家兔缺氧时吸入CO_2所引起的血压变化的观察

(一)家兔在急性缺氧前对短时間吸入5％、7％和9％ CO_2的反应是:呼吸分間量明显增加,血压不变或微升,心縮力量稍增强。急性缺氧时,約有91％的动物,吸入CO_2則引起了降压反应。 (二)CO_2的降压程度,多和吸入CO_2的濃度以及缺氧发展的速度成平行关系。而降压維持的时間,在一定范圍內与吸入CO_2时間的长短成平行关系。 (三)急性缺氧后CO_2的降压作用,不受呼吸运动改变的影响。但在全麻、切断四条緩冲神經、切断两侧頸迷走神經或摘除頸交感神經节以后,則明显地使之减弱。     

清醒狗对急性低氧的心泵反应

6条清醒雄狗,于左心室和肺动脉干装置慢性导管,记录压力、dp/dt、d~2p/dt~2以及dp/dt/p 等。于手术后第4至第12天,给予轻度(p_(IO_2)=84mmHg)和中度(p_(IO_2)=64mmHg)低氧气体吸入,观察心泵反应。在24次实验中,都见到常用的泵功能指标增强,反应状况与麻醉开胸狗上的结果大体相似。但心率加速反应比麻醉犬明显。中度低氧时,dp/dt_max、左室与肺动脉压力常有强弱交替的周期性波动,此现象可被麻醉或β-及 α-受体同时阻断所消除。有时,当 dp/dt_max 值处于增大状态,dp/dt/p DP40值却减小。收缩相与舒张相d~2p/dt~2max 的比值(C/R),在中度低氧时增大(P<0.02),反映了收缩作用与舒张作用的反应不匹配,这可能是泵功能欠佳的早期信号。     

人体急性缺氧性意识障碍

实验分为低压组(低压舱7,000米)与常压组(吸入7.6％低氧混合气),每组受试者各为12名,有7名参加了两组实验。每组各有4名平均经15分23秒发生了意识模糊或丧失(通称意识障碍)。障碍者的肺泡氧分压为29.9±0.8mmHg。障碍发生前,呈现严重无力,觉醒度降低,反应迟钝,脑波特征是高幅6波(100-300μV)占优势。障碍发生时,高幅δ波丧失节律,幅度衰减,波型不规则,额枕失同步;呼吸循环代偿功能增强程度明显高于障碍前。本工作对于预测和评价人体急性缺氧引起的意识障碍有意义。     

模糊集理论在急性缺氧反应综合评定中的应用

对人体缺氧程度进行综合性定量评定是个有待解决的重要问题,本文试图应用模糊集理论对此加以探讨。在机体缺氧代偿理论的基础上,引入缺氧代偿率(Z)的概念,其中着重考虑了各循环指标在缺氧时所起作用的大小,并根据指标变化与症状分类符合的程度确定其值。按照模糊集理论再把被试者的不同代偿能力看作不同的模糊集合,并以 Z 为论域,分別构造出代偿好、代偿差和代偿一般三个模糊子集的隶属函数。依照模糊集中的隶属原则,可确定出给定 Z 值所代表的子集合,从而对不同被试者的代偿能力以及同一被试者不同缺氧时刻的代偿能力作出评价。在本文中代偿能力被分为五个等级:代偿最佳、代偿好、代偿一般、代偿差和代偿障碍。按此等级对39名被试者的缺氧代偿能力作出评价,取得了与实际非常一致的结果。     

慢性缺氧对大鼠心室功能和ATP酶活性的影响

将大鼠置于不同模拟海拔高度低压舱内4d,观察其左、右心室功能代偿与失代偿的某些生物化学基础。结果表明,5000m中度缺氧4d使左、右心室功能、重量、心肌蛋白含量及Ca~(2 )-ATP酶活性均有不同程度的增高。提示机体在整体、心脏器官及心肌细胞分子各个水平的代偿机制均有加强。8000m重度缺氧4d后,左室重量增加,dp/dt_(max)与蛋白含量均下降,肌原纤维ATP酶活性则保持中度缺氧的代偿水平,提示左心功能似已受到损害。与此同时,右室蛋白含量虽也明显减少,但其ATP酶活性则继续增高,dp/dt_(max)未出现下降,表明右心功能仍具有相当的代偿能力。从而支持我们关于在短期内因供氧严重不足而造成的左室心肌的直接损伤作用大于右室心肌的推论。     

