综述了针对进入高海拔地区人群的不同习服方法,以此为科学高效的高原习服训练策略研究和应用提供参考。

, authors=王永春, 李嘉翔, authorsList=王永春, 李嘉翔, authorCompany=null, correspAuthors=王永春, authorNote=null, correspAuthorsNote=
王永春,博士,教授,博士研究生导师,空军军医大学航空航天医学系航空航天医学训练教研室主任。国家重点学科和军队重点学科组成学科骨干成员,教育部创新团队以及教育部重点实验室学科重要成员,第四军医大学精英人才计划资助和“珠峰工程”军事医学人才资助对象。长期从事航空航天飞行环境对人体不良影响及防护的相关教学研训工作。近五年以第一负责人获国家自然科学基金、军队重点等10余项课题资助,发表论文30多篇,其中SCI论文10余篇,获得软件著作权专利9项。主编3部、副主编1部本科生规划教材。兼任陕西省医学会航空航天医学分会常务委员,陕西省生理学会理事,航空卫勤与卫生训练分委会委员。E-mail:
WANG Yongchun,E-mail:
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高原习服的训练方法及其在军事中的应用
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王永春 , 李嘉翔
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高原习服的训练方法及其在军事中的应用
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王永春 , 李嘉翔
作者信息
  • 1空军军医大学航空航天医学系航空航天医学训练教研室,陕西 西安
通讯作者:
王永春,博士,教授,博士研究生导师,空军军医大学航空航天医学系航空航天医学训练教研室主任。国家重点学科和军队重点学科组成学科骨干成员,教育部创新团队以及教育部重点实验室学科重要成员,第四军医大学精英人才计划资助和“珠峰工程”军事医学人才资助对象。长期从事航空航天飞行环境对人体不良影响及防护的相关教学研训工作。近五年以第一负责人获国家自然科学基金、军队重点等10余项课题资助,发表论文30多篇,其中SCI论文10余篇,获得软件著作权专利9项。主编3部、副主编1部本科生规划教材。兼任陕西省医学会航空航天医学分会常务委员,陕西省生理学会理事,航空卫勤与卫生训练分委会委员。E-mail:
WANG Yongchun,E-mail:
Training methods for high-altitude acclimatization and its applications in military
Yongchun WANG , Jiaxiang LI
Affiliations
  • 1Department of Aerospace Medical Training,School of Aerospace Medicine,Air Force Medical University,Xi’an,Shaanxi,China
出版时间: 2025-01-15 doi: 10.16016/j.2097-0927.202409111
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高原特殊的地理、气候、自然条件给驻训官兵的生理健康和作战效能带来极大挑战。在高海拔地区,适应不良会导致机体出现高原肺水肿、脑水肿等急性高原病。既往研究表明,阶梯习服是预防和减轻高原反应的有效策略。此外,间歇性低氧和预先模拟海拔训练等非药物预防措施也被证明可以有效促进高原习服。传统的习服策略需要较长时间,不利于军事人员快速进入高原。本文综述了针对进入高海拔地区人群的不同习服方法,以此为科学高效的高原习服训练策略研究和应用提供参考。

急性高原反应  /  习服  /  高原训练  /  军事训练

The unique geography,climate,and natural conditions of plateaus pose significant challenges to the physical health and combat effectiveness of stationed troops. In high-altitude regions,maladaptation can lead to acute mountain sickness,such as high-altitude pulmonary edema and high-altitude cerebral edema. Previous studies have shown that gradual acclimatization is an effective strategy for preventing and mitigating altitude sickness. Additionally,non-pharmacological strategies such as intermittent hypoxia and pre-simulated altitude training have also been proven to effectively promote altitude acclimatization. Conventional acclimatization strategies take longer time and are not conducive to rapid deployment of military personnel. In this article,we review various acclimatization training for individuals entering high-altitude areas,in order to provide a reference for the research and application of scientific and efficient altitude acclimatization training strategies.

