适度间歇性低氧对临床相关疾病的康复作用

doi:10.3969/j.issn.1006-9771.2021.10.009

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (10): 1190-1198.doi: 10.3969/j.issn.1006-9771.2021.10.009

适度间歇性低氧对临床相关疾病的康复作用

刘晓丽¹,Xiangrong SHI²,向政¹(),朱欢¹

1.湖北民族大学体育学院,湖北恩施市 445000
2.北德州大学健康科学中心老年健康研究所,美国德克萨斯州沃斯堡 76007

收稿日期:2019-10-15 修回日期:2021-09-01 出版日期:2021-10-25 发布日期:2021-10-29
通讯作者: 向政 E-mail:2216311@qq.com
作者简介:刘晓丽(1980-),女,土家族,湖北建始县人,博士,博士后,副教授,主要研究方向：间歇性低氧对人体的影响。
基金资助:
湖北省教育厅社科重大项目(20ZD068);湖北省教育厅科研计划项目基金项目(D20191901);湖北民族大学研究生教育创新项目(MYG2021002)

Rehabilitation of Moderate Intermittent Hypoxia on Clinical Related Diseases (review)

LIU Xiao-li¹,Xiangrong SHI²,XIANG Zheng¹(),ZHU Huan¹

1. Department of Physical Education, Hubei Minzu University, Enshi, Hubei 445000, China
2. Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas 76007, United States

Received:2019-10-15 Revised:2021-09-01 Published:2021-10-25 Online:2021-10-29
Contact: XIANG Zheng E-mail:2216311@qq.com
Supported by:
Hubei Provincial Department of Education Social Research Foundation(20ZD068);Hubei Provincial Department of Education Science Research Foundation(D20191901);Graduate Education Innovation Project of Hubei Minzu University(MYG2021002)

摘要/Abstract

摘要：

目的系统综述适度间歇性低氧(IH)对临床相关疾病的康复作用。方法通过关键词检索和滚雪球方式在PubMed、ScienceDirect数据库、中国知网、万方检索适度IH对临床相关疾病康复作用的相关文献,检索时间2004年至2021年。结果共获得有效文献27篇,主要集中在适度IH对神经系统、呼吸系统和心血管疾病的作用,对机体代谢的调节和改善运动能力方面的研究。结论适度IH能改善认知功能,缓解脑缺血性卒中症状,加速脊髓损伤恢复,抗抑郁,降血压,调节机体代谢,改善有氧运动能力,增强呼吸功能,并对冠心病具有康复作用。但应用于临床还需深入研究,特别是IH干预的低氧浓度、每次IH的周期及频率、干预切入时机及整个疗程的时间均需要进一步确定和规范。

关键词: 适度间歇性低氧, 认知功能, 心肌功能, 代谢综合征, 综述

Abstract:

Objective To systematically review the rehabilitation effects of moderate intermittent hypoxia on clinical related diseases.Methods Literatures about rehabilitation effects of moderate intermittent hypoxia on clinical related diseases from 2004 to 2021 were searched in PubMed, ScienceDirect, CNKI and Wanfang databases using a systematic review method.Results A total of 27 literatures were included, which focused on the effects on neural system, respiratory system, and cardiovascular diseases, as well as the regulation of metabolic and the improvement of exercise ability.Conclusion Moderate intermittent hypoxia could improve the cognitive function, alleviate the symptoms of ischemic stroke, accelerate the recovery of spinal cord injury, resist depression and reduce blood pressure; regulate metabolism, improve aerobic capacity, enhance respiratory function and myocardial function. However, more researches are needed to make it clear that the standard on the duration of hypoxia within episodes, the number of hypoxia/reoxygenation cycles (episodes) per session every day, the pattern of presentation, and the cumulative duration of exposure.

Key words: moderate intermittent hypoxia, cognitive function, myocardial function, metabolic syndrome, review

中图分类号:

刘晓丽,Xiangrong SHI,向政,朱欢. 适度间歇性低氧对临床相关疾病的康复作用[J]. 《中国康复理论与实践》, 2021, 27(10): 1190-1198.

