人体位改变对凝血因子某些因素水平的影响

目的 :探讨不同体位对凝血因子检测的影响 ,给循证医学和凝血因子检测全面质量控制提供实验室证据。方法 :1 0 5名志愿者经同体配对试验 ,在不同季节分批抽取不同体位、不同时间、同一部位血液 ,在全自动凝血分析仪上与质控品同批分析疑血因子 5项指标。结果 :以卧位为基线与坐位相比 ,各项指标平均改变 7.0 7% ,多者9.33 % ,差别非常显著 (P <0 .0 0 1 )。根据变化百分数大小依次为 :纤维蛋白原 (FIB) ,凝血酶时间 (TT) ,活化部分凝血活酶时间 (APTT) ,凝血酶原时间 (PT) ,国际标准化比值 (INR)。其中FIB、TT、APTT结果升高 ,呈正相关 (r>0 .97) ,而PT、INR则下降 ,呈负相关。改变体位 1 5min内 ,各参数平均恢复到原体位的 95 .2 %。季节、年龄和仪器差别不影响本实验。结论 :人体位改变能引起凝血因子显著生理变异     

The effect of sensitization to the electrical activity of the muscles of the lower respiratory tract in the rat

The electrical activity of the smooth muscle of the trachea was studied on sensibilized ovalbumine rats. The role of intramural ganglions of the airway was shown.     

The effect of increased respiratory resistance on glycogen and triglyceride levels in the respiratory muscles of the rat

The effect of increased respiratory resistance (stenosis of the trachea) on glycogen and triglyceride levels in the diaphragm (D) and intercostal (external-IE, internal-II) muscles was studied in the rat. Tracheal stenosis resulted in a reduction of glycogen level in the muscles. For the fed rats the reductions were: D-45 and 79%, IE-14 and 30%, II-14 and 35%, 0.5 and 3 h after stenosis, respectively. For rats fasted for 24 h the reductions were: D-64 and 86%, IE-33 and 71%, II-40 and 82%, after 0.5 and 3 h respectively. The level of triglycerides in the muscles was stable during stenosis in the fed group, whereas in the fasted group it were reduced in the diaphragm by 50% after 0.5 h, and by 52% after 3 h. It is concluded that both endogenous and blood-born energy fuels are utilized by the respiratory muscles during increased resistance breathing.     

The effect of some sulfhydryl reagents on the respiratory chain activity

The observation that in cation transport experiments N-ethylmaleimide (NEM) behaves as uncoupler and as a respiratory inhibitor at the same time, the effect of sulfhydryl reagents on the redox state of respiratory chain, has been studied. Spectra of mitochondrial suspension in the span 300-630 nm have revealed that NEM promotes the oxidation of all the respiratory intermediates, cytochrome a included. Azide completely reverses the oxidation effect of NEM, suggesting that it cannot be ascribed to an irreversible damage of mitochondrial intactness. Mersalyl, which shares the highly sensitive SH reagent and specific inhibitor of Pi transport properties of NEM, gives completely different results. It is proposed that, besides the generally accepted inhibitory effect on primary dehydrogenases reacting with their SH groups, NEM may also behave as an oxidizing agent which can promote the release of reducing equivalents from the respiratory chain.     

Aging effect on oxygen consumption of respiratory muscles in humans

The first purpose of the present study was to develop a new method to examine oxygen consumption of respiratory muscles (VO2resp) in human subjects. The apparatus consists of an expandable dead space and a respirometer. When the dead space was increased at a constant rate (approximately 100 ml/min), minute ventilation (VE) and VO2resp increased gradually. Because the logarithm of VO2 was found to be approximately linearly related to VE, we characterized this relationship by the slope (logVO2/VE) and the intercept at VE = 0 (VO2met) of the semilog regression line. The second purpose of this study was to examine the relationship between VO2resp and aging. Six anthropometric and spirometric factors (age, height, weight, vital capacity, forced expiratory volume in 1 s, and body surface area) were analyzed in 37 normal subjects by simple and stepwise multiple regression analyses. We found a significant increase in logVO2/VE and a significant decrease in VO2met with age. In conclusion, 1) the present method is convenient to use, and we are able to study VO2resp over a wide range of ventilation without voluntary effort, and 2) age per se is one of the factors accounting for the observed increase in VO2resp with age.     