acute mountain sickness  /  acclimatization  /  high-altitude training  /  military training
王永春, 李嘉翔. 高原习服的训练方法及其在军事中的应用. 陆军军医大学学报, 2025 , 47 (1) : 1 -9 . DOI: 10.16016/j.2097-0927.202409111
Yongchun WANG, Jiaxiang LI. Training methods for high-altitude acclimatization and its applications in military[J]. Journal of Army Medical University, 2025 , 47 (1) : 1 -9 . DOI: 10.16016/j.2097-0927.202409111
高原地区氧气稀薄、气温低、紫外线强等环境特点是影响官兵驻训期间健康水平的重要因素。随着海拔的升高,氧气分压急剧下降,高原低氧环境可引起机体呼吸、循环、血液、运动等多系统出现生理病理改变,导致官兵的体能、认知和作业能力明显降低,影响驻训官兵应急应战任务的顺利完成。其中,急性高原反应或急性高山病(acute mountain sickness,AMS)是发病率最高、影响最广泛的急性高原病。AMS多发生于未适应者在进入海拔2 500 m以上后的6~12 h内,常表现为头痛、恶心、嗜睡、疲劳、虚弱和失眠等症状,其严重程度与上升速度、暴露高度、体力消耗强度、水合状态及个体差异等因素密切相关。
高原习服是指机体从平原进入高原环境后为适应低压低氧条件而产生的一种非遗传、可逆的形态或生理改变。截至目前,高原习服训练依然是提高机体适应能力、预防高原损伤发生的最有效措施。科学有效的高原习服训练对于减少高原疾病的发生,保障部队官兵的环境适应能力和战斗力具有重要的现实意义和军事意义。如何开展高原习服训练,以促进高原习服快速形成、降低高原病的发生率,一直是高原军事医学研究的重点和热点。然而,目前有关高原习服认知仍然有限,传统高原训练方法已不适应于现代军事,因此亟需开展相关研究,探索更加高效、适应现代军事需求的高原训练策略(图1)。
经过数十年的研究,急性缺氧及其适应过程中的全身生理变化已得到广泛的证实[1]。高海拔的低压缺氧环境会引发一系列生理反应,包括肺通气、血液动力学、心血管、神经、代谢和体液平衡的变化。其中,缺氧通气反应(hypoxic ventilatory response,HVR)通过增加呼吸中枢的传入信号和呼吸肌的反射激活,提高呼吸潮气量和频率,是维持体内平衡的重要机制。急性高原暴露初期,交感神经激活迅速提高心率和全身血压。随着适应的进行,在高海拔前8~10 d内肺通气量逐渐增加并趋于平稳,心率逐渐下降。急性暴露 12 h后脑血流量增加,并在3~5 d的适应后恢复正常,从而保持脑氧供应。交感神经系统是脑血流的重要调节器,急性缺氧期间交感神经的兴奋作为适应性反应,调节氧输送和动脉血压[2]。高原暴露初期促红细胞生成素(erythropoietin,EPO)上调有助于维持血红蛋白浓度和动脉氧含量的增加。随着暴露时间的延长,红细胞生成和血容量的增加在3个月后减慢,8个月后趋于稳定。长期暴露于低氧环境可诱导血管生成,促进骨骼肌等组织的氧气输送和有氧代谢[3]。
高海拔的低氧环境会给机体带来诸多健康影响,药物治疗仍是防治AMS的主要手段,然而药物剂量和副作用之间的平衡仍存在争议,部分人群使用后出现不适反应,导致运动效能和作业能力下降等。目前仍缺乏安全有效的防护手段,因此探索高原低氧习服的非药物干预措施,在高原损伤发生前实施干预尤为重要。
