Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA 01760, USA.
Oak Ridge Institute for Science and Education, 1299 Bethel Valley Road, Oak Ridge, TN 37830, USA.
Mil Med. 2020 Aug 14;185(7-8):e1161-e1167. doi: 10.1093/milmed/usaa041.
High altitude missions pose significant challenges to Warfighter medical readiness and performance. Decreased circulating oxygen levels cause a decrease in exercise performance and can cause debilitating symptoms associated with acute mountain sickness, especially with rapid ascent. Acetazolamide (AZ) is known to minimize symptoms of acute mountain sickness, but it is unknown whether this medication alters hand strength and manual dexterity during altitude exposure.
Ten male volunteers (22 ± 4 yr, 75.9 ± 13.7 kg, 174.9 ± 9.3 cm) participated in two separate 30 h simulated altitude exposures (496 mmHg, equivalent to 3,500 m, 20°C, 20% RH) in a hypobaric chamber. Participants were given either a placebo or 250 mg of AZ twice daily for 3.5 d (2 sea-level [SL] days + the 30 h altitude exposure) in a randomized, single-blind, crossover design. During SL and both altitude (ALT) exposures, hand function tests were performed, including hand grip and finger pinch strength tests, as well as the Purdue Pegboard (PP) and magazine loading tests to assess manual dexterity. Paired T tests and two-way repeated measure analysis of variance were used as appropriate to evaluate the effects of AZ and ALT. The value of p < 0.05 was accepted for statistical significance.
There were no influences of acute ALT exposure or AZ treatment on hand strength (eg, grip strength; SL: 39.2 ± 5.5 kg vs. ALT: 41.5 ± 6.9 kg, p > 0.05) or dexterity (eg, PPassembly; placebo: 35.5 ± 5.3 vs. AZ: 34.3 ± 4.6, p > 0.05) in our volunteers. Two dexterity tests (PPsum and magazine loading) showed improvements over time at ALT, regardless of treatment, where scores were improved after 10 h of exposure compared to at 1 h (eg, magazine loading: 56 ± 12 vs. 48 ± 10, p < 0.001). This pattern was not seen in the PPassembly test or any strength measurements.
Our results suggest that 500 mg/d of AZ does not influence hand strength or manual dexterity during a 30 h exposure to 3,500 m simulated ALT. Acute ALT exposure (1 h) did not influence dexterity or strength, although some measures of dexterity showed improvements as exposure time increased. We conclude that use of AZ to optimize medical readiness at ALT is unlikely to impair the Warfighter's ability to complete mission tasks that depend on hand function.
高海拔任务对作战人员的医疗准备和表现构成重大挑战。循环氧气水平降低会导致运动表现下降，并可能导致与急性高原病相关的使人虚弱的症状，尤其是在快速上升时。乙酰唑胺（AZ）已知可最大程度地减轻急性高原病的症状，但尚不清楚该药物是否会改变海拔暴露时的手力和手灵巧度。
10 名男性志愿者（22 ± 4 岁，75.9 ± 13.7kg，174.9 ± 9.3cm）在减压舱中分别参加了两次 30 小时的模拟海拔暴露（496mmHg，相当于 3500m，20°C，20%RH）。参与者以随机、单盲、交叉设计的方式，每日两次服用 250mg 的 AZ，为期 3.5 天（2 个海平面[SL]天+ 30 小时的海拔暴露）。在 SL 和 ALT 暴露期间，进行了手部功能测试，包括握力和手指捏力测试，以及普渡钉板（PP）和杂志装弹测试，以评估手的灵巧度。使用配对 T 检验和双向重复测量方差分析来评估 AZ 和 ALT 的影响。p 值<0.05 被认为具有统计学意义。
急性 ALT 暴露或 AZ 治疗对志愿者的手部力量（例如握力；SL：39.2 ± 5.5kg 与 ALT：41.5 ± 6.9kg，p>0.05）或灵巧度（例如 PPassembly；安慰剂：35.5 ± 5.3 与 AZ：34.3 ± 4.6，p>0.05）均无影响。两项灵巧度测试（PPsum 和杂志装弹）显示，无论治疗如何，在 ALT 上的时间都有所改善，与 1 小时相比，暴露 10 小时后的得分有所提高（例如，杂志装弹：56 ± 12 与 48 ± 10，p<0.001）。PPsum 测试或任何力量测量均未出现这种模式。
我们的结果表明，在 3500 米模拟 ALT 暴露 30 小时内，每天 500mg 的 AZ 不会影响手部力量或手的灵巧度。急性 ALT 暴露（1 小时）不会影响灵巧度或力量，尽管一些灵巧度测量值随着暴露时间的增加而有所提高。我们得出的结论是，使用 AZ 来优化 ALT 的医疗准备不太可能损害作战人员完成依赖手部功能的任务的能力。
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