急进高海拔时健康人夜间睡眠、呼吸状态和血氧饱和度的变化

在海拔2300m选择健康成年男性5人,急进抵海拔4660m,用多导监测仪分别在两地连续7h监测夜间睡眠、呼吸状态和血氧饱和度变化,进行自身对比。结果发现:(1)急进高海拔后,总睡眠时间、有效睡眠指数、Ⅲ～Ⅳ期深睡眠均较中度高原减少(p<0.01);总觉醒时间、Ⅰ～Ⅱ期浅睡眠高海拔较中度高原增多(p<0.05):(2)急进高海拔后,有3名健康人出现周期性呼吸,其中1名健康者出现周期性呼吸119次,伴有中枢性睡眠呼吸暂停,最低Sao_2为78％;(3)同海拔高度夜间睡眠时与清醒时Sao_2相比较,中度高原下降4.2％,高海拔下降11.2％(p<0.01);高海拔与中度高原夜间清醒时Sao_2相比较下降7.4％,睡眠时下降14.4％(p<0.001)。结果提示:(1)睡眠加重了高原人原有的低氧血症;(2)低氧血症导致睡眠结构的紊乱和睡眠质量的降低;(3)睡眠中出现的周期性呼吸,应视为机体的一种自我保护机制;(4)频发的周期性呼吸或睡眠呼吸暂停将影响大脑机能。     

高原红细胞增多症患者夜间睡眠呼吸变化

高原睡眠结构紊乱和周期性呼吸已有较多记载,我们对海拔3730m处8例高原红细胞增多症(HAPC)患者在高原和平原夜间睡眠呼吸变化进行了研究,以探讨高原与平原对其夜间睡眠、呼吸和血氧饱和度(Sao_2)的影响。     

急性低氧对高原土生动物藏系绵羊血气的影响

为了探讨急性低氧时藏系绵羊(Ovis aries)的血气特点,揭示其低氧适应机制,将7只雄性藏系绵羊和5只雄性移居绵羊分别置于高低压氧舱内,测定模拟海拔0、2 300和4 500 m时各动物清醒状态下的血气指标。用热稀释法测定心输出量。使用血气分析仪和EG7血样板,测定动脉及混合静脉血的血气指标,按Ficks方法计算氧耗量。结果显示,随着模拟海拔高度的升高,藏羊和移居羊的动静脉血氧饱和度(So2)、氧分压(Po2)、二氧化碳分压(Pco2)都呈明显下降趋势(P<0.05),血红蛋白浓度(Hb)、血液pH、心输出量及氧耗量虽无明显的差异性改变,但它们在4 500 m处的绝对值是增加的。在相同海拔,藏羊的Hb明显低于移居羊(P<0.05),4 500 m时藏羊的动脉血氧饱和度(Sao2)及组织摄氧量显著高于移居羊(P<0.05)。表明藏羊在急性低氧时表现出的高Sao2及高组织摄氧量,低Hb、低pH是它适应高原低氧的生理基础。     

低氧反应和屏气反应在急性高原反应预测中的作用

目的:探讨低氧反应和屏气反应在急性高原反应预测中的作用.方法:在平原观察113名入藏人员吸入10%低氧气体10 min和屏气过程中的血氧饱和度、心率和血压变化;进入高原后进行急性高原反应(AMS)症状评分;两组数据进行相关分析,并对急性高原反应者和基本无反应者数据进行分析.结果:吸入10%低氧气体过程中,动脉血氧饱和度进行性下降,心率迅速升高,血压普遍呈现先升高后降低的变化趋势.急性高原反应者吸入低氧气体1min时的心率明显慢于基本无反应者.所观测指标均存在着较大的个体差异,但相关分析表明,AMS评分仅与吸入低氧气体7 min时的心率呈显著负相关,相关系数r为-0.176.结论:在平原单纯用低氧和屏气反应来预测3 658 m高原地区的AMS发病情况意义可能有限.     