阶梯习服,包括缓慢上升和分期适应,是预防与高海拔有关疾病的主要策略之一。缓慢上升的原则是:在海拔2 500 m以上,每日上升速度应不超过500 m,其中上升高度每增加1 000~1 500 m就需要增加休息日,使日均上升高度低于500 m[4]。此外,也有研究建议每天上升速度为400 m[5]。分期适应是指在2 000~3 000 m的中等海拔停留数天以充分适应环境,再快速上升到更高海拔。FULCO等[6]研究表明,在海拔2 200 m进行6 d的适应可降低快速上升至4 300 m时AMS的发生率和严重程度。美国陆军环境医学研究所在高原习服指南中也提出了分期适应的训练方案[7]。目前公认的阶梯习服指南为:①尽可能逐步上升;②避免快速上升到海拔≥3 000 m;③海拔超过3 000 m后,每天上升应不超过300~500 m;④海拔超过3 000 m后,每上升1 000 m,则增加1 d的适应时间;⑤在上升到更高海拔(4 000 m)之前,在海拔1 500~2 500 m处停留4~6 d。阶梯习服技术作为常用的习服方法,已被证实能有效预防AMS,适用于需长期驻防和驻训的官兵。这种方法在大规模部队进入高原时便于实施。在内陆驻地部队进驻高原时,应选择1~3个中间海拔高度进行阶梯式习服,直到达到预定高度,并结合高原生理适应标准进行训练和健康监督。然而,该方法的缺点在于增加了高原驻防的准备适应期,不适用于需要快速部署的作战任务。
低氧预适应(hypoxic preconditioning,HPC)是通过周期性、短期反复暴露于一定海拔高度的缺氧环境来增强机体对高原环境耐受能力的方法。机体对低氧环境的适应可通过预缺氧的方式建立机体习服,其本质为生物进化上的内源性保护机制[8]。
间歇性低氧暴露(inter-mittent hypoxia exposure,IHE)作为一种低氧预适应策略,通过定期在低氧环境中暴露,逐步提高个体的适应能力。相比于传统的分级上升方法,IHE在降低高原反应风险方面表现出显著优势,已被广泛应用于科研、体育训练和军事医学领域。研究表明,IHE能够降低AMS的发生率和死亡率,并提高有氧耐力和无氧表现[9]。此外,IHE还可缓解与AMS相关的神经症状,增强认知功能并提升高海拔地区的情绪状态[10]。这些保护作用可能与改善血氧饱和度(pulse oxygen saturation,SpO2)、维持颅内压、降低炎症反应及脑损伤有关[11]。根据目前的研究,部队进驻前进行模拟海拔4 000 m的预缺氧,每天1.5~2.0 h,重复5~7 d,有较好的降低高原反应的效果[12-13]。IHE的持续效果受训练时间、方式和缺氧程度的影响,具有简便易行的特点,适用于基层部队,能够减轻卫勤保障负担并提升战斗力。结合当前的技术条件,我军常采用的模拟低氧的训练设备包括单人面罩式设备、低氧房间或帐篷。目前关于IHE的研究大多集中于实验室阶段,尚未广泛应用于部队的日常训练,且持续性尚不清楚,监测和评估体系有待完善。
间歇性低氧训练(inter-mittent hypoxia training,IHT)是一种通过短暂吸入低氧气体或暴露于低压室、缺氧帐篷或自然低氧环境并结合体育运动的训练方法。相比于IHE,IHT将低氧暴露与体育训练相结合,通常暴露时间为30 s至90 min,在训练期间施加短暂低氧压力,能够提高高原耐受力和运动表现。其机制可能包括增强糖酵解酶活性、肌肉缓冲能力和毛细血管密度以及刺激线粒体代谢和生物发生[14]。美军已有报道通过IHT方式训练官兵,以便在阿富汗山区的高原环境中快速部署部队[15]。然而,IHT在实施过程中也伴随潜在风险,如低氧血症、头痛和呼吸困难等不适症状[11]。此外,IHT与静息IHE持续时间的最佳比例尚未确定,需进一步研究以优化其应用策略。
