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目的 分析和评估某大型水面舰艇舰员的自主神经功能状况.方法 对157名正在执行海上任务的舰员行24 h动态心电图监测,离线分析其心率变异性(heart rate variability,HRV)、心率减速力(deceleration capacity of heart rate,DC),比较HRV、DC在不同部门、不同舰面工作位置以及不同任务时间舰员之间的差异,并分析舰员舰上工作时间与HRV、DC的相关性.结果 机电部门舰员24 h内全部正常心动周期的标准差(SDNN)[(168.57 ±28.02) ms]、24 h每5 min时段心动周期的均值标准差(SDANN)[(151.79±28.59) ms]、全程2个相邻的正常心动周期差值的均方根值(RMSSD)[(39.21±11.44)ms]、相邻2个正常心动周期差值大于50 ms的心搏数占全程心搏数的百分比(PNN50)[(15.45±8.09)％]、高频功率(HF)[(548.18±329.27) ms2]和舰务部门舰员的SDNN[(168.93 ±26.97) ms]、RMSSD[(41.06±13.91) ms]、PNN50[(17.45±8.58)％]、DC值[(7.35±2.08) ms]较医务、政工部门舰员[SDNN为(183.87 ±42.50) ms、SDANN为(166.40±43.07) ms、RMSSD为(49.78±17.74) ms、PNN50为(21.94±11.16)％、HF为(806.93±603.37) ms2、DC值为(8.11±1.43)ms]均降低,差异均有统计学意义(P＜0.05或P＜0.01).舰面上与舰面下工作的舰员的HRV和DC值差异无统计学意义(P＞0.05).舰员任务中RMSSD、PNN50、HF、DC值较任务前降低(P＜0.05).舰员的舰上工作时间[(39±29)个月]与SDNN、SDANN、RMSSD、PNN50、HF、LF均呈负相关(P＜0.05).结论 水面舰艇工作环境和海上航行任务能够损伤舰员的自主神经功能;自主神经功能受损程度在不同部门之间具有差异性,且其与舰上工作时间有一定的相关性.

Objective To analyze autonomic nervous function in the crew of a large surface ship.Methods Dynamic 24-hour Holter monitoring was performed in 157 afloat naval personnel at sea.Heart rate variability (HRV)and deceleration capacity of heart rate (DC) were analyzed off-line,and differences in the detected data were compared between naval personnel working or performing tasks at different departments or decks,or working at different hours.Then,the correlation between different working hours and HRV and DC was analyzed statistically.Results HRV standard deviation (SDNN) [(168.57 ± 28.02) ms] of the naval personnel in the mechanical and electrical department within 24 hours,SDANN every 5 minutes within 24 hours [(151.79 ± 28.59)ms],RMSSD within the 2 adjacent cardiac cycles in the whole course [(39.21 ± 11.44) ms],the percentage of PNN50 within the 2 adjacent cardiac cycles greater than 50 ms [(15.45 ± 8.09)％],high frequency (HF) [(548.18 ±329.27) ms2],and the data of SDNN [(168.93 ±26.97)ms],RMSSD [(41.06± 13.91)ms],PNN50[(17.45 ±8.58)％] and DC [(7.35 ±2.08)ms] in the ship husbandry department were all lower than those of the medical department and administrative department [SDNN (183.87 ± 42.50) ms,SDANN (166.40 ± 43.07) ms,RMSSD (49.78 ± 17.74) ms,PNN50 (21.94 ± 11.16) ％,HF (806.93 ± 603.37) ms2 and DC (8.11 ± 1.43) ms].Statistical significance could be noted,when comparisons were made between them(P ＜ 0.05 or P ＜ 0.01).However,there was no statistical significance in HRV and DC,when comparisons were made between the naval personnel working on the top surface deck and below the surface deck(P ＞0.05).The data of RMSSD,PNN50,HF andDC during deployment were lower than those before deployment (P ＜ 0.05).The length of afloat naval service [(39 ± 29) months] was negatively correlated with SDNN,SDANN,RMSSD,PNN50,HF and LF(P ＜ 0.05).Conclusions The working environment on the surface ship and deployment at sea could devastate autonomic nervous function of the crew.There existed certain extent of the injury in naval personnel working at different departments and correlation could be seen between the extent of injury and length of afloat naval service onboard the ship.