装甲步兵不同体力者的耐热能力

为了解装甲步兵不同体力乘员耐热能力的差异,为该兵种提供防暑工作的依据,于1985年6～7月在豫东地区进行了现场试验研究。方法采用PWC_(170)踏车法(指心率在170次/分时体力下的工作能力,以千克·米/公斤体重·分为单位),对全连60名19～24岁的战士进行体力普查,参考国人PWC_(170)正常值和美陆军体力标准,按照均值±标准差的范围进行体力分类:PWC_(170)>15kg·m/kg·     

缺铁性贫血对学龄前儿童身体做功能力的影响

本文试用PWC_(170)机能试验,在控制7个干扰因素使每组年龄、性别组成、体重、身高、头围、胸围、体表面积尽可能一致的情况下,研究了缺铁性贫血(IDA)对学龄前儿童身体做功能力(PWC_(170))的影响。结果表明IDA治疗组在补铁前PWC_(170)和最大吸氧量(VO_(2max))分别为172.47±25.29kg·M/min,1.53±0.09L/min低于对照组相应值(P<0.01),铁剂治疗80天后,分别增至198.52±44.53kg·M/min、1.65±0.17L/min,和治疗前比较P<0.01,且与对照组没有统计学差异(P<0.05)。IDA安慰剂组治疗前后PWC_(170)和VO_(2max)没有明显变化且都低于对照组相应值。IDA幼儿运动负荷后的心率高于正常幼儿,治疗后下降。本研究指示IDA对学龄前儿童身体做功能力有一定影响,并能被补铁治疗矫正。     

平原人快速进入海拔4370米高原后尿八项生化指标的变化

通过对40名平原人乘飞机进驻海拔4370m高原后尿8项生化指标变化的动态分析和急性高原病(AMS)发病调查,可见尿液pH值在达高原的第1天为6.6,比平原值6.4略有升高,以后呈下降趋势,第5天与第6天降为5.8,明显低于第1天和平原值(P<0.01);尿蛋白阳性率在到达高原后头3天分别为20.6%、26.5%和25.9%,皆明显高于7.5%的平原值(P<0.05),第4天后逐渐降低;尿酮体阳性率在达高原后的第3～5天分别为92.6%、82.3%和47.1%,皆明显高于10%的平原值(P<0.01),其余时间未检出阳性;尿潜血阳性率于到达高原的第3天和第4天分别为14.8%与5.9%,其余时间和在平原时均未检出阳性;尿亚硝酸盐、尿糖、尿胆红素和尿胆元4项指标始终未见明显变化.AMS患者的尿pH值和尿蛋白浓度明显高于基本无AMS者(P<0.05);在13名AMS患者中,69.2%的人尿蛋白阳性,30.8%的人尿蛋白可疑,而且尿蛋白阳性者的AMS症状持续的时间明显长于尿蛋白可疑者(P<0.05).受试者在达高原第4天递增负荷运动后尿pH值明显降低和尿酮体明显增加,所测PWC_(170)明显低于平原值(P<0.05).结果提示,平原人乘飞机急进高原后肾功能会受到严重损伤,但经短期高原适应后可以很快恢复.     

急进高原自主神经功能变化与急性高原反应的关系

目的研究急进高原前、后心血管自主神经(autonomic nervous system,ANS)功能变化及其与急性高原反应(acute mountain sickness,AMS)之间关系,揭示ANS在AMS发病中的作用,探求预防AMS的可能途径。方法对99名健康男性青年在海拔450m平原和空运急进3700m高原后2~4d内进行心率变异性(heart rate variability,HRV)和冷加压试验(cold pressor test,CPT)检测;在急进高原后1~5d接受AMS发病情况调查。结果急进高原后第1天AMS发病率92%,其中,中重度AMS占10%、轻度占36%、基本无反应占54%。LF/HFn随AMS程度减轻而减少,HFn随AMS程度加重而增加。中重度、轻度、基本无AMS反应组平原时收缩压(SBP)分别为(123.42±7.14)mmHg、(120.6±11.22)mmHg、(122.58±10.92)mmHg,均显著高于无反应组(111.31±9.48)mmHg,(P<0.05);中重度AMS组在平原CPT后心率(HR)变化幅度〔(7.57±8.22)b/min〕显著低于基本无反应组〔(25.47±19.26)b/min,(P<0.05)〕。急进高原后,中重度、轻度、基本无AMS反应组CPT后SBP变化幅度分别为(8.14±4.95)mmHg、(9.56±7.77)mmHg、(9.97±6.80)mmHg,均显著低于无反应组〔(17.00±12.75)mmHg,(P<0.05)〕;HR变化幅度分别为(11.13±6.08)b/min、(10±7.5)b/min、(12.25±8.14)b/min,均显著低于无反应组(〔19.71±9.35)b/min,P<0.05〕。AMS症状积分与平原时LF/HF正相关(r=0.437,P<0.01),与平原时CPT后HR变化幅度呈负相关(r=-0.35,P=0.01)。结论平原交感神经活动较高者其ANS的应激调节能力相对较小,对AMS易感性较高。改善ANS功能可能有助于预防AMS。     