低氧预适应在特殊军事环境中的应用具有重要意义。以往的高原驻训存在较长适应期,部队官兵受环境影响,战术行动迟缓,通常是先驻后训、先训后战,缺乏临战意识。而在紧急情况下,预适应技术可以帮助官兵在短时间内适应低氧环境。低氧预适应的应用可提升部队在高海拔地区的机动性和灵活性,可作为高原战备训练中的有效习服策略。
缺血预处理(ischemic preconditioning,IPC)是一种重要的生物保护机制,旨在通过施加一次或多次短暂的缺血与再灌注周期,以增强关键器官对随后的严重或持续缺血的耐受性。这一方法于1986年由MURRY等[16]首次提出,研究表明人工诱导缺血能够有效保护心肌免受后续缺血事件的损伤。最近的研究表明IPC可降低缺氧时的肺动脉收缩压,并且降低了AMS症状的严重程度[17]。除了临床应用,IPC在运动科学领域也被视为是提高运动表现的有效手段。一项关于IPC的Meta分析结果显示:该技术对有氧和无氧运动的表现均有积极影响[18]。其潜在生理效应包括组织氧合和血流、线粒体功能、内皮功能和能量需求的变化。因此,面对高海拔带来的生理挑战时,IPC的应用能够为训练者提供有力支持。
远端肢体缺血预处理(remote ischemic preconditioning,RIPC)通过短暂、非侵入性地对肢体进行人工缺血处理以减轻或预防远隔器官缺血缺氧损伤的方法。RIPC作为IPC的衍生物,不直接强调目标组织,而是通过其他器官的短暂和非致命缺血发挥保护作用。分析既往关于RIPC的研究发现[19-20],多次重复的RIPC在快速上升到高海拔之前显著增加HVR、降低AMS的严重程度,并缓解SpO2的下降和血压变化。同时,短期的RIPC干预,如在高海拔(3 680 m)暴露前进行7 d的干预,也能有效降低AMS发生率并改善空间记忆能力和睡眠质量[21]。李悦等[22]研究进一步表明,RIPC可通过缓解低压低氧引起的外周循环阻力下降,维持组织氧供,并减轻急进高原所致的心血管代偿性反应。此外,RIPC还能改善低氧暴露期间的局部氧合和有氧运动能力[23]。其后续血管反应性的测试还可用于预测高原训练损伤[24]。研究[25]显示,RIPC通过激活抗炎反应、神经和血管调节等内源性机制,增强缺氧保护和适应能力。
总体而言,与HPC所需严格低氧干预条件相比,RIPC具有操作简单、重复性好、安全性高等特点。对于跨域执行紧急任务以及高原驻训官兵前往更高海拔从事军事任务时,RIPC有助于官兵度过高原反应早期阶段。但RIPC的疗效可能因不同人群、治疗方案和海拔高度而有所不同,其通过激活内在防御系统提高高原耐受力的机制尚不明确。未来研究应重点确定合适的预处理生物标志物,以优化刺激和剂量的选择,并进一步探讨其具体机制。
随着对IPC研究的不断深入,血流限制训练(blood flow restriction,BFR)作为原理相似技术逐渐受到广泛关注,已成为运动科学与康复领域的重要研究热点。BFR主要通过外部压力限制四肢血流以增强训练效果[26]。在运动实践中,BFR以较低的负荷进行,通过增加局部缺氧和代谢应激,刺激合成代谢反应,诱导各种生长因子的释放,促进血管形成、神经适应和肌肉生长[27]。通过创造类似于高原训练的局部缺氧环境,提高机体氧气利用率和耐力表现。研究表明,BFR可改善肌肉的血流量和骨骼肌抗氧化功能[28]。国内研究显示,适当的局部缺氧并不会对身体造成损害,BFR训练对于高原世居人群维持和改善注意力定向功能具有潜在价值,且与低强度间歇训练的结合能有效改善执行功能[29]。在高原体能训练中,官兵可采用BFR训练,以较低的负荷减轻心肺系统的压力,同时提升局部肌肉的血液供应与氧气利用效率。BFR为高原环境中的军事训练提供了新的视角与实践应用。
