地理环境差异对抵渝训练人员中暑发病率影响因素的初步研究
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摘要
目的分析来自不同地域部队人员抵渝后首日的中暑影响因素。方法 2018年8月对驻地为高原温带半干旱气候区(代号A)和温带大陆性气候区(代号B)的两部队人员来渝前、来渝中、来渝后的基本生活训练情况及中暑情况采用问卷调查法进行调查,将抵渝首日发生中暑的人员设为中暑组、未发生中暑的人员设为非中暑组,采用统计学方法分析两部队成员各自中暑发病情况及其影响因素。结果 2018年8月重庆市平均气温为28.3℃,根据中暑诊断标准,A部队与B部队在抵渝后首日发生中暑人数分别为12人(33.3%)、16人(48.6%)。A部队中暑组与非中暑组在机动过程中日均饮水量、日均睡眠时间、日均睡眠质量方面的差异具有统计学意义(P<0.05)。B部队中暑组与非中暑组在平时每周训练时间、抵渝首日饮水量方面的差异具有统计学意义(P<0.05)。Logistic多因素回归发现A部队机动过程中日均饮水量增加、日均睡眠质量增加是中暑的保护因素,B部队平常每周训练时间增加是中暑的保护因素。结论两部队驻地地理环境间(气候、海拔)的差异导致其各自成员抵渝后首日中暑的影响因素明显不同,提示对跨区域机动部队进行疾病防治时,需考虑驻地与任务地点地理环境的差异及可能引发的环境敏感性疾病。
Objective To analyze the factors contributing to heat stroke in troops from different regions on the first day after arrival in Chongqing. Methods Using a self-designed questionnaire, we investigated the daily activities, training, and the occurrence of heat stroke in 2 troops from 2 different regions before and during the transportation and after their arrival at Chongqing. The individuals having heat stroke on the first day of arrival served as the heat stroke group, and those without heat stroke served as the control group for comparison of the data to identify the factors contributing to heat stroke in the 2 troops. Results Twelve(33.3%) individuals in troop A and 16(48.6%) in troop B had heat stroke on the first day after arrival in Chongqing. In troop A, the volume of daily water intake, sleep time and sleep quality differed significantly between the individuals with heat stroke and those without during the transportation(P<0.05); In troop B, the weekly training time and the volume of water intake on the first day of arrival differed significantly between the heat stroke and non-heat stroke groups(P<0.05).Logistic multivariate regression showed that an increased mean daily water intake and improved daily sleep quality during transportation in troop A and a longer weekly training time in troop B were the protective factors against heat stroke. Conclusion The differences in the geographical environment in terms of climate and altitude between the 2 troops resulted in significant differences in the factors affecting the occurrence of heat stroke on the first day after their arrival, suggesting the importance of addressing the geographical differences between the stationing site and the mission site in designing measures for controlling environmentally sensitive diseases for the trans-regional mobile troops.
Objective To analyze the factors contributing to heat stroke in troops from different regions on the first day after arrival in Chongqing. Methods Using a self-designed questionnaire, we investigated the daily activities, training, and the occurrence of heat stroke in 2 troops from 2 different regions before and during the transportation and after their arrival at Chongqing. The individuals having heat stroke on the first day of arrival served as the heat stroke group, and those without heat stroke served as the control group for comparison of the data to identify the factors contributing to heat stroke in the 2 troops. Results Twelve(33.3%) individuals in troop A and 16(48.6%) in troop B had heat stroke on the first day after arrival in Chongqing. In troop A, the volume of daily water intake, sleep time and sleep quality differed significantly between the individuals with heat stroke and those without during the transportation(P<0.05); In troop B, the weekly training time and the volume of water intake on the first day of arrival differed significantly between the heat stroke and non-heat stroke groups(P<0.05).Logistic multivariate regression showed that an increased mean daily water intake and improved daily sleep quality during transportation in troop A and a longer weekly training time in troop B were the protective factors against heat stroke. Conclusion The differences in the geographical environment in terms of climate and altitude between the 2 troops resulted in significant differences in the factors affecting the occurrence of heat stroke on the first day after their arrival, suggesting the importance of addressing the geographical differences between the stationing site and the mission site in designing measures for controlling environmentally sensitive diseases for the trans-regional mobile troops.
引文
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[13] 申晋波,马春伟,黄亚鑫.合理睡眠对大学生体质影响的研究—以运城学院为例[J].搏击·武术科学,2015,12(12):125-128 .DOI:10.3969/j.issn.1004-5643(w).2015.12.050.SHEN J B,MA C W,HUANG Y X.The effect of reasonable sleep on the physical constitution of college students[J].Wushu Sci,2015,12(12):125-128.DOI:10.3969/j.issn.1004-5643(w).2015.12.050.
