目的 分析高强度训练对新兵横纹肌和重要器官的影响,评价补水、碱化尿液的干预效果。方法 随机抽样某部新兵500名,随机分为常规训练组和高强度训练组。训练后4周,收集血生化、心电图进行统计分析。高强度训练组给予定时补水、碳酸氢钠片1.5 g/d碱化尿液干预治疗,观察干预前后生化指标的变化情况。结果 两组横纹肌损伤率(6.67% vs.16.38%)、横纹肌溶解率(0.00% vs. 2.59%)、心肌损伤率(0.00% vs. 7.76%)、肝脏损伤率(7.50% vs. 29.31%)、肾脏损伤率(3.33% vs. 9.48%)、炎性反应发生率(19.17% vs. 43.10%,),高强度训练组均显著高于常规训练组,差异具有统计学意义(P＜0.05)。两组窦性心动过缓的发生率(2.50% vs. 6.90%)、窦性心动过速的发生率(0.83% vs. 6.03%)、左室高电压的发生率(2.50% vs. 7.76%)、短PR间期的发生率(0.00% vs. 2.59%),高强度训练组均显著高于常规训练组,差异具有统计学意义(P＜0.05)。干预前后生化指标均值Cr(80.31 μmol/L vs. 75.32 μmol/L),生化指标中位数CK(117.50 U/L vs. 88.70 U/L)、CKMB(2.09 ng/ml vs. 1.86 ng/ml) 、LDH(167.75 U/L vs. 147.75 U/L)、Myo(37.00 ng/ml vs. 31.60 ng/ml)、ALT(23.45 U/L vs. 20.00 U/L)、AST(24.25 U/L vs. 19.20 U/L),与干预前相比,反映各脏器功能的生化指标得到有效改善,差异具有统计学意义(P＜0.05)。结论 高强度训练条件下新兵横纹肌和重要脏器损伤发生率更高,补水、碱化尿液可以减少横纹肌损伤和重要脏器损伤的发生率。
Abstract
Objective To analyze the effect of high-intensity training on striated muscle and vital organs in recruits and to evaluate the intervention effect of hydration and alkalization of urine. Methods In this study, 500 recruits from a certain troop were selected and randomly divided into a conventional training group and a high-intensity training group. Effects of high-intensity training on striated muscle and important organs of the recruits and its intervention effect 4 weeks after training, blood biochemistry and electrocardiogram were collected for statistical analysis. The high-intensity training group was given periodic hydration, sodium bicarbonate tablet 1.5 g/day alkalized urine intervention treatment, , and the changes of biochemical indexes before and after intervention were observed. Results The rates of striated muscle injury (6.67% vs. 16.38%), rhabdomyolysis (0.00% vs. 2.59%), myocardial injury (0.00% vs. 7.76%), liver injury (7.50% vs. 29.31%), kidney injury (3.33% vs. 9.48%) and inflammatory response (19.17% vs. 43.10%) were compared between the two groups. We compared the incidence rate of sinus bradycardia (2.50% vs. 6.90%), sinus tachycardia (0.83% vs. 6.03%), left ventricular high voltage (2.50% vs. 7.76%), and short PR interval (0.00% vs. 2.59%). All the indexes of the high-intensity training group were significantly higher than those of the conventional training group, and the differences were statistically significant (P<0.05).In addition, we compared the changes of biochemical measures before and after the intervention, such as mean of Cr (80.31 μmol/L vs. 75.32 μmol/L), median of CK (117.50 U/L vs. 88.70 U/L), median of CKMB (2.09 ng/ml vs. 1.86 ng/ml), median of LDH (167.75 U/L vs. 147.75 U/L), median of Myo (37.00 ng/ml vs. 31.60 ng/ml), median of ALT (23.45 U/L vs. 20.00 U/L) and median of AST (24.25 U/L vs. 19.20 U/L). Compared with indexes before the intervention, the biochemical indexes of each organ were effectively improved, and the difference was statistically significant (P<0.05). Conclusions The incidence of striated muscle injury and vital organ injury is higher in recruits under the condition of high-intensity training, and hydration and alkalization of urine can reduce the incidence of striated muscle injury and vital organ injury.
关键词
军事训练 /
横纹肌损伤 /
脏器损伤 /
碱化尿液
Key words
military training /
striated muscle injury /
organ injury /
alkalization of urine
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参考文献
[1] Mao H D, Li X, Liu S Y, et al. Exertional rhabdomyolysis in newly enrolled cadets of a military academy[J]. Muscle Nerve, 2021, 64(3): 336-341.
[2] Gupta A, Thorson P, Penmatsa K R, et al. Rhabdomyolysis: revisited[J]. Ulster Med J, 2021, 90(2): 61-69.
[3] 陈 欢, 何颖雪, 陈之力. 横纹肌溶解并发急性肾损伤的危险因素分析[J]. 中国中西医结合肾病杂志, 2022, 23(12): 1095-1097.
[4] 黄 宇, 贺王伟, 黄峥嵘. 运动性横纹肌溶解症2例诊治分析[J]. 中国医学工程, 2017, 25(10): 106-108.
[5] 肖春明, 李超景, 方 斌, 等. 军人横纹肌溶解症12例临床特点分析[J]. 人民军医, 2020, 63(11): 1088- 1089, 1101.