既往研究表明,在低氧条件下保持适当强度的运动训练不仅有助于减少包括骨骼肌等多个组织和器官的损伤,还能显著提升官兵在高海拔和各类环境中的作战能力。高原训练作为提高身体素质和心肺功能的有效手段,是以运动能力提升为目的的习服训练。这一训练的有效性使其成为适应高原自然条件的积极方法[30]。近年来,训练理念从传统的“高住高训”转变为“高住低训”及其他组合训练策略。对于高原驻训的官兵而言,制定科学有效的训练方案,合理利用海拔高度引发的生理效应,最大限度地激发机体适应潜力,以降低AMS的发病率并提升作战能力,是当前研究和实践重点。
高住高训(live high train high,LHTH)是1种在高海拔环境中生活和训练的经典高原训练模型[31]。在体育领域中,LHTH通常在1 800~ 2 500 m海拔进行为期1个月的短期训练,分为适应、训练、恢复和下降等4个阶段。LHTH为机体提供持续的缺氧状态,促进中枢和外周适应,增加红细胞体积、提高血红蛋白质量(Hbmass)以及线粒体效率[32]。研究显示,海拔2 000 m以上的高海拔训练可以将Hbmass提高4%~7%,训练组受试者的运动表现显著优于未训练组[33]。然而,训练海拔过高会降低训练质量和强度,抵消有益的缺氧适应[34]。因此,初期适应阶段应安排低强度和低训练量的训练负荷,待官兵建立稳定的适应反应后逐渐增加训练强度和时间,以优化适应能力和训练效果,目前我军驻训官兵受制于地形条件多采用此方法进行体能训练。其次,LHTH主要目的在于提高运动员的运动表现,尤其适合于耐力性项目。官兵亦可通过短期LHTH方案来增强心肺功能和耐力。由于LHTH需要在高海拔地区较长时间停留,不适用于急进高原的军事任务。
高住低训(live high train low,LHTL)是由LEVINE[35]研究团队提出的一种高原训练模式。该方法通过居住在中等高原或模拟海拔高度(1 500~3 000 m)来适应缺氧,在海平面附近或较低海拔高度(0~1 200 m)进行训练,从而保持训练强度和量的同时,促进生理适应。研究表明,LHTL通常可使海平面的运动表现提高0.3%~7.7%。其生理机制包括增强肌肉的缓冲能力、提高糖酵解酶活性,以及增加血液中的氧转运能力和红细胞生成[36]。LHTL作为提高海平面运动表现的方式已被广泛接受和认可[37]。然而,这种方法需要频繁变换海拔高度往返训练和居住场地,所以合适的训练场所较为有限,运输成本较高。因此,针对高原驻训官兵,建设可供氧的高原体能训练室,模拟低海拔环境进行训练,有助于提高官兵训练质量。其次,对于即将进驻高原的官兵可提前制定计划选择在模拟低氧帐篷或低压方舱中睡眠实现高住低训,以缩短高原适应期。
低住高训(live low train high,LLTH)是1种现代体育训练方法,其核心在于在低海拔地区生活,同时在缺氧条件下进行训练。该方法具有对日常生活干扰较小和易于实施的优点。LLTH通常每次持续不到2 h,每周2~5次,避免在缺氧状态下睡眠保障了良好的睡眠质量和恢复效果。LLTH包括多种方式[38],自愿低肺容量低通气训练(voluntary hypoventilation at a low lung volume,VHL)、缺氧重复冲刺训练(repeated sprint training in hypoxia,RSH)以及缺氧阻力训练(resistance training in hypoxia,RTH)等,各种方式旨在最大化训练效果、提升运动表现。RTH是在低氧环境下进行抗阻训练以提高肌肉力量和功率的训练手段。BFR多用于四肢训练,而RTH则是在低氧条件下的全身抗阻训练。研究人员发现RTH可通过降低血压和抗氧化作用改善身体功能,对改善肌萎缩有显著作用,但在高原习服中的应用较少。RSH是在低氧条件下进行的高强度训练模式,通过不完全恢复的短跑冲刺,增加代谢压力[39]。其机制通过氧传感途径和肌肉适应机制,提高磷酸肌酸合成速率和耐力表现。VHL是通过短时间高强度运动与呼气末屏气交替进行的训练方法。研究表明,VHL可使机体产生强烈的缺氧效应[40]。经过数周训练,训练者的无氧表现有所提高。这可能得益于更高的氧气摄取、恢复期间肌肉再氧合的增强,从而延迟肌肉疲劳。