[14] 陈勇胜,王生成.高原低氧环境对睡眠和脑功能的影响[J].空军医学杂志,2012,28(3):150-153.CHEN Y S,WANG S C.Effects of high altitude hypoxia on sleep and brain function[J].Med J Air Force,2012,28(3):150-153.
[15] KINSMAN T A,TOWNSEND N E,GORE C J,et al.Sleep disturbance at simulated altitude indicated by stratified respiratory disturbance index but not hypoxic ventilator response[J].Eur J Appl Physiol,2005,94(5/6):569-575.DOI:10.1007/s00421-005-1368-6.
[16] CASA D J,ARMSTRONG L E,GANIO M S,et al.Exertional heat stroke in competitive athletes[J].Curr Sports Med Rep,2005,4(6):309-317.
[17] 李晓海,王爱红,王群利,等.高温热浪期间居民行为习惯变化与中暑的关联研究[J].环境与健康杂志,2017,34(6):509-512.DOI:10.16241/j.cnki.1001-5914.2017.06.010.LI X H,WANG A H,WANG L Q,et al.Relationship between residents ’ behavioral habits change and heat stroke during high temperature heat wave[J].J Environ Health,2017,34(6):509-512.DOI:10.16241/j.cnki.1001-5914.2017.06.010.
[18] 赵佳佳,宋青.热射病快速降温研究进展[J].解放军医学杂志,2014,39(10):838-842.DOI:10.11855/j.issn.0577-7402.2014.10.17.ZHAO J J,SONG Q.Advances in rapid cooling treatment for heat stroke[J].Med J Chin PLA,2014,39(10):838-842.DOI:10.11855/j.issn.0577-7402.2014.10.17.
[19] 齐兰兰,周素红,闫小培,等.医学地理学发展趋势及当前热点[J].地理科学进展,2013,32(8):1276-1285.DOI:10.11820/dlkxjz.2013.08.011.QI L L,ZHOU S H,YAN X P,et al.Trend and hot topics of medical geography[J].Prog Geogr,2013,32(8):1276-1285.DOI:10.11820/dlkxjz.2013.08.011.
[2] 李代波,曾岚,银涛,等.热区某特种部队中暑现状及个体易感因素调查研究[J].第三军医大学学报,2017,39(4):337-341.DOI:10.16016/j.1000-5404.201606171.LI D B,ZENG L,YIN T,et al.Survey on status and individual susceptible factors of heat stroke in a troop of special forces stationed in thermal region[J].J Third Mil Med Univ,2017,39(4):337-341.DOI:10.16016/j.1000-5404.201606171.
[3] 于晓华,郭建斌,卜爱文.夏季5 km武装越野训练预防中暑的几个关键环节[J].东南国防医药,2014,16(1):102-104.DOI:10.3969/j.issn.1672-271X.2014.01.037.YU X H,GUO J B,BU A W.Several key links to prevent heat stroke in 5 km armed off-road training in summer[J].Mili Med J Southeast China,2014,16(1):102-104.DOI:10.3969/j.issn.1672-271X.2014.01.037.
[4] 黄江燕,董力,邹贵勉,等.南战区军事训练中中暑因素的研究[J].华南国防医学杂志,2014,28(7):697-698.DOI:10.3969/j.issn.1009-2595.2014.07.025.HUANG J Y,DONG L,ZOU G M,et al.Study on the factors of heat stroke in military training in the southern theater[J].Mil Med J S Chin,2014,28(7):697-698.DOI:10.3969/j.issn.1009-2595.2014.07.025.
[5] 王利华,林淑瑜,黄阳.驻南方某部夏季野战训练官兵中暑情况调查及防治[J].人民军医,2013,56(4):416-417.WANG L H,LIN S Y,HUANG Y.Investigation and prevention of heat stroke among officers and men in summer field training in a certain station in the south[J].People Mili Surg,2013,56(4):416-417.
[6] 杨昌伟,刘善收,李俊杰,等.2013—2017年某部队附属医院急诊科255例中暑患者临床分析[J].解放军医药杂志,2018,30(4):107-110.DOI:10.3969/j.issn.2095-140X.2018.04.028.YANG C W,LIU S S,LI J J,et al.Clinical analysis of 255 heatstroke patients in emergency department of one military affiliated hospital from 2013 to 2017[J].Med Pharm J Chin PLA,2018,30(4):107-110.DOI:10.3969/j.issn.2095-140X.2018.04.028.
