THE COST TO THE CENTRAL NERVOUS-SYSTEM OF CLIMBING TO EXTREMELY HIGH-ALTITUDE
THE COST TO THE CENTRAL NERVOUS-SYSTEM OF CLIMBING TO EXTREMELY HIGH-ALTITUDE
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DOI：
10.1056/nejm198912213212505
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发表时间：
1989-12-21
影响因子：
158.5
通讯作者：
HOUSTON, CS
中科院分区：
文献类型：
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作者：
HORNBEIN, TF;TOWNES, BD;HOUSTON, CS
为了评估攀登极高海拔可能导致大脑缺氧损伤的可能性，我们对35名登山者在攀登海拔5488 - 8848米之前和之后1 - 30天进行了神经心理和生理测试，并对6名受试者在攀登海拔8848米40天的模拟之前和之后进行了测试。神经心理测试显示，与登山前相比，登山后视觉长期记忆有所下降；在韦氏记忆量表上的14项视觉信息中，模拟攀登组和模拟攀登组在攀登后回忆起的信息较少(平均值[.+-]。SD值为10.14。以前是1.68项，而现在是7.00项。3.35项后；P < 0.05)，登山运动员(12.33 .+-。1.96比11.36。1.88;P < 0.05)。言语长期记忆也受到影响，但仅限于模拟上升组；在总共10个单词中，平均8.14 .+-。在模拟爬坡前召回了1.86辆，但只有6.83辆。1.47 （P < 0.05）。在失语筛查测试中，正常人在言语表达上的平均错误不超过一次，登山运动员在登山后的失语错误率是正常人的两倍(1.03 .+-。1.10)和以前一样(0.52 .+-。0.80;P < 0.05)。缺氧时较高的通气反应与上升后言语学习能力下降（r = -0.88, P < 0.05）和长期言语记忆能力下降（r = -0.99, P < 0.01）相关。在模拟攀登组（r = 0.94, P < 0.01）和11名登山者亚组（r = 0.59, P < 0.05）中，失语筛查测试中失语错误数量的增加也与较高的缺氧通气反应相关。我们的结论是，对缺氧有更强烈通气反应的人在返回低海拔后有更多残留的神经行为障碍。这一发现可以解释为，尽管通气更大，但大脑的氧合更差，这可能是因为低碳酸血症导致的脑血流量减少，超过了动脉氧饱和度的增加。
To assess the possibility that climbing to extremely high altitude may result in hypoxic injury to the brain, we performed neuropsychological and physiologic testing on 35 mountaineers before and 1 to 30 days after ascent to altitudes between 5488 and 8848 m, and on 6 subjects before and after simulation in an altitude chamber of a 40-day ascent to 8848 m. Neuropsychological testing revealed a decline in visual long-term memory after ascent as compared with before; of 14 visual items of information on the Wechsler Memory Scale, fewer were recalled after ascent by both the simulated-ascent group (a mean [.+-. SD] of 10.14 .+-. 1.68 items before, as compared with 7.00 .+-. 3.35 items after; P < 0.05) and the mountaineers (12.33 .+-. 1.96 as compared with 11.36 .+-. 1.88; P < 0.05). Verbal long-term memory was also affected, but only in the simulated-ascent group; of a total of 10 words, an average of 8.14 .+-. 1.86 were recalled before simulated ascent, but only 6.83 .+-. 1.47 afterward (P < 0.05). On the aphasia screening test, on which normal persons make an average of less than one error in verbal expression, the mountaineers made twice as many aphasic errors after ascent (1.03 .+-. 1.10) as before (0.52 .+-. 0.80; P < 0.05). A higher ventilatory response to hypoxia correlated with a reduction in verbal learning (r = -0.88, P < 0.05) and with poor long-term verbal memory (r = -0.99, P < 0.01) after ascent. An increase in the number of aphasic errors on the aphasia screening test also correlated with a higher ventilatory response to hypoxia in both the simulated-ascent group (r = 0.94, P < 0.01) and a subgroup of 11 mountaineers (r = 0.59, P < 0.05). We conclude that persons with a more vigorous ventilatory response to hypoxia hae more residual neurobehavioral impairment after returning to lower elevations. This finding may be explained by poorer oxygenation of the brain despite greater ventilation, perhaps because of a decrease in cerebral blood flow caused by hypocapnia that more than offsets the increase in arterial oxygen saturation.