冠状动脉狭窄程度和药物对频域心电图的影响

本实验在于阐明频域心电图(FCG)可以反映冠状动脉血流量(CBF)。狗的冠状动脉(CA)左前降支予以轻度狭窄,R_x、R_(xy)、F_(min)值都增大,说明FCG这些参数的变化比由CA左旋支狭窄引起的变化提前出现(左旋支在中度狭窄时才出现FCG的变化)。当狭窄程度达到中度或重度时,除了R_y在中度狭窄不发生明显变化外,其余指标都显著增大(p<0.05),F_(min)和R_(xy)增大程度尤其明显(p<0.01),心率(HR)和CBF显著下降,主动脉平均压(P_a)轻度下降。 在CBF减少的情况下,通过CA灌注硝酸甘油(8μg/min)10min后,HR、CBF、R_x、R_y、R_(xy),和F_(min)没有明显变化,而小冠状动脉远端平均压(P_c)降低(p<0.01),p_x、P_y也降低(p<0.05)。在相同情况下,灌注烟浪丁,HR和P_a几乎不变,P_c和CBF明显上升;除F_(min)外,FCG所有的指标都增大(p<0.05)。在CA狭窄的情况下,麦角新碱可诱发血管收缩,反映在P_a、HR和CBF轻度下降和P_c、P_x、P_y、R_x、F_(min)、R_y和R_(xy)显著上升,CA灌注麦角新碱(0.2μg/min)后,FCG的指标随着缺血程度的改变而变化。     

慢性缺氧的猪肺动脉内皮细胞在急性缺氧时PDGF-B链mRNA的表达

采用原位杂交技术结合图象分析检测常氧(PO2±21.3kPa)及慢性缺氧(P025.3±0.7kPa)培养的猪肺动脉内皮细胞PDGF-BmRNA的表达及其对急性缺氧刺激的反应.结果常氧及慢性缺氧培养的肺动脉内皮细胞(PAEC)在急性缺氧后PDGF-BmRNA表达均增加(P＜0.05),以第4、6代慢性缺氧组升高的幅度更大.结果表明慢性缺氧可增强PAEC在急性缺氧时PDGF-BmRNA的表达,可能促进肺血管改建和肺动脉高压的发展.     

重度急性失血对刺激家兔中脑中央灰质诱发防御升压反应的影响

重度急性失血(30％总量)可使麻醉家兔防御性升压反应明显降低(P<0.05)。吸入低氧(含10％～14％氧气)混合气1～2min可使防御升压反应轻度增加(P<0.05)。持续低氧10～20min则使防御升压反应明显降低(P<0.01)。失血状态下侧脑室注射纳洛酮50～80μg/100μl,可使基础血压和防御升压反应明显升高(P<0.01)。提示重度失血时,防御升压反应明显降低可能与中枢缺氧及失血时脑内阿片样物质的释放抑制心血管中枢有关。     

成人急性低氧通气压抑中的内啡肽作用

本工作设想,内啡肽参与了成人急性低氧通气压抑机制。受试者均为健康成年男子。6名受试者吸入中度低氧混合气(12.8％O_2)30min;7名吸入重度低氧混合气(10.8％O_2)20min,其中6名并在重度低氧下吸入三口纯氮气。吸入低氧气前先由静脉注入生理盐水(对照)或纳洛酮(中度低氧5mg,重度低氧10mg)。观察低氧时的通气反应、终末潮气二氧化碳分压(P_(ETCO2)、动脉血氧饱和度和外周低氧通气敏感性以及纳洛酮对上述测定的影响。结果表明,纳洛酮使重度低氧下的通气压抑明显减弱,低氧第3～15分钟的通气水平明显高于对照实验;而P_(ETCO2)明显低于对照值。但纳洛酮对中度低氧下的通气压抑无明显作用。此外,纳洛酮显著增强外周低氧敏感性。结果提示,在重度低氧下,内啡肽参与了成人低氧通气压抑机制,并对外周低氧敏感性有抑制作用。     