3600m模拟高度人血浆中β—内啡肽的变化与终末呼出气氧分压和氧饱和度的关系

本实验室以前的工作表明,动物在急性低氧条件下,中枢大量释放β-内啡肽,这是中枢对低氧的应激反应,而这种反应的结果引起低氧通气抑制。除了中枢反应外,是否还存在外周β-内啡肽系统对低氧的反应尚不清楚。为此,我们测定了在模拟3600m高度时人血浆中β-内啡肽含量的变化,并同时观察了这种变化与终末呼出气氧分压(P_(EO2))和氧饱和度(Sao_2)间的关系。     

高原青少年最大有氧能力的研究

采用自行车递增负荷运动试验,对青海西宁地区(海拔2260m)86名13～16岁男女中学生的最大摄氧量,无氧阈以及血氧饱和度等指标进行了测定。结果表明,高原青少年的最大摄氧量较低,而无氧阈则较高。血氧饱和度随负荷增加逐渐降低,在接近极限负荷时迅速下降,提示高原低氧是限制最大运动能力的主要因素。无氧阈较高说明高原青少年组织细胞利用氧的能力提高,这是对高原低氧环境长期适应的结果。     

急性低氧对耐力运动员无氧代谢阈值的影响

通过观察急性低氧对耐力运动员无氧代谢阈值的影响,探讨了急性低氧对耐力运动员体力活动能力的影响,并分析与上述影响强弱有关的若干可能因素。18名青年耐力运动员分别吸入21％O_2(常氧对照)和12.8％O_2(急性低氧),进行逐级递增体力负荷运动,直至最大耐受量。观察运动期间每分通气量、氧耗量、二氧化碳排出量、动脉血氧饱和度、心率和氧脉搏,并测定无氧代谢阈值。结果表明,急性低氧使耐力运动员的无氧代谢阈值明显降低。各个体无氧代谢阈值的降低程度分别与该个体动脉血氧饱和度以及氧脉搏的降低程度呈正相关。急性低氧下无氧代谢阈值降低提示了体力活动能力的削弱,而低氧下心肺代偿功能较弱以及动脉血氧饱和度较低者,其体力活动能力的削弱较明显。     

516例参训官兵高原反应测试分析

目的:探讨在模拟不同海拔高度时,拟赴高原的参训官兵在急进高原时高原反应发生的特点,为高原参训官兵高原病的预防提供理论依据。方法:应用西北特殊环境人工实验舱模拟不同海拔高度,随机对516名平原部队参训官兵进行急进不同海拔高原反应进行测试,动态观察平原环境、急进高原2000 m、3000 m、4500 m海拔高度的自觉症状及部分生理指标(心率、血氧饱和度)的动态变化以及进舱前和出舱后血压值变化情况。结果:(1)516名官兵均完成测试,在海拔2000 m时,53例出现耳闷、耳涨症状,94例出现耳鸣症状,作吞咽动作后在以后的"上升"和"下降"过程中均未出现症状;在海拔4500 m时,39例出现高原反应,其中19例出现头晕症状,20例出现手足麻木,高原反应发生率7.56%。(2)随着海拔高度逐渐升高,受试者心率逐渐加快,从2000 m开始加快明显(p0.05),血氧饱和度逐渐降低,到3000 m开始血氧饱和度下降明显(p0.05)。(3)进舱前和出舱后血压值相比没有统计学差异(p0.05)。结论:参训官兵急进高原后,高原反应主要出现在4500 m海拔高度,高原反应发生率7.56%;高原环境对机体的心率、血氧饱和度的影响随着海拔高度增加而明显,2000 m开始心率明显加快,3000 m开始出现血氧饱和度明显下降,耳部不适症状主要出现在2000 m,但在做吞咽动作后消失。     