随着技术的不断进步,LLTH在高原训练领域的可行性显著提升。首先,在平原驻地进行模拟低氧环境训练,可帮助参训者在平原环境下快速突破体能增长瓶颈。其次,低海拔环境生活保障睡眠并促进了机体恢复。但目前这些训练方法在高原习服中的研究仍较少,现有研究多侧重于通过低氧训练的方式提高运动能力,未来可进一步针对上述方案展开深入研究。
目前,上述主要的训练策略已被广泛应用于相关领域。除了这些常见的适应训练方式外,研究人员正致力于探索不同方法的组合以最大限度发挥各自的潜能。例如,间歇性低氧-高氧训练(intermittent hypoxia-hyperoxia training,IHHT)是间歇性缺氧衍生而来的一种新兴措施,其机制为缺氧-高氧的交替循环[41]。与单独间歇性缺氧相比,IHHT可有效地限制心脏和大脑的氧化损伤并促进缺氧后的恢复[42]。LHTL和RSH的组合称为高住高练低训(live high-train low and high,LHTLH),即在高海拔地区进行低强度训练,而在低海拔地区进行缺氧高强度训练,可增强个体对缺氧的耐受性和心肺功能。研究[43]报道,仅2周的LHTLH能够显著提高有氧和无氧的适应能力,并且在3周内都有较好的维持效果。间歇性低氧间歇训练(intermittent hypoxic exposure with interval training,IHIT)是1种在同一训练过程中交替进行低氧和常氧训练的方法[41]。此外,全身低氧和血管阻断的结合的训练方法,例如BFR+RTH或BFR+RSH可以最大化训练刺激[44]。这些综合训练策略不仅能够增强训练效果,还为训练多样性提供了新的思路。然而,这些组合训练方法间的对比研究仍较少,未来应通过更多实证研究探索其应用潜力并优化方案。
随着高海拔地区军事任务的增加,理解个体如何适应这种极端环境变得尤为重要。既往研究表明,具有高原旅居史人群由于先前的低氧适应,可能会在神经和肌肉系统中形成记忆效应,从而提升通气和氧合功能。当再次暴露于高原环境时,这种记忆效应能够迅速启动并刺激神经调节及其他系统的反馈反应。SUBUDHI等[45]研究发现,在极高海拔(5 260 m)环境下,先前经历低氧环境的个体重返高原时,部分适应性反应得以保留。国内学者[46-47]的研究显示:高原旅居次数越多,AMS及睡眠障碍发生率越低,身体对高原的适应能力越强,这可能与肺泡通气量、血液携氧能力的增加以及骨骼肌逐步适应有关。MACNUTT等[48]的研究也证实了这一点,先前适应的徒步旅行者在重返高原环境时,行走速度提高了20%,AMS症状减轻,用药量减少。综上所述,既往的高原暴露能有效减少AMS发生,并且高原暴露次数越多、时间越长,适应效应的持续时间越长[47-49]。因此,为满足高原训练的实战需求,推动高原训练的常态化,应适当增加部队进驻高原的次数,增强机体的记忆效应,提升部队对高原环境的适应能力。
人类对缺氧的反应从短期调整到各种生理系统的长期适应。如前文所述,反复的低氧暴露会产生累积的生理和分子适应。低氧累积效应的实现依赖于机体对长期低氧刺激的逐步适应,包括红细胞生成增加、SpO2提高、心肺功能增强等机制。研究[50]报道:士兵反复在3 500 m高原驻训后,Hbmass显著高于平原士兵。而在多年度高原训练计划中,连续4年高原训练后运动员的Hbmass较第1次高原训练时升高10%[51]。优秀的耐力运动员在奥运周期内通常会多次进行高原训练,以利用先前的适应及累积效应提升竞技表现[52]。同样,这一生理适应机制为高原军事人员的多次驻训提供了科学依据。
