志愿献血者献血前心血管反应研究

摘要

目的 通过观察志愿献血者献血前5~10 min、0~3 min时血压和心率的变化,探讨机体对献血应激的心理生理反应能力及其与血管迷走反应(VVR)的关系.方法 选取解放军中部战区某部现役军人共687例,其中对照组是未参加献血军人211例,实验组是参加献血军人476例:随机分为5~10 min组(共335例军人在献血前5~10 min测量血压及心率)、0~3 min组(共141例军人在献血前0~3 min测量血压及心率),观察献血过程中是否出现VVR.结果 采血前5~10 min组与对照组比较,舒张压、平均动脉压升高,采血前0~3 min组与对照组、采血前5~10 min组比较,收缩压、舒张压、平均动脉压及心率均升高,差异有统计学意义(P均<0.05);在采血前5~10 min组中,与对照组比较,非VVR组舒张压、平均动脉压增加,VVR组收缩压增加,差异有统计学意义(P均<0.05).非VVR组和VVR组比较无显著差异;在采血前0~3 min组,与对照组比较,非VVR组收缩压、舒张压、平均动脉压及心率增加,VVR组仅心率增加;非VVR组舒张压及平均动脉压显著高于VVR组(P均<0.05).结论 献血前机体交感神经系统被激活,献血后出现VVR者心理生理储备能力较低,观察志愿献血者即将穿刺进针的3 min内血压、心率可在一定程度上评估献血者的心理生理反应,并预测VVR发生.%Objective To discuss the psychological and physical reactions of the body to blood donation stress, and relationship between these reactions and vasovagal reactions (VVR) through observing the changes of blood pressure (BP) and heart rate (HR) in voluntary donors 5 min-10 min (timepoint 1) and 0 min-3 min (timepoint 2) before blood donation. Methods The soldiers on service (n=687) were chosen, and 211 in control group (nonparticipants of blood donation), and 476 in test group. The test group was randomly divided into timepoint 1 group (n=335, BP and HR detected 5 min-10 min before blood donation) and timpoint 2 group (n=141, BP and HR detected 0 min-3 min before blood donation). The occurrence of VVR was observed during blood donation. Results The diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased in timepoint 1 group compared with control group before blood sampling, and systolic blood pressure (SBP), DBP, MAP and HR increased all in timepoint 2 group compared with control group and timepoint 1 group before blood sampling (all P<0.05). In timepoint 1 group before blood sampling, DBP and MAP increased in non-VVP group, and SBP increased in VVR group compared with control group (all P<0.05). The comparison between non-VVP group and VVR group had no significant difference. In timepoint 2 group before blood sampling, SBP, DBP, MAP and HR increased in non-VVP group, and only HR increased in VVR group compared with control group, and DBP and MAP were significantly higher in non-VVR group than those in VVR group (all P<0.05). Conclusion The sympathetic nerve system will be activated before blood donation, and psychological and physical reserve capacity will be lower in voluntary donors with VVR after blood donation. The observation on BP and HR changes within 3 min immediately before puncturing can review psychological and physical reactions and predict VVR in voluntary donors of blood.