川芎嗪对缺氧所致大鼠呼吸效应和脑干神经元型一氧化氮合酶表达的影响

本文旨在研究川芎嗪对缺氧引起的呼吸变化和脑干神经元型一氧化氮合酶(neuronal nitric oxide synthase,nNOS)表达的影响。用吸入8%O2+92%N2的方法引起大鼠全身性缺氧,以膈肌放电作为指标,动态观察呼吸活动的变化;用免疫组织化学的方法观察脑干中nNOS表达的变化。在缺氧组大鼠,缺氧20 min时,呼吸活动受到显著抑制,表现为吸气时程缩短,呼气时程延长,呼吸频率减慢和吸气幅度降低(P<0.05);在川芎嗪预处理组大鼠,缺氧未引起呼吸抑制(P>0.05)。缺氧时,延髓腹外侧网状核、斜方体核、舌下神经核和面神经核的nNOS表达增加(P<0.05);川芎嗪预处理组大鼠上述核团的nNOS的表达均进一步增加(P<0.05)。结果表明,川芎嗪对缺氧引起的呼吸抑制有对抗作用,nNOS可能参与了这一过程。     

Partitioning of respiration between the gills and air-breathing organ in response to aquatic hypoxia and exercise in the pacific tarpon, Megalops cyprinoides

The evolution of air-breathing organs (ABOs) is associated not only with hypoxic environments but also with activity. This investigation examines the effects of hypoxia and exercise on the partitioning of aquatic and aerial oxygen uptake in the Pacific tarpon. The two-species cosmopolitan genus Megalops is unique among teleosts in using swim bladder ABOs in the pelagic marine environment. Small fish (58-620 g) were swum at two sustainable speeds in a circulating flume respirometer in which dissolved oxygen was controlled. For fish swimming at 0.11 m s(-1) in normoxia (Po2 = 21 kPa), there was practically no air breathing, and gill oxygen uptake was 1.53 mL kg(-0.67) min(-1). Air breathing occurred at 0.5 breaths min(-1) in hypoxia (8 kPa) at this speed, when the gills and ABOs accounted for 0.71 and 0.57 mL kg(-0.67) min(-1), respectively. At 0.22 m s(-1) in normoxia, breathing occurred at 0.1 breaths min(-1), and gill and ABO oxygen uptake were 2.08 and 0.08 mL kg(-0.67) min(-1), respectively. In hypoxia and 0.22 m s(-1), breathing increased to 0.6 breaths min(-1), and gill and ABO oxygen uptake were 1.39 and 1.28 mL kg(-0.67) min(-1), respectively. Aquatic hypoxia was therefore the primary stimulus for air breathing under the limited conditions of this study, but exercise augmented oxygen uptake by the ABOs, particularly in hypoxic water.     

Effect of oxygen breathing on micro oxygen bubbles in nitrogen-depleted rat adipose tissue at sea level and 25 kPa altitude exposures