研究表明,过长或过强的缺氧暴露会损害训练和表现,而过短或过低的暴露不足以引发显著的生理适应。关于高原训练计划所需的最佳缺氧剂量的量化方法尚不完善,理想的低氧剂量应最大化地提高生理益处。缺氧剂量的基本变量包括低氧暴露的严重程度、持续时间、频率、类型和模式。GARVICAN-LEWIS等[53]提出用“km×h”衡量缺氧剂量,基于模拟海拔高度和暴露时间量化高海拔暴露的外部负荷。现有研究多将SpO2作为反映内部负荷的重要指标[54]。鉴于个体对低氧环境的反应存在显著差异,有学者提出使用SF指数[55],即SpO2与FiO2的比率作为量化个体低氧反应的工具。这些指标的探索有助于制定更加个体化的低氧训练方案。在平衡训练效益与风险的基础上,合理安排低氧训练的剂量和强度是实现最佳适应效果的关键。
随着国际形势日趋复杂,军事人员频繁赴高原地区执行任务,快速提高其在高原环境中的适应能力,维持部队的战斗力并减少非战斗减员,已成为亟待解决的问题。高原低氧训练具有巨大潜力,能够提高生理适应性和运动表现,已在全球范围各个领域得到广泛应用。首先,建议将低氧训练纳入日常生活和训练计划中,合理利用低氧记忆效应和累积剂量效应,进一步研究开发预防措施,以支持军事快速部署和减少非战斗性伤害。其次,不同的适应策略针对不同的高原任务各有侧重和优势,可根据任务需求灵活调整,提高官兵在不同高原任务中的适应能力。目前关于官兵进驻到高海拔地区的训练研究报道较少,现有研究仍处于初级阶段,缺乏对缺氧参数(持续时间、暴露频率和海拔高度)的深入研究及不同群体的系统评估。因此,需要系统研究军事人员在高原环境下的训练方式、预警预防和诊断治疗,为部队高原驻训、军事行动以及降低非战斗减员等方面提供重要的数据支持和保障。

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doi: 10.16016/j.2097-0927.202409111
  • 接收时间:2024-09-19
  • 首发时间:2026-10-30
  • 出版时间:2025-01-15
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  • 收稿日期:2024-09-19
  • 修回日期:2024-10-02
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    1空军军医大学航空航天医学系航空航天医学训练教研室,陕西 西安

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王永春,博士,教授,博士研究生导师,空军军医大学航空航天医学系航空航天医学训练教研室主任。国家重点学科和军队重点学科组成学科骨干成员,教育部创新团队以及教育部重点实验室学科重要成员,第四军医大学精英人才计划资助和“珠峰工程”军事医学人才资助对象。长期从事航空航天飞行环境对人体不良影响及防护的相关教学研训工作。近五年以第一负责人获国家自然科学基金、军队重点等10余项课题资助,发表论文30多篇,其中SCI论文10余篇,获得软件著作权专利9项。主编3部、副主编1部本科生规划教材。兼任陕西省医学会航空航天医学分会常务委员,陕西省生理学会理事,航空卫勤与卫生训练分委会委员。E-mail:
WANG Yongchun,E-mail:
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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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