低压仓内训练提高人体PWC_(170)机能的研究

本文通过12名16～22岁男自行车运动员,在低压仓内2000米、3000米、4000米模拟高度分别停留5、11、11天,每天上午踏车3小时,其余时间均在仓外进行一般体育训练的方式,观察了PWC_(170)的变化。结果表明,训练前PWC_(170)978±34kgm/min,训练后提高到1372±46kgm/min,增加40%(P<0.01)。说明:(1)所采用的阶梯性间断缺氧复合训练的方式共27天时间,明显提高了有氧代谢能力,有利于快速进入高原地区人员对缺氧的适应;(2)PWC_(170)可用于评定呼吸与循环机能,衡量体力和训练的效果;亦可试用于对高原适应能力作出前瞻性的估计。     

海拔4 100m人体体力活动时氧耗量及血氧饱和度的观察

目的观察海拔4 100m人体体力活动时氧耗量(VO2)和氧脉搏(VO2/HR)及血氧饱和度(SaO2)的关系.方法受试者坐于踏车功量机上,以60r@min-1连续蹬车,每3 min递增25 W,蹬车至衰竭时停止,用心电图机记录每个负荷最后5 s的心率(HR),用O2CO2气体测定仪及掌式血氧仪分析每个负荷最后0.5 min的O2和CO2含量及SaO2,计算VO2和VO2/HR.结果HR在100～170 b@min-1时,VO2随着HR的增加而呈线性的增加(y=-0.1345+0.0077 x,r=0.9692,P＜0.01);HR为100～130 b@min-1时,VO2/HR也随HR的增加而增加;HR增加到140～170 b@min-1时,VO2/HR不但不增加反而减少,SaO2随VO2的增加而减少.结论高原低氧环境增加了人体生理负荷,致使人体在高原的劳动能力下降.     

轻度缺铁性贫血对儿童身体作功能力的影响

本文研究了130名轻度缺铁性贫血和正常的7岁儿童的身体作功能力。分别在治疗前、后30天及60天时采手指血分析Hb、FEP、FEP/Hb、SF;同时测定身体作功能力指标(PWC_(170)、R·PWC_(170)、W·HR、Vo_2max)。发现轻度缺铁性贫血儿童的各测定指标均与正常儿童有显著差异,但经硫酸亚铁(300mg/d)治疗60天后,各测定指标均恢复到正常水平。本文研究结果证明了轻度缺铁性贫血可使儿童身体作功能力明显降低。     

海拔3 680 m体力活动时氧耗量及血氧饱和度的观察

目的观察高海拔地区体力活动时的氧耗量(VO2)、氧脉搏(VO2/HR)及血氧饱和度(Sa%)的变化.方法受试者坐于踏车功率计上,以60 r@min-1连续踏车,每3 min递增25W,踏车至极量点最后时停止,记录每个量级符合最后5 s的心率,测量每个量级负荷最后半分钟O2和CO2含量及Sa%,计算VO2和VO2/HR.结果HR在100～170 b@min-1,VO2随HR的增加而呈线性增加(Y=106.4208-0.1928 X r=0.9936,P＜0.01),HR为100～130 b@min-1时,VO2/HR也随HR的增加而增加;HR增加到140～170 b@min-1,VO2/HR不但不增加反而减少;Sa%随HR的增加而呈线性减少(Y=104.964-0.1821 X r=0.9981 P＜0.01);Sa%亦随VO2的增加呈线性减少(Y=104.9608-25.142 X r=0.9928).结论高原低氧环境增加了人体生理负荷,造成体力活动时氧耗量的增加,血氧饱和度下降,这可能是造成人体在高原劳动能力下降的原因.     