The standard treatment of altitude decompression sickness (aDCS) caused by nitrogen bubble formation is oxygen breathing and recompression. However, micro air bubbles (containing 79% nitrogen), injected into adipose tissue, grow and stabilize at 25 kPa regardless of continued oxygen breathing and the tissue nitrogen pressure. To quantify the contribution of oxygen to bubble growth at altitude, micro oxygen bubbles (containing 0% nitrogen) were injected into the adipose tissue of rats depleted from nitrogen by means of preoxygenation (fraction of inspired oxygen = 1.0; 100%) and the bubbles studied at 101.3 kPa (sea level) or at 25 kPa altitude exposures during continued oxygen breathing. In keeping with previous observations and bubble kinetic models, we hypothesize that oxygen breathing may contribute to oxygen bubble growth at altitude. Anesthetized rats were exposed to 3 h of oxygen prebreathing at 101.3 kPa (sea level). Micro oxygen bubbles of 500-800 nl were then injected into the exposed abdominal adipose tissue. The oxygen bubbles were studied for up to 3.5 h during continued oxygen breathing at either 101.3 or 25 kPa ambient pressures. At 101.3 kPa, all bubbles shrank consistently until they disappeared from view at a net disappearance rate (0.02 mm(2) × min(-1)) significantly faster than for similar bubbles at 25 kPa altitude (0.01 mm(2) × min(-1)). At 25 kPa, most bubbles initially grew for 2-40 min, after which they shrank and disappeared. Four bubbles did not disappear while at 25 kPa. The results support bubble kinetic models based on Fick's first law of diffusion, Boyles law, and the oxygen window effect, predicting that oxygen contributes more to bubble volume and growth during hypobaric conditions. As the effect of oxygen increases, the lower the ambient pressure. The results indicate that recompression is instrumental in the treatment of aDCS.     

Hypoxia augments apnea-induced peripheral vasoconstriction in humans.

Obstructive apnea and voluntary breath holding are associated with transient increases in muscle sympathetic nerve activity (MSNA) and arterial pressure. The contribution of changes in blood flow relative to the contribution of changes in vascular resistance to the apnea-induced transient rise in arterial pressure is unclear. We measured heart rate, mean arterial blood pressure (MAP), MSNA (peroneal microneurography), and femoral artery blood velocity (V(FA), Doppler) in humans during voluntary end-expiratory apnea while they were exposed to room air, hypoxia (10.5% inspiratory fraction of O2), and hyperoxia (100% inspiratory fraction of O2). Changes from baseline of leg blood flow (Q) and vascular resistance (R) were estimated from the following relationships: Q proportional to V(FA), corrected for the heart rate, and R proportional to MAP/Q. During apnea, MSNA rose; this rise in MSNA was followed by a rise in MAP, which peaked a few seconds after resumption of breathing. Responses of MSNA and MAP to apnea were greatest during hypoxia and smallest during hyperoxia (P < 0.05 for both compared with room air breathing). Similarly, apnea was associated with a decrease in Q and an increase in R. The decrease in Q was greatest during hypoxia and smallest during hyperoxia (-25 +/- 3 vs. -6 +/- 4%, P < 0.05), and the increase in R was the greatest during hypoxia and the least during hyperoxia (60 +/- 8 vs. 21 +/- 6%, P < 0.05). Thus voluntary apnea is associated with vasoconstriction, which is in part mediated by the sympathetic nervous system. Because apnea-induced vasoconstriction is most intense during hypoxia and attenuated during hyperoxia, it appears to depend at least in part on stimulation of arterial chemoreceptors.     

Operation Everest II: preservation of cardiac function at extreme altitude

Hypoxia at high altitude could depress cardiac function and decrease exercise capacity. If so, impaired cardiac function should occur with the extreme, chronic hypoxemia of the 40-day simulated climb of Mt. Everest (8,840 m, barometric pressure of 240 Torr, inspiratory O2 pressure of 43 Torr). In the five of eight subjects having resting and exercise measurements at the barometric pressures of 760 Torr (sea level), 347 Torr (6,100 m), 282 Torr (7,620 m), and 240 Torr, heart rate for a given O2 uptake was higher with more severe hypoxia. Slight (6 beats/min) slowing of the heart rate occurred only during exercise at the lowest barometric pressure when arterial blood O2 saturations were less than 50%. O2 breathing reversed hypoxemia but never increased heart rate, suggesting that hypoxic depression of rate, if present, was slight. For a given O2 uptake, cardiac output was maintained. The decrease in stroke volume appeared to reflect decreased ventricular filling (i.e., decreased right atrial and wedge pressures). O2 breathing did not increase stroke volume for a given filling pressure. We concluded that extreme, chronic hypoxemia caused little or no impairment of cardiac rate and pump functions.     

