进行心肺运动试验能否预测登顶成功和急性高原病？极高海拔地区的一项前瞻性观察现场研究。

Do cardiopulmonary exercise tests predict summit success and acute mountain sickness? A prospective observational field study at extreme altitude.

机构信息

Department of Pulmonary Medicine, Inselspital,Bern University Hospital, University of Bern, Bern, Switzerland.

Institute of Clinical Chemistry, Inselspital University Hospital, University of Bern, Bern, Switzerland.

出版信息

Br J Sports Med. 2023 Jul;57(14):906-913. doi: 10.1136/bjsports-2022-106211. Epub 2023 Mar 10.

DOI:10.1136/bjsports-2022-106211

PMID:36898769

Abstract

OBJECTIVE

During a high-altitude expedition, the association of cardiopulmonary exercise testing (CPET) parameters with the risk of developing acute mountain sickness (AMS) and the chance of reaching the summit were investigated.

METHODS

Thirty-nine subjects underwent maximal CPET at lowlands and during ascent to Mount Himlung Himal (7126 m) at 4844 m, before and after 12 days of acclimatisation, and at 6022 m. Daily records of Lake-Louise-Score (LLS) determined AMS. Participants were categorised as AMS+ if moderate to severe AMS occurred.

RESULTS

Maximal oxygen uptake (V̇O) decreased by 40.5%±13.7% at 6022 m and improved after acclimatisation (all p<0.001). Ventilation at maximal exercise (VE) was reduced at 6022 m, but higher VE was related to summit success (p=0.031). In the 23 AMS+ subjects (mean LLS 7.4±2.4), a pronounced exercise-induced oxygen desaturation (ΔSpO) was found after arrival at 4844 m (p=0.005). ΔSpO >-14.0% identified 74% of participants correctly with a sensitivity of 70% and specificity of 81% for predicting moderate to severe AMS. All 15 summiteers showed higher V̇O (p<0.001), and a higher risk of AMS in non-summiteers was suggested but did not reach statistical significance (OR: 3.64 (95% CI: 0.78 to 17.58), p=0.057). V̇O ≥49.0 mL/min/kg at lowlands and ≥35.0 mL/min/kg at 4844 m predicted summit success with a sensitivity of 46.7% and 53.3%, and specificity of 83.3% and 91.3%, respectively.

CONCLUSION

Summiteers were able to sustain higher VE throughout the expedition. Baseline V̇O below 49.0 mL/min/kg was associated with a high chance of 83.3% for summit failure, when climbing without supplemental oxygen. A pronounced drop of SpO at 4844 m may identify climbers at higher risk of AMS.

摘要

目的

在一次高海拔探险中，研究了心肺运动测试（CPET）参数与高原反应（AMS）发病风险和登顶机会的关系。

方法

39 名受试者在低海拔和海拔 4844 米的 Himlung 喜马拉雅山（7126 米）进行最大 CPET，在 12 天适应期前后，以及在海拔 6022 米处进行 CPET，并记录每日的 Lake-Louise-Score（LLS）以确定 AMS。如果出现中度至重度 AMS，则将参与者归类为 AMS+。

结果

在海拔 6022 米处，最大摄氧量（V̇O）下降了 40.5%±13.7%，适应后有所改善（均<0.001）。最大运动时的通气量（VE）在海拔 6022 米处降低，但更高的 VE 与登顶成功相关（p=0.031）。在 23 名 AMS+受试者（平均 LLS 7.4±2.4）中，到达海拔 4844 米后发现明显的运动诱导血氧饱和度下降（ΔSpO）（p=0.005）。ΔSpO >-14.0%可正确识别 74%的参与者，其敏感性为 70%，特异性为 81%，可预测中度至重度 AMS。所有 15 名登顶者的 V̇O 更高（p<0.001），非登顶者发生 AMS 的风险更高，但未达到统计学意义（OR：3.64（95%CI：0.78 至 17.58），p=0.057）。低海拔时 V̇O≥49.0 mL/min/kg 和 4844 米时 V̇O≥35.0 mL/min/kg 可预测登顶成功，其敏感性分别为 46.7%和 53.3%，特异性分别为 83.3%和 91.3%。