摘要目的 分析高原环境导致心脏改变的影响因素及危险概率.方法 2015年回顾分析高原某铁路养护公司工务系统268名作业人员的2006至2013年超声心动图数据,应用生存曲线法分析心脏异常率,用Kaplan-Meier法和Cox比例风险回归模型的前进法进行影响因素分析.结果 高原作业人员首次心脏异常数据显示,主要的异常类型是右心房增大(53.47％)、右心室增大(17.36％)和三尖瓣返流(16.67％).Cox回归分析结果显示工作地海拔和首次体检年龄为心脏异常的2个影响因素,相对危险度分别是1.661和1.039.部分作业人员(近40％)在高海拔地区(3 600～4 000 m)环境下心脏未发生改变,但未观察到适应超高海拔地区(≥4 000 m)的人员.结论 人体对高原适应性存在个体差异,应对4000m以上和年龄偏大的作业人员采取更严格的健康监护措施,并应遵守适合高原的铁路轮休轮换制度.

abstractsObjective To analyze the heart rate changes and risk factors,as a result of high altitude.Methods Retrospective analysis of echocardiographic data of plateau workers at a railway maintenance company from 2006 to 2013.The survival curve method was used to analyze the abnormal rate of the heart.Kaplan-Meier method and Cox proportional hazards regression model were used to analyze the influencing factors.Results In the first occurrence of cardiac abnormalities,the main types of abnormalities were right atrium enlargement (53.47％),right ventricle enlargement (17.36％),and tricuspid regurgitation (16.67％).Cox regression analysis showed that workplace altitude and first physical examination age are two influencing factors of cardiac abnormalities,and their relative risk was 1.661 and 1.039.At high altitudes (3 600～4 000 m),nearly 40％ of workers heart has not changed.But this adaptation does not observed in the ultra-high altitudes (≥ 4 000 m).Conclusion There are individual differences in human adaptability to high altitude.We should take more stringent measures of health care for older people and those who work at more than 4000m.And we should abide by the rotation system for railways that are suitable for the plateau.