Long-term facilitation in obstructive sleep apnea patients during NREM sleep.

Repetitive hypoxia followed by persistently increased ventilatory motor output is referred to as long-term facilitation (LTF). LTF is activated during sleep after repetitive hypoxia in snorers. We hypothesized that LTF is activated in obstructive sleep apnea (OSA) patients. Eleven subjects with OSA (apnea/hypopnea index = 43.6 +/- 18.7/h) were included. Every subject had a baseline polysomnographic study on the appropriate continuous positive airway pressure (CPAP). CPAP was retitrated to eliminate apnea/hypopnea but to maintain inspiratory flow limitation (sham night). Each subject was studied on 2 separate nights. These two studies are separated by 1 mo of optimal nasal CPAP treatment for a minimum of 4-6 h/night. The device was capable of covert pressure monitoring. During night 1 (N1), study subjects used nasal CPAP at suboptimal pressure to have significant air flow limitation (>60% breaths) without apneas/hypopneas. After stable sleep was reached, we induced brief isocapnic hypoxia [inspired O(2) fraction (FI(O(2))) = 8%] (3 min) followed by 5 min of room air. This sequence was repeated 10 times. Measurements were obtained during control, hypoxia, and at 5, 20, and 40 min of recovery for ventilation, timing (n = 11), and supraglottic pressure (n = 6). Upper airway resistance (Rua) was calculated at peak inspiratory flow. During the recovery period, there was no change in minute ventilation (99 +/- 8% of control), despite decreased Rua to 58 +/- 24% of control (P < 0.05). There was a reduction in the ratio of inspiratory time to total time for a breath (duty cycle) (0.5 to 0.45, P < 0.05) but no effect on inspiratory time. During night 2 (N2), the protocol of N1 was repeated. N2 revealed no changes compared with N1 during the recovery period. In conclusion, 1) reduced Rua in the recovery period indicates LTF of upper airway dilators; 2) lack of hyperpnea in the recovery period suggests that thoracic pump muscles do not demonstrate LTF; 3) we speculate that LTF may temporarily stabilize respiration in OSA patients after repeated apneas/hypopneas; and 4) nasal CPAP did not alter the ability of OSA patients to elicit LTF at the thoracic pump muscle.     

Cardiac performance in humans during breath holding

The effects on cardiac performance of high and low intrathoracic pressures induced by breath holding at large and small lung volumes have been investigated. Cardiac index and systolic time intervals were recorded from six resting subjects with impedance cardiography in both the nonimmersed and immersed condition. A thermoneutral environment (air 28 degrees C, water 35 degrees C) was used to eliminate the cold-induced circulatory component of the diving response. Cardiac performance was enhanced during immersion compared with nonimmersion, whereas it was depressed by breath holding at large lung volume. The depressed performance was apparent from the decrease in cardiac index (24.1% in the immersed and 20.9% in the nonimmersed condition) and from changes in systolic time intervals, e.g., shortening of left ventricular ejection time coupled with lengthening of preejection period. In the absence of the cold water component of the diving response, breath holding at the large lung volume used by breath-hold divers tends to reduce cardiac performance presumably by impeding venous return.     