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。     

急性低氧对藏族长期移居海平后动脉血气的影响

本工作目的是研究长期移居海平后的藏族人回到高原后功能变化。研究对象是16名年轻藏族人,来上海(海平)前,均出生并居住于西藏高原(海拔高度约3700m),在上海上学4年期间从未返回高原。同时选取10名海平年轻汉族人作对照。观察急性低氧至3700m 2h后动脉血气的变化。动脉血气的各项指标用ABL3型血气分析仪自动测定。在经受3700m急性减压低氧后,长期移居海平藏族人的Pao_2和Sao_2明显高于海平汉族,分别为7.2±0.6,5.5±0.2kPa(P<0.05)和87.9±3.3％,78.2±1.6％(P<0.05)。长期移居海平后藏族人的Paco_2仍低于汉族人,而pH值高于海平汉族人,藏族人Hb含量低于海平汉族。研究结果提示,藏族人在低氧高原环境生长和发育过程中所形成的低氧适应能力可能是由藏族人遗传因素所决定的。     

急性高山反应判别式与判别图的建立及应用

为探讨急性高山反应的生理学评价方法,以12名男性青年为受试对象,每人参加三次低压舱实验(模拟海拔高度为5000m),进行症状学调查的同时,测量f、V_E、P_AO_2、PaO_2、AaDO_2、P_ACO_2、PaCO_2和pH_a。结果表明,急性高山反应重者,PaO_2较低,AaDO_2较高,反应轻者,PaO_2较高,A_aDO_2较低。在此基础上,到青藏高原(海拔4700m)对52名受试者进行症状学调查的同时,测量PaO_2和AaDO_2,其结果同上。可见,急性高山反应程度与PaO_2和AaDO_2大小有密切关系。因此,我们用PaO_2和AaDO_2作为评价指标,并建立了判别式和判别图。为验证该判别式和判别图的准确性和实用性,又到青藏高原(海拔4700m)观察174名男性青年,用症状学和判别式两种方法评价急性高山反应,两种方法判定结果的总吻合率达89.0％。     

Cardio-respiratory adaptation to physical exercise and hypoxia after a high-altitude expedition.

Seven young, male subjects were tested before and immediately after 6 weeks high-mountain expedition. Cardio-respiratory measurements were performed at rest and during standard physical excercise (10 min, 100 W) when breathing atmospheric air or hypoxic mixture (14% O2 in N2). After the expedition an increased V o2 max (16% an average) and diminished heart rate response to submaximal exercise were found. This was observed during air and hypoxic mixture breathing. There was significant increase in stroke volume and cardiac output during the exercise. No significant differences in ventilatory parameters were found nor at rest or during exercise under condition of breathing atmospheric air or hypoxic mixture. No changes in erythrocyte count or haemoglobin concentration in the blood were found. The physiological changes which developed during high-mountain expedition were more dependent on physical that hypoxic training.     

Metabolic Adaptations May Counteract Ventilatory Adaptations of Intermittent Hypoxic Exposure during Submaximal Exercise at Altitudes up to 4000 m

Intermittent hypoxic exposure (IHE) has been shown to induce aspects of altitude acclimatization which affect ventilatory, cardiovascular and metabolic responses during exercise in normoxia and hypoxia. However, knowledge on altitude-dependent effects and possible interactions remains scarce. Therefore, we determined the effects of IHE on cardiorespiratory and metabolic responses at different simulated altitudes in the same healthy subjects. Eight healthy male volunteers participated in the study and were tested before and 1 to 2 days after IHE (7×1 hour at 4500 m). The participants cycled at 2 submaximal workloads (corresponding to 40% and 60% of peak oxygen uptake at low altitude) at simulated altitudes of 2000 m, 3000 m, and 4000 m in a randomized order. Gas analysis was performed and arterial oxygen saturation, blood lactate concentrations, and blood gases were determined during exercise. Additionally baroreflex sensitivity, hypoxic and hypercapnic ventilatory response were determined before and after IHE. Hypoxic ventilatory response was increased after IHE (p<0.05). There were no altitude-dependent changes by IHE in any of the determined parameters. However, blood lactate concentrations and carbon dioxide output were reduced; minute ventilation and arterial oxygen saturation were unchanged, and ventilatory equivalent for carbon dioxide was increased after IHE irrespective of altitude. Changes in hypoxic ventilatory response were associated with changes in blood lactate (r = −0.72, p<0.05). Changes in blood lactate correlated with changes in carbon dioxide output (r = 0.61, p<0.01) and minute ventilation (r = 0.54, p<0.01). Based on the present results it seems that the reductions in blood lactate and carbon dioxide output have counteracted the increased hypoxic ventilatory response. As a result minute ventilation and arterial oxygen saturation did not increase during submaximal exercise at simulated altitudes between 2000 m and 4000 m.     