[6] 张文砚, 修长庆. 军事训练致横纹肌溶解症23例临床分析[J]. 临床军医杂志, 2016, 44(8): 869-870.
[7] Backer H C, Busko M, Krause F G, et al. Exertional rhabdomyolysis and causes of elevation of creatine kinase[J]. Phys Sportsmed, 2020, 48(2): 179-185.
[8] Arnautovic J Z, Tereziu S. Evaluation of clinical outcomes in hospitalized patients with exertional rhabdomyolysis[J]. J Am Osteopath Assoc, 2019, 119(7): 428-434.
[9] Eichner E R. Exertional rhabdomyolysis in civilian and military populations[J]. Curr Sports Med Rep, 2020, 19(3): 99-100.
[10] 李瑜祯, 张申利. 大学生运动性横纹肌溶解症3例报告并文献复习[J]. 保健医学研究与实践, 2021, 18(5): 186-188.
[11] Luetmer M T, Boettcher B J, Franco J M, et al. Exertional rhabdomyolysis: a retrospective population-based study[J]. Med Sci Sports Exerc, 2020, 52(3): 608-615.
[12] 龚 俊, 姚 宣, 马 倍, 等. 创伤性横纹肌溶解综合征诊治研究进展[J]. 创伤外科杂志, 2022, 24(10): 791-794.
[13] Peng F, Lin X, Sun L Z, et al. Exertional rhabdomyolysis in a 21-year-old healthy man resulting from lower extremity training: a case report[J]. Medicine (Baltimore), 2019, 98(28): e16244.
[14] Al Badi A, Al Rasbi S, Alalawi A M. Exercise-induced rhabdomyolysis: a case report and literature review[J]. Cureus, 2020, 12(8): e10037.
[15] 刘 嘉, 赵华昌. 运动性横纹肌溶解症防治进展[J]. 国外医药(抗生素分册), 2022, 43(5): 342-345.
[16] Kumar R, Kumar S, Kumar A, et al. Exercise-Induced rhabdomyolysis causing acute kidney injury: a potential threat to gym lovers[J]. Cureus, 2022, 14(8): e28046.
[17] Nolte H W, Hew-Butler T, Noakes T D, et al. Exercise-associated hyponatremic encephalopathy and exertional heatstroke in a soldier: high rates of fluid intake during exercise caused rather than prevented a fatal outcome[J]. Phys Sportsmed, 2015, 43(1): 93-8.
[18] 刘 婷.横纹肌溶解症相关急性肾损伤32例临床分析[C]. 2017年第五次世界中西医结合大会论文摘要集(下册).中国中西医结合学会.2017.广东广州. 中国中西医结合学会,2017:1.
[19] Atias-Varon D, Sherman H, Yanovich R, et al. Rhabdomyolysis after crawling military training[J]. Mil Med, 2017, 182(7): e1948-e1952.
[20] Knapik J J, Epstein Y. Exertional heat stroke: pathophysiology, epidemiology, diagnosis, treatment, and prevention[J]. J Spec Oper Med, 2019, 19(2): 108-116.
[21] Adhikari P, Hari A, Morel L, et al. Exertional rhabdomyolysis after crossfit exercise[J]. Cureus, 2021, 13(1): e12630.
[22] Kim J, Lee J, Kim S, et al. Exercise-induced rhabdomyolysis mechanisms and prevention: a literature review[J]. J Sport Health Sci, 2016, 5(3): 324-333.
[23] Carneiro A, Viana-Gomes D, Macedo-Da-Silva J, et al. Risk factors and future directions for preventing and diagnosing exertional rhabdomyolysis[J]. Neuromuscul Disord, 2021, 31(7): 583-595.
[24] 王劭亮, 陈 蓉, 王明欢. 运动性横纹肌溶解症37例诊治分析[J]. 中华临床医师杂志(电子版), 2020, 14(1): 35-38.
[25] Wu M, Wang C, Liu Z, et al. Sequential organ failure assessment score for prediction of mortality of patients with rhabdomyolysis following exertional heatstroke: a longitudinal cohort study in southern China[J]. Front Med (Lausanne), 2021, 8: 724319.
[26] Aalborg C, Rod-Larsen C, Leiro I, et al. An increase in the number of admitted patients with exercise-induced rhabdomyolysis[J]. Tidsskr Nor Laegeforen, 2016, 136(18): 1532-1536.
[27] Lipman G S, Gaudio F G, Eifling K P, et al. Wilderness medical society clinical practice guidelines for the prevention and treatment of heat illness: 2019 Update[J]. Wilderness Environ Med, 2019, 30(4S): S33-S46.
[28] Scharf C, Liebchen U, Paal M, et al. Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis[J]. Crit Care, 2021, 25(1): 41.
[29] 刘向东, 蔡延东, 秦延军, 等. 运动性横纹肌溶解症并发急性肾功能不全及透析管相关性血栓1例并文献复习[J]. 临床荟萃, 2022, 37(9): 831-833.
[30] 丛 林, 朱静华, 张兆臣. 运动性横纹肌溶解症的防治[J]. 田径, 2020(12): 84,73.
基金
解放军总医院青年成长项目(QNC19004)
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