Cardiac output and O2 consumption during inspiratory threshold loaded breathing

In this study, noninvasive measurements of cardiac output and O2 consumption were performed to estimate the blood flow to and efficiency of the respiratory muscles that are used in elevated inspiratory work loads. Five subjects were studied for 4.5 min at a respiratory rate of 18 breaths/min and a duty cycle of 0.5. Studies were performed at rest without added respiratory loads and at elevated inspiratory work loads with the use of an inspiratory valve that permitted flow only when a threshold pressure was maintained. Cardiac output and O2 consumption were calculated using a rebreathing technique. Respiratory muscle blood flow and O2 consumption were estimated as the difference between resting and loaded breathing. Work of breathing was calculated by integrating the product of mouth pressure and volume. Increases in cardiac output and O2 consumption in response of 4.5 min loaded breathing averaged 1.84 l/min and 108 ml/min, respectively. No increases were seen in response to 20-s loaded breathing. In a separate series of experiments on four subjects, though, cardiac output increased for the first 2 min then leveled off. These results indicate that the increase in cardiac output was a metabolic effect of the increased work load and was not caused primarily by the influence of the highly negative intrathoracic pressure on venous return. Efficiency of the respiratory muscles during inspiratory threshold loading averaged 5.9%, which was similar to measurements of efficiency of respiratory muscles using whole-body O2 consumption that have been reported previously in humans and in dogs.     

Cardiovascular response to hand-grip isometric exercise in healthy men. Noninvasive study

Noninvasive polygraphic tracings obtained at rest and during isometric hand-grip exercise were analysed in 67 healthy subjects. The purpose of the study was to determine the response of noninvasive polygraphic parameters to isometric exercise. During the third minute of sustained squeezing of a balloon dynamometer (30% of maximal voluntary contraction) a significant increase occurred in heart rate (+16.8 +/- 10.7 beats/min) an increase in both systolic and diastolic blood pressure (+3.4 +/- 1.6 kPa and 2.6 +/- 1.7 kPa respectively), increase in apexcardiographic index 100.a/D (+14.5 +/- 15.0% "D" amplitude), decrease of diastolic amplitude time index square root 2-c/(2-0) X (a/D) (-20.1 +/- 26.5), shortening of pulse transmission time (-0.006 +/- 0.005 s) and prolongation of cardiac cycle length corrected for left ventricular ejection time (+0.011 +/- 0.010 s) discussed. All these changes were statistically significant.     

Recovery of the ventilatory response to hypoxia in normal adults

Recovery of the initial ventilatory response to hypoxia was examined after the ventilatory response had declined during sustained hypoxia. Normal young adults were exposed to two consecutive 25-min periods of sustained isocapnic hypoxia (80% O2 saturation in arterial blood), separated by varying interludes of room air breathing or an increased inspired O2 fraction (FIO2). The decline in the hypoxic ventilatory response during the 1st 25 min of hypoxia was not restored after a 7-min interlude of room air breathing; inspired ventilation (VI) at the end of the first hypoxic period was not different from VI at the beginning and end of the second hypoxic period. After a 15-min interlude of room air breathing, the hypoxic ventilatory response had begun to recover. With a 60-min interlude of room air breathing, recovery was complete; VI during the second hypoxic exposure matched VI during the first hypoxic period. Ventilatory recovery was accelerated by breathing supplemental O2. With a 15-min interlude of 0.3 FIO2 or 7 min of 1.0 FIO2, VI of the first and second hypoxic periods were equivalent. Both the decline and recovery of the hypoxic ventilatory response were related to alterations in tidal volume and mean inspiratory flow (VT/TI), with little alteration in respiratory timing. We conclude that the mechanism of the decline in the ventilatory response with sustained hypoxia may require up to 1 h for complete reversal and that the restoration is O2 sensitive.     

Effect of hypoxia on immediate ventilatory load response in dogs.

The effective elastance of the respiratory system (which has been previously shown to provide an index of the ability of the respiratory musculature to compensate rapidly for transient mechanical ventilatory loads) was measured in six hypoxic dogs to determine whether hypoxia hindered immediate load-compensatory mechanisms. The effective elastance value was computed from measurements of control tidal volume and the pressure developed at the airway opening during the first inspiratory effort following airway occlusion at FRC. The mean effective elastance was 197 cmH2O/l while the animals were breathing room air and did not change significantly when the animals were rendered hypoxic by reducing the inspired oxygen concentration, in five dogs, or by controlled hemorrhage, in two dogs. It was concluded that inasmuch as effective elastance measurements remain constant during hypoxia, the stability of ventilation is not significantly impaired in this situation.