Acetazolamide reduces exercise capacity and increases leg fatigue under hypoxic conditions.

Acetazolamide (Acz) is used at altitude to prevent acute mountain sickness, but its effect on exercise capacity under hypoxic conditions is uncertain. Nine healthy men completed this double-blind, randomized, crossover study. All subjects underwent incremental exercise to exhaustion with an inspired O(2) fraction of 0.13, hypoxic ventilatory responses, and hypercapnic ventilatory responses after Acz (500 mg twice daily for 5 doses) and placebo. Maximum power of 203 +/- 38 (SD) W on Acz was less than the placebo value of 225 +/- 40 W (P < 0.01). At peak exercise, arterialized capillary pH was lower and Po(2) higher on Acz (P < 0.01). Ventilation was 118.6 +/- 20.0 l/min at the maximal power on Acz and 102.4 +/- 20.7 l/min at the same power on placebo (P < 0.02), and Borg score for leg fatigue was increased on Acz (P < 0.02), with no difference in Borg score for dyspnea. Hypercapnic ventilatory response on Acz was greater (P < 0.02), whereas hypoxic ventilatory response was unchanged. During hypoxic exercise, Acz reduced exercise capacity associated with increased perception of leg fatigue. Despite increased ventilation, dyspnea was not increased.     

Somatostatin inhibits the ventilatory response to hypoxia in humans

The effects of a 90-min infusion of somatostatin (1 mg/h) on ventilation and the ventilatory responses to hypoxia and hypercapnia were studied in six normal adult males. Minute ventilation (VE) was measured with inductance plethysmography, arterial 02 saturation (SaO2) was measured with ear oximetry, and arterial PCO2 (Paco2) was estimated with a transcutaneous CO2 electrode. The steady-state ventilatory response to hypoxia (delta VE/delta SaO2) was measured in subjects breathing 10.5% O2 in an open circuit while isocapnia was maintained by the addition of CO2. The hypercapnic response (delta VE/delta PaCO2) was measured in subjects breathing first 5% and then 7.5% CO2 (in 52-55% O2). Somatostatin greatly attenuated the hypoxic response (control mean -790 ml x min-1.%SaO2 -1, somatostatin mean -120 ml x min-1.%SaO2 -1; P less than 0.01), caused a small fall in resting ventilation (mean % fall - 11%), but did not affect the hypercapnic response. In three of the subjects progressive ventilatory responses (using rebreathing techniques, dry gas meter, and end-tidal Pco2 analysis) and overall metabolism were measured. Somatostatin caused similar changes (mean fall in hypoxic response -73%; no change in hypercapnic response) and did not alter overall O2 consumption nor CO2 production. These results show an hitherto-unsuspected inhibitory potential of this neuropeptide on the control of breathing; the sparing of the hypercapnic response is suggestive of an action on the carotid body but does not exclude a central effect.     

Women at altitude: ventilatory acclimatization at 4,300 m.

