Effect of high-altitude exposure in the elderly - The Tenth Mountain Division Study
Effect of high-altitude exposure in the elderly - The Tenth Mountain Division Study
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DOI：
10.1161/01.cir.96.4.1224
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发表时间：
1997-08-19
期刊：
影响因子：
37.8
通讯作者：
deFilippi, CR
中科院分区：
文献类型：
--
作者：
Levine, BD;Zuckerman, JH;deFilippi, CR
研究背景60岁以上老年人每年有500多万人进入高原，可能会加重心肺疾病，我们假设老年人在高原会表现出功能受损，心肌缺血与海拔(SL)相比增加。方法与结果20名退伍军人(68+/-3年)进入高原(1)SL，(2)急性模拟海拔2500米，(3)急性高原5天后，PaO(2)和氧合血红蛋白饱和度下降，肺动脉压升高43%，并伴有交感神经兴奋。Vo(2峰)急剧下降12%，但驯化后恢复正常。Vo(2峰)与急性海拔高度的预测最好的是SL处的Vo(2峰)(r=0.94)。急性高原运动时诱发L-mm ST段压低的倍积比SL降低5%，但习服后恢复正常。1例严重冠心病患者在运动试验后发生心肌梗死。结论中度高原暴露与老年人低氧血症、交感神经兴奋和肺动脉高压有关，导致运动能力降低，这是基于SL运动能力的预测。在SL得到很好补偿的冠心病患者在中等海拔地区表现良好，尽管心肌和全身作业率略低时可能会引发急性缺血。老年人在5天后SL表现恢复正常，适应良好。对于老年人，特别是那些患有冠状动脉疾病的老年人，一个谨慎的政策是在高原的头几天限制他们的活动，以允许这种适应过程发生。
Background More than 5 million people/year over age 60 visit high altitude, which may exacerbate underlying cardiac or pulmonary disease, We hypothesized that the elderly would exhibit an impaired functional capacity at altitude, with increased myocardial ischemia compared with sea level (SL).Methods and Results Twenty veterans (68+/-3 years) were studied at (1) SL, (2) acute simulated altitude to 2500 m, and (3) after 5 days of acclimatization to 2500 m, With acute altitude, Pao(2) and oxyhemoglobin saturation decreased and pulmonary artery pressure increased 43%, associated with sympathetic activation. Vo(2peak) decreased 12% acutely but normalized after acclimatization. The best predictor of Vo(2peak) with acute altitude was Vo(2peak) at SL (r=.94). The double product that induced l-mm ST depression during exercise with acute altitude was 5% less than SL but normalized after acclimatization. One patient with severe coronary disease sustained a myocardial infarction after an exercise test.Conclusions Moderate altitude exposure in the elderly is associated with hypoxemia, sympathetic activation, and pulmonary hypertension resulting in a reduced exercise capacity that is predictable based on exercise performance at SL. Patients with coronary artery disease who are well compensated at SL do well at moderate altitude, although acutely ischemia may be provoked at modestly lower myocardial and systemic work rates. The elderly acclimatize well with normalization of SL performance after 5 days. A prudent policy would be for elderly Individuals, particularly those with coronary artery disease, to limit their activity during the first few days at altitude to allow this acclimatization process to occur.