高原康胶囊对快速进入高原者水负荷的影响及意义

目的　通过实验了解高原康胶胶对大批快速进入高原者水负荷的影响及其意义。方法　将 80名由平原乘飞机初次进入高原的战士随机分为实验组和对照组 ,实验组于平原登机前开始给予口服高原康胶囊 ,2粒 /次 ,3次 /d ;对照组不给予任何药物预防 ,在两组进入高原的前 1d及进入高原的第 3d下午后给予水负荷实验 ,并对其饮水后 15 0min内各时相点的尿量进入观察比较。结果　对照组进入高原后水负荷实验 61～ 15 0min各时间段的尿量及相应时间的总尿量与平原时相应各时间段的尿量及相应时间的总尿量相比显著减少 (P <0 0 5～ 0 0 1) ,实验组则无显著变化 ;且实验组进入高原后水负荷实验 60～ 90min的尿量及 12 0、15 0min的尿量显著多于对照组 ( P <0 0 5 )。结论　高原康能改善机体高原缺氧状态下水负荷的调节能力 ,对大批快速进入高原者急性高原病发病有预防作用     

酚妥拉明和多巴胺联合佐治小儿重症肺炎并心力衰竭疗效观察及其预防多器官功能衰竭的临床意义

目的:观察酚妥拉明和多巴胺联合佐治小儿重症肺炎并心力衰竭(心衰)的疗效,探讨血管活性药物对重症肺炎合并多器官功能衰竭(MSOF)的预防作用。方法:选择1998年11月～2002年12月收治的39例重症肺炎并心衰患儿为观察组,在综合治疗基础上给予酚妥拉明0.2～0.3mg/kg·次,2～4次/d,多巴胺0.5mg/kg·次,以5～10μg/kg·min的速度静滴,2～4次/d,疗程2～3d。结果:39例患儿有效38例(97.44%),显著高于对照组(P<0.05);显效33例(84.62%),与对照组相比有高度显著性(P<0.01);观察组无1例并发MSOF,而对照组有6例并发MSOF(14.63%),两组比较有显著性差异(P<0.05)。结论:酚妥拉明和多巴胺联合佐治重症肺炎并心衰疗效肯定。两种血管活性药物联合应用可有效预防重症肺炎时MSOF的发生。     

高原不同海拔地区儿童肺活量肺通气量与形态指标的相关性

目的 了解高原不同海拔地区儿童肺活量肺通气量与形态指标的相关性,以便为制定高原性疾病防控策略提供参考依据.方法 于2019年1月至2020年6月采用随机抽样调查法,选择青海西宁地区(海拔2 260m,低海拔组)、青海海西地区(海拔2 900m,中海拔组)、青海玉树地区(海拔4 493m,高海拔组)7～15岁中小学生作为...     

控制性降压结合急性高容血液稀释在鼻内镜手术中的应用

目的探讨硝酸甘油联合艾司洛尔控制性降压结合急性高容血液稀释（acute hypervolemic hemodilution,AHH）在鼻内镜手术中的应用效果。方法选择鼻内镜手术ASA I～Ⅱ级的患者40例。随机分为硝酸甘油组（A组,n=20）和硝酸甘油联合艾司洛尔组（B组,n=20）。术前采用乳酸林格氏液及6%羟乙基淀粉急性高容量血液稀释,术中硝酸甘油组微量泵注硝酸甘油0.5～5.0μg/（kg·min）;硝酸甘油联合艾司洛尔组微量泵注硝酸甘油0.5～5.0μg/（kg·min）,同时艾司洛尔0.01～0.02 mg/（kg·min）泵注维持,记录两组患者手术过程中MAP、HR、出血量及术野质量评分等。结果 B组硝酸甘油用量显著少于A组（P〈0.05）;A组降压期间HR增快,较降压前差异有统计学意义（P〈0.05）,B组降压期间HR轻度下降,与A组比较差异有统计学意义（P〈0.05）;两组MAP均较术前显著降低,45min时,B组MAP值显著小于A组;两组均未出现明显降压性并发症。结论硝酸甘油联合艾司洛尔控制性降压可以安全有效地应用于鼻内镜手术,结合急性血液稀释可明显减少术中出血量。     