Women living at low altitudes or acclimatized to high altitudes have greater effective ventilation in the luteal (L) compared with follicular (F) menstrual cycle phase and compared with men. We hypothesized that ventilatory acclimatization to high altitude would occur more quickly and to a greater degree in 1) women in their L compared with women in their F menstrual cycle phase, and 2) in women compared with men. Studies were conducted on 22 eumenorrheic, unacclimatized, sea-level (SL) residents. Indexes of ventilatory acclimatization [resting ventilatory parameters, hypoxic ventilatory response, hypercapnic ventilatory response (HCVR)] were measured in 14 women in the F phase and in 8 other women in the L phase of their menstrual cycle, both at SL and again during a 12-day residence at 4,300 m. At SL only, ventilatory studies were also completed in both menstrual cycle phases in 12 subjects (i.e., within-subject comparison). In these subjects, SL alveolar ventilation (expressed as end-tidal PCO(2)) was greater in the L vs. F phase. Yet the comparison between L- and F-phase groups found similar levels of resting end-tidal PCO(2), hypoxic ventilatory response parameter A, HCVR slope, and HCVR parameter B, both at SL and 4,300 m. Moreover, these indexes of ventilatory acclimatization were not significantly different from those previously measured in men. Thus female lowlanders rapidly ascending to 4,300 m in either the L or F menstrual cycle phase have similar levels of alveolar ventilation and a time course for ventilatory acclimatization that is nearly identical to that reported in male lowlanders.     

Human hypoxic ventilatory response with blood dopamine content under intermittent hypoxic training

Adaptation to intermittent hypoxia can enhance a hypoxic ventilatory response (HVR) in healthy humans. Naturally occurring oscillations in blood dopamine (DA) level may modulate these responses. We have measured ventilatory response to hypoxia relative to blood DA concentration and its precursor DOPA before and after a 2-week course of intermittent hypoxic training (IHT). Eighteen healthy male subjects (mean 22.8+/-2.1 years old) participated in the study. HVRs to isocapnic, progressive, hypoxic rebreathing were recorded and analyzed using piecewise linear approximation. Rebreathing lasted for 5-6 min until inspired O2 reached 8 to 7%. IHT consisted of three identical daily rebreathing sessions separated by 5-min breaks for 14 consecutive days. Before and after the 2-week course of IHT, blood was sampled from the antecubital vein to measure DA and DOPA content. The investigation associated pretraining high blood DA and DOPA values with low HVR (r = -0.66 and -0.75, respectively), elevated tidal volume (r = 0.58 and 0.37) and vital capacity (r = 0.69 and 0.58), and reduced respiratory frequency (r = -0.89 and -0.82). IHT produced no significant change in ventilatory responses to mild hypoxic challenge (Peto2 from 110 to 70-80 mm Hg; 1 mm Hg = 133.3 Pa) but elicited a 96% increase in ventilatory response to severe hypoxia (from 70-80 to 45 mm Hg). Changes in HVRs were not accompanied by statistically significant shifts in blood DA content (24% change), although a twofold increase in DOPA concentration was observed. Individual subject's changes in DA and DOPA content were not correlated with HVR changes when these two parameters were evaluated in relation to the IHT. We hypothesize that DA flowing to the carotid body through the blood may provoke DA autoreceptor-mediated inhibition of endogenous DA synthesis-release, as shown in our baseline data.     

Role of dopamine in the peripheral mechanisms of respiration control

Under clinical conditions, we studied the interaction between dopamine (DA) metabolism and hypoxia stimulationrelated ventilatory responses (HVR) before and after adaptation to periodical hypoxic episodes. Thirty-seven young and elder persons were tested; among elder tested subjects there were patients with Parkinson’s desease treated or not treated with DOPA-DA precursor-containing drugs (levoDOPA/carbiDOPA). We measured the HVR indices and DA and DOPA contents in the venous blood of tested persons before and after a 14-day-long hypoxic training. The highest indices of the ventilation sensitivity to hypoxia together with the lowest above-mentioned chemical indices were observed in young persons. An increase in the DA and DOPA levels in the venous blood were observed concurrently with suppression of the ventilation responses to hypoxic episodes. After a course of periodical hypoxic sessions, we observed in all groups opposite dynamics of DA and DOPA metabolism. An increase in the DA level in young persons and a trend toward its decrease in older healthy persons and parkinsonian patients was nevertheles accompanied by an HVR increase in all groups. Possible relations between the DA metabolism indices and peripheral mechanisms of respiratory control are discussed.