LIU Xiao-li,Xiangrong SHI,XIANG Zheng,ZHU Huan. Rehabilitation of Moderate Intermittent Hypoxia on Clinical Related Diseases (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(10): 1190-1198.

图/表 2

图1

表1

适度IH在疾病康复应用的文献分类"

类别	纳入文献	研究对象	IH干预策略	结果	效果
改善认知功能障碍	Zhang等^[9](2005)	幼年小鼠	16.0%O₂,每天4 h,持续3~4周	水迷宫和八臂迷宫成绩显著增加,海马中突触增多	提高空间学习和记忆能力
	Manukhina等^[10](2010)	阿尔茨海默病小鼠	每天模拟海拔4000 m高度环境4 h,持续14 d	被动回避性条件反射增强,NO代谢产物减少	有效阻止氧化应激,减缓神经退行性病变及维持认知功能
	Bayer等^[11](2017)	64~92岁记忆力减退老人	4~7 min 10%~14%O₂-2~4 min 30%~40%O₂,每次4~8个循环,每周3次,持续5~7周	DemTect量表测试和画钟试验成绩均显著提高	提高老人认知功能
	Serebrovska等^[12](2019)	轻度认知功能障碍患者	5 min 12%O₂-3 min常氧,每次4个循环,每周5次,持续3周	蒙特利尔认知评估量表测试成绩显著提高,β-淀粉样蛋白表达显著降低	改善认知功能,减缓症状发展
	Wang等^[4](2020)	记忆力减退老人	5 min 10%O₂-5 min常氧,每次8个循环,每周3次,持续8周	大脑氧含量增加,短时记忆能力测试和数字广度测试成绩提高	提高短时记忆和注意力
缺血性脑卒中康复	Tsai等^[13](2013)	脑缺血大鼠	12%O₂,每天4 h,持续7 d	海马神经元BDNF表达增加,突触素强度和密度增加	能够促使海马神经和突触发生,挽救缺血引起的空间学习和记忆障碍
抗抑郁	Rybnikova等^[14](2008)	成年大鼠	每天模拟5000 m海拔高度环境2 h,持续10 d	抗抑郁和焦虑效果与抗抑郁药物一致	具有抗抑郁和焦虑作用,预防抑郁发作
抗抑郁	Zhu等^[15](2010)	成年大鼠	每天模拟5000 m海拔高度4 h,持续14 d	海马神经发生显著增加	潜在治疗抑郁的方法
脊髓损伤康复	Trumbower等^[16](2012)	慢性脊神经损伤患者	单次1 min 9%O₂-1 min常氧,15个循环	足底屈曲力矩和踝关节跖屈电活性显著增加	增强慢性脊髓损伤患者运动能力
	Hayes等^[17](2017)	脊髓损伤1年以上患者	90 s 9%O₂-60 s常氧,15个循环,持续5 d	显著提高患者步行速度和距离	促进患者功能恢复
	Navarrete-Opazo等^[18](2017)	损伤> 6个月的脊髓损伤患者	90 s 9%O₂-60 s常氧,15个循环,持续4周	10 m步行测试和6 min步行试验显著增强	改善患者步行功能
	Naidu等^[19](2020)	受伤时间< 12个月的脊髓损伤患者	90 s 9%O₂-60 s常氧,15个循环,持续15 d	10 m步行测试、6 min步行试验和平衡能力显著增强。	患者步行功能得到改善
改善呼吸功能	Lovett-Barr等^[20](2012)	脊髓完全半切大鼠	5 min 10%O₂-5 min常氧,每次10个周期,持续7 d	增加大鼠的肺通气量和增强膈肌收缩	改善呼吸功能
改善呼吸功能	Satriotomo等^[21](2012)	脊髓完全半切大鼠	5 min 10.5% O₂-5 min常氧,每次10个周期,持续7 d	膈神经长时程易化	引起膈神经化学可塑性
缓解COPD症状	Burtscher等^[22](2009)	COPD患者	3~5 min 12%~15% O₂-3~5 min常氧,每天5~9个周期,持续15 d	显著增加患者压力反射敏感性、高碳酸血症通气反应、时间肺活量和肺活量	改善COPD症状