Upper airway negative-pressure effects on respiratory activity of upper airway muscles

Influence of upper airway negative-pressure change on the respiratory activity of various upper airway muscles was investigated in 13 anesthetized rabbits. Phasic inspiratory activity increased or appeared during virtually all negative-pressure trials in nasolabial, cricothyroid, and posterior cricoarytenoid muscles. No phasic inspiratory activity was seen in the sternothyroid (ST) and sternohyoid (SH) muscles before negative-pressure applications but appeared during 80% of trials in ST and 62% of trials in SH. During maintained negative pressure, a gradual decline in activity was often observed in the nasolabial and laryngeal muscles, whereas a rapid decline in activity was seen in the cervical strap muscles. Reflex effects of negative pressure was markedly reduced or abolished by sectioning the internal branch of the superior laryngeal nerve bilaterally. Reflex augmentation of upper airway muscle activity reported here may have functional significance in the maintenance of upper airway patency. It could prevent upper airway collapse when negative pressure swings in the upper airway increase or facilitate recovery when large negative pressure swings are produced by obstructed inspiratory efforts.     

Electrical and mechanical activity of respiratory muscles during hypercapnia

In nine anesthetized supine spontaneously breathing dogs, we compared moving average electromyograms (EMGs) of the costal diaphragm and the third parasternal intercostal muscles with their respective respiratory changes in length (measured by sonomicrometry). During resting O2 breathing the pattern of diaphragm and intercostal muscle inspiratory shortening paralleled the gradually incrementing pattern of their moving average EMGs. Progressive hypercapnia caused progressive increases in the amount and velocity of respiratory muscle inspiratory shortening. For both muscles there were linear relationships during the course of CO2 rebreathing between their peak moving average EMGs and total inspiratory shortening and between tidal volume and total inspiratory shortening. During single-breath airway occlusions, the electrical activity of both the diaphragm and intercostal muscles increased, but there were decreases in their tidal shortening. The extent of muscle shortening during occluded breaths was increased by hypercapnia, so that both muscles shortened more during occluded breaths under hypercapnic conditions (PCO2 up to 90 Torr) than during unoccluded breaths under normocapnic conditions. These results suggest that for the costal diaphragm and parasternal intercostal muscles there is a close relationship between their electrical and mechanical behavior during CO2 rebreathing, this relationship is substantially altered by occluding the airway for a single breath, and thoracic respiratory muscles do not contract quasi-isometrically during occluded breaths.     

Non-invasive detection of respiratory muscles activity during assisted ventilation

The instantaneous pressure applied by the respiratory muscles [Pmus(t)] of a patient under ventilatory support may be continuously assessed with the help of a model of the passive respiratory system updated cycle by cycle. Inspiratory activity (IA) is considered present when Pmus goes below a given threshold. In six patients, we compared IA with (i) inspiratory activity (IAref) obtained from esophageal pressure and diaphragmatic EMG and (ii) that (IAvent) detected by the ventilator. In any case, a ventilator support onset coincides with an IA onset but the opposite is not true. IA onset is always later than IAref beginning ((0.21 +/- 0.10 s) and IA end always precedes IAref end (0.46 +/- 0.16 s). These results clearly deteriorate when the model is not updated.     

Effect of body posture on respiratory impedance

The effects of posture on the mechanics of the respiratory system are not well known, particularly in terms of total respiratory resistance. We have measured respiratory impedance (Zrs) by the forced random noise excitation technique in the sitting and the supine position in 24 healthy subjects. Spirometry and lung volumes (He-dilution technique) were also measured in both postures. The equivalent resistance (Rrs), compliance (Crs), and inertance (Irs) were also calculated by fitting each measured Zrs to a linear series model. When subjects changed from sitting to the supine position, the real part of Zrs increased over the whole frequency band. The associated equivalent resistance, Rrs, increased by 28.2%. The reactance decreased for frequencies lower than 18 Hz and increased for higher frequencies. Consequently, Crs decreased by 38.7% and Irs increased by 15.6%. All of these parameter differences were significant (P less than 0.001). A covariance analysis showed that a significant amount of the postural change in Rrs and Crs can be explained by the reduction of functional residual capacity (FRC). This indicates that the observed differences on Zrs can in part be explained be a shift of the operating point of the respiratory system induced by the decrease in the FRC.