[7] 李莉莉,江伟.军事训练致重症中暑的综合治疗[J].中外医学研究,2011,9(28):12-13.DOI:10.3969/j.issn.1674-6805.2011.28.009.LI L L,JIANG W.Comprehensive treatment of severe heat stroke caused by military training[J].Chin Foreign Med Res,2011,9(28):12-13.DOI:10.3969/j.issn.1674-6805.2011.28.009.
[8] BERGERON M F,DEVORE C,RICE S G.Policy statement—Climatic heat stress and exercising children and adolescents[J].Pediatrics,2011,128(3):e741-e747.DOI:10.1542/Peds.2011-1664.
[9] 郑静晨,雷志勇,王发强,等.部队在高温大运动量训练条件下中暑的防治研究[J].武警医学院学报,2000,9(3):177-179.DOI:10.16548/j.2095 -3720.2000.03.009.ZHENG J C,LEI Z Y,WANG F Q,et al.Prophylaxis and treatment of heat stroke in armed policemen during strong exercise in high temperature[J].Acta Academiae Medicinae CPAPF,2000,9(3):177-179.DOI:10.16548/j.2095-3720.2000.03.009.
[10] 王文玲.驻福州陆军军事训练中暑现状与影响因素研究[D].福州:福建医科大学,2013.WANG W L.Study on the status and the influence factors of heatstroke in the fuzhou army military training[D].Fuzhou:Fujian Medical University,2013.
[11] 赵景平,史清连,张俊卿,等.某部炮兵强化快速反应训练中暑情况调查分析[J].人民军医,2000,43(6):314.ZHAO J P,SHI Q L,ZHANG J Q,et al.Investigation and analysis of heatstroke in a certain artillery strengthening rapid response training[J].People Mili Surg,2000,43(6):314.
[12] 仙登沁,任晓兰,刘攀丽.影响高原援建军官睡眠质量有关因素的调查分析[J].武警医学,2017,28(11):1118-1120.DOI:10.14010/j.cnki.wjyx.2017.11.010.XIAN D Q,REN X L,LIU P L.Factors that affect sleep quality of military officers temporarily on the plateau[J].Med J Chin PAP,2017,28(11):1118-1120.DOI:10.14010/j.cnki.wjyx.2017.11.010.
[13] 申晋波,马春伟,黄亚鑫.合理睡眠对大学生体质影响的研究—以运城学院为例[J].搏击·武术科学,2015,12(12):125-128 .DOI:10.3969/j.issn.1004-5643(w).2015.12.050.SHEN J B,MA C W,HUANG Y X.The effect of reasonable sleep on the physical constitution of college students[J].Wushu Sci,2015,12(12):125-128.DOI:10.3969/j.issn.1004-5643(w).2015.12.050.
[14] 陈勇胜,王生成.高原低氧环境对睡眠和脑功能的影响[J].空军医学杂志,2012,28(3):150-153.CHEN Y S,WANG S C.Effects of high altitude hypoxia on sleep and brain function[J].Med J Air Force,2012,28(3):150-153.
[15] KINSMAN T A,TOWNSEND N E,GORE C J,et al.Sleep disturbance at simulated altitude indicated by stratified respiratory disturbance index but not hypoxic ventilator response[J].Eur J Appl Physiol,2005,94(5/6):569-575.DOI:10.1007/s00421-005-1368-6.
[16] CASA D J,ARMSTRONG L E,GANIO M S,et al.Exertional heat stroke in competitive athletes[J].Curr Sports Med Rep,2005,4(6):309-317.
[17] 李晓海,王爱红,王群利,等.高温热浪期间居民行为习惯变化与中暑的关联研究[J].环境与健康杂志,2017,34(6):509-512.DOI:10.16241/j.cnki.1001-5914.2017.06.010.LI X H,WANG A H,WANG L Q,et al.Relationship between residents ’ behavioral habits change and heat stroke during high temperature heat wave[J].J Environ Health,2017,34(6):509-512.DOI:10.16241/j.cnki.1001-5914.2017.06.010.
[18] 赵佳佳,宋青.热射病快速降温研究进展[J].解放军医学杂志,2014,39(10):838-842.DOI:10.11855/j.issn.0577-7402.2014.10.17.ZHAO J J,SONG Q.Advances in rapid cooling treatment for heat stroke[J].Med J Chin PLA,2014,39(10):838-842.DOI:10.11855/j.issn.0577-7402.2014.10.17.
[19] 齐兰兰,周素红,闫小培,等.医学地理学发展趋势及当前热点[J].地理科学进展,2013,32(8):1276-1285.DOI:10.11820/dlkxjz.2013.08.011.QI L L,ZHOU S H,YAN X P,et al.Trend and hot topics of medical geography[J].Prog Geogr,2013,32(8):1276-1285.DOI:10.11820/dlkxjz.2013.08.011.