对冠心病的康复作用	del Pilar Valle等^[23](2006)	冠心病患者	模拟2400 m海拔高度每天持续1 h,14次	心肌灌注明显改善,且无心肌损伤现象	可能是治疗冠心病的新方法
对冠心病的康复作用	Glazachev等^[24](2017)	冠心病患者	4~6 min 10%~12% O₂-3 min 30%~35%O₂,每次5~7个循环,每周3次,持续5周	运动能力改善,收缩压和舒张压降低,左心室射血分数提高	能够改善运动耐受性,提高生活质量
降血压	Kong等^[25] (2014)	肥胖成年人	每周16 h常氧训练+6 h模拟1000~2000 m海拔高度训练,持续4周	与每周常氧22 h训练组相比,收缩压和平均动脉压显著下降	IH环境下训练有利于血压降低
	Zhang等^[26](2015)	健康成年人	5~6 min 10% O₂-4 min常氧,每次5~10个循环,持续14 d	增强基线迷走心功能,减弱对缺氧的心动过速反应	增强迷走神经功能
	Liu等^[3] (2020)	健康老人	单次5 min 10%O₂-5 min常氧循环5个周期	收缩压和舒张压平均下降2~6 mmHg	有降血压作用
	Wang 等^[4] (2020)	记忆力减退老人	5 min 10% O₂-5 min常氧,每次8个周期,每周3次,持续8周	安静时血压降低5~7 mmHg	降血压作用
减肥	Netzer等^[27](2008)	肥胖成年人	90 min 15%O₂,每周3次,持续8周的运动训练	较常氧训练组体质量降低更多	较好的减肥方法
	Lippl等^[28] (2010)	男性肥胖受试者	海拔2650 m高度居住7 d	体质量显著降低	肥胖者在高海拔地区体质量减轻
	Kong等^[25] (2014)	肥胖成年人	每周16 h常氧训练+6 h模拟1000~2000 m海拔高度训练,持续4周	与每周常氧22 h训练组相比,体质量降低更多	IH环境下运动减肥效果更好
	Hobbins等^[29](2021)	肥胖受试者	15 min 13%O₂-2 min常氧,每次8个循环,持续2周(低氧时运动,常氧休息)	体质量和6 min步行测试与常氧训练组相比无显著性差异	IH环境下运动对体质量影响不显著
改善T2D症状	Serebrovska 等^[30](2017)	前驱糖尿病患者	5 min 12%O₂-5 min常氧,每次4个循环,每周3次,持续3周	血糖水平显著下降	有助于预防T2D的发展
改善T2D症状	de Groote等^[31](2018)	肥胖青少年	每天60 min 15%O₂,每周3次,持续6周耐力和抗阻运动	增强胰岛素敏感性,降低血糖和甘油三酯水平	减轻胰岛素抵抗和降低青少年T2D
改善运动能力	Burtscher等^[32](2004)	50~70岁老人	3~5 min 10%~14%O₂-3 min常氧,每周5次,持续3周	峰值耗氧量和血氧饱和度均显著增加	提高有氧能力和耐力
	Bayer等^[11] (2017)	64~92岁老人	4~7min 10%~14%O₂-2~4 min 30%~40%O₂,每次4~8个循环,每周3次,持续5~7周	6 min步行试验成绩显著提高	提高老人有氧运动能力
	Bayer等^[33] (2019)	64~92岁健康老人	4~7 min 10%~14%O₂-2~4 min 30%~40%O₂,每次4~8个循环,每周3次,持续5~7周	Tinetti运动试验、起立行走试验、Barthel指数与对照组相比无显著性差异	低氧-高氧干预并不能显著增加感知能力和平衡协调性

表1

参考文献 51

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适度间歇性低氧对临床相关疾病的康复作用

Rehabilitation of Moderate Intermittent Hypoxia on Clinical Related Diseases (review)

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