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摘要: 目的 分析高海拔缺氧严重程度对提示心室传导障碍的QRS波群的影响。方法 选取高海拔地区(海拔3400~5400 m)375例青年官兵作为观察组，另选取海平面地区(海拔0~40 m)121例青年官兵作为对照组，所有研究对象均非高海拔出生及生长。根据缺氧严重程度将观察组分为两组：中度缺氧组(SPO2≥90%)和重度缺氧组(SPO2 < 90%)。记录静息12导联心电图，QRS参数包括QRSmax、QRS时限、电轴和fQRS的发生。结果 与对照组相比较，中、重缺氧组的QRS电轴[(67.54±20.31)°∶(79.86±49.65)°；(67.54±20.31)°∶(93.29±42.30)°]和QRSmax[(1.89±0.57)mV∶(2.15±0.69)mV；(1.89±0.57)mV∶(2.29±0.81)mV]均明显升高，差异有统计学意义(P＜0.05)。其中，重度缺氧组QRS电轴右偏的值显著高于中度缺氧组及对照组；在QRS电轴正常的人群中，中、重度缺氧组的QRSmax明显高于对照组，差异有统计学意义(P＜0.05)。fQRS的发生率在组间的差异亦有统计学意义(P＜0.05)。结论 高海拔缺氧环境会导致健康青年官兵的亚临床心电图改变，如出现QRS波群形态的改变，心电轴向右偏移，高QRSmax和fQRS，提示高海拔地区青年官兵更有可能发生心室传导障碍和右心室肥厚。Abstract: Objective To analyze the effect of high altitude hypoxia severity on QRS complex suggestive of ventricular conduction disorder.Methods A total of 375 young soldiers at high altitude area(3400~5400 m) were selected as the observation group. The 121 young soldiers at sea level area(0~40 m) were selected as the control group. None of the subjects were born or raised at high altitude. According to the severity of hypoxia, the observation group was divided into two groups: moderate hypoxia group(SPO2≥90%) and severe hypoxia group(SPO2 < 90%). Resting 12-lead ECG was recorded. The QRS parameters included QRSmax, QRS duration, and occurrence of fQRS.Results Compared with the control group, the QRS axis[(67.54±20.31)° vs (79.86±49.65)°; (67.54±20.31)° vs (93.29±42.30)°] and QRSmax[(1.89±0.57)mV vs (2.15±0.69)mV; (1.89±0.57)mV vs (2.29±0.81)mV] of the moderate and severe hypoxia groups were significantly increased, and the difference was statistically significant(P < 0.05). Among them, the right deviation of QRS axis in the severe hypoxia group was significantly higher than that in the moderate hypoxia group and the control group. In the population with normal QRS axis, the QRSmax in the moderate and severe hypoxia group was significantly higher than that in the control group, and the difference was statistically significant(P < 0.05). There was also a statistically significant difference in the incidence of fQRS between the groups(P < 0.05). Compared with the moderate hypoxia group and the control group, the incidence of fQRS in the severe hypoxia group was significantly higher, and the difference was statistically significant(P < 0.05).Conclusion High-altitude hypoxia environment can lead to subclinical ECG changes in healthy young officers and soldiers, such as changes in QRS complex shape, rightward deviation of the ECG axis, high QRSmax and fQRS, which indicated that young officers and soldiers in high altitude areas were more likely to suffer from ventricular conduction disturbance and right ventricular hypertrophy.
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Key words:
- high altitude /
- QRS complex /
- electric axis /
- fragmented QRS
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图 1 QRS电轴正常和右偏的QRS在不同组中的分布
Figure 1. Distribution of QRS with normal and right-biased QRS axis in different groups
图 2 QRS电轴正常和右偏的QRSmax在不同组中的分布
Figure 2. Distribution of QRSmax with normal and right-biased QRS axis in different groups
表 1 青年男性官兵的基线资料组间比较
Table 1. General data
X±S 变量 对照组(121例) 中度缺氧组(165例) 重度缺氧组(210例) F/t/χ2 P值 年龄/岁 21.10±1.39 21.42±1.51 21.31±1.46 1.685 0.187 驻藏时间/年 — 2.09±1.73 2.22±1.99 -0.677 0.499 海拔高度/m — 3778.10±306.27 4425.68±558.533) -13.393 ＜0.001 血氧饱和度/% 98.32±0.66 91.90±1.622) 85.03±3.782)3) 996.69 ＜0.001 SBP/mmHg 114.00±11.18 115.50±11.90 116.54±11.50 1.470 0.231 DBP/mmHg 63.54±7.01 76.93±8.912) 77.02±8.002) 123.381 ＜0.001 RHR /(次·min-1) 61.93±8.71 71.47±12.732) 77.21±13.142)3) 61.525 ＜0.001 QRSmax/mV 1.89±0.57 2.15±0.692) 2.29±0.812) 11.575 ＜0.001 QRS时限/ms 98.28±8.76 96.08±12.0 97.72±13.23 1.413 0.244 QRS电轴/° 67.54±20.31 79.86±49.651) 93.29±42.302)3) 15.684 ＜0.001 QRS电轴/例(%) 54.515 ＜0.001 正常 111(91.7) 99(60.0) 123(58.6) 右偏 10(8.3) 59(35.8) 86(41.0) 左偏 0(0) 7(4.2) 1(0.4) fQRS(+)/例(%) 6(5.0) 9(5.5) 31(14.8) 13.055 ＜0.001 与对照组比较，1)P＜0.05，2)P＜0.01；与中度缺氧组比较，3)P＜0.01。 
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