高原与平原条件下48h完全睡眠剥夺对血压和心率的影响

目的：探讨高原(海拔约2850m)与平原(海拔约400m)环境下完全睡眠剥夺对人体血压和心率变化的影响。方法：在完全睡眠剥夺条件下，分别在高原与平原对15名被试者(高原7名，平原8名)于间隔为6h的8个时间点进行血压和心率测量。结果：高原被试的血压和心率与平原的相比，除收缩压在时间点3(第1天晚间21：30／20：30)、时间点5(第2天上午9：30／8：30)和时间点8(第3天凌晨03：30／02：30)存在显著性差异外，其余均不存在显著性差异。结论：中等海拔高度约2850m的高原，在只进行轻体力劳动的条件下，48h睡眠剥夺对机体血压和心率变化的影响同平原大致相似。     

Effects of high altitude and season on fasting heat production in the yak Bos grunniens or Poephagus grunniens

Thirty growing yaks Bos grunniens or Poephagus grunniens, 1.0-3.5 years and 50-230 kg, from their native altitudes (3000-4000 m), were used to study the basal metabolism in this species and to evaluate the effects of high altitude and season on the energy metabolism. Fasting heat production (FHP) was measured at altitudes of 2260, 3250 and 4270 m on the Tibetan plateau in both the summer and the winter, after a 90 d adaptation period at each experimental site. Gas exchanges of the whole animals were determined continuously for 3 d (4-5 times per d, 10-12 min each time) after a 96 h starvation period, using closed-circuit respiratory masks. Increasing altitude at similar ambient temperature (Ta) did not affect (P>0.10) FHP in the summer, but decreased (P<0.05) it at different Ta in the winter. However, the decrease of FHP in the winter was mainly due to the decrease of Ta instead of the increase of altitude. In the summer, the respiratory rate, heart rate and body temperature were unaffected by altitude, except for a decrease (P<0.05) in body temperature at 4270 m; in the winter, they were decreased (P<0.05) by increasing altitude. In both seasons, the RER was decreased (P<0.05) by increasing altitude. At all altitudes for all groups, the daily FHP was higher (P<0.05) in the summer (Ta 6-24 degrees C) than in the winter (Ta 0 to -30 degrees C), and the Ta-corrected FHP averaged on 920 kJ/kg body weight(0.52) at Ta 8-14 degrees C and on 704 kJ/kg body weight(0.52) at Ta -15 degrees C respectively. We conclude that in the yak high altitude has no effect on the energy metabolism, whereas the cold ambient temperature has a significant depressing effect. The results confirm that the yak has an excellent adaptation to both high altitude and extremely cold environments.     

负荷运动对大学生运动生理功能影响

目的探讨负荷运动对男、女大学生最大摄氧量(Vo2 max)、身体工作能力(PWC170)和心功能适应指数的效应,为进一步指导大学生体育锻炼提供参考。方法随机抽取右江民族医学院一年级180名男生和218名女生。采用二级阶梯负荷法测定其心率变化,计算Vo2 max、PWC170和心功能适应指数值。结果男生Vo2 max为(44.52±3.76)mL/(min.kg),女生为(42.74±3.47)mL/(min.kg);男、女生PWC170分别为(974.78±184.07)和(948.57±187.84)kg.m/min;心功能适应指数男生为(84.24±15.16),女生为(82.38±15.92)。在等级分组发现,Vo2 max增高,PWC170和心功能适应指数也随之升高,Vo2 max下降,PWC170和心功能适应指数也随之降低,男、女生优组与差组差异有统计学意义(P<0.01)。结论男生与女生的PWC170和心功能适应指数的变化与Vo2 max变化有显著相关,提示加强在校大学生体育训练,可增强体能。     

雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.     

Gastric Emptying in Critically Ill Children

Background: Delayed gastric emptying (GE) impedes enteral nutrient (EN) delivery in critically ill children. We examined the correlation between (a) bedside EN intolerance assessments, including gastric residual volume (GRV); (b) delayed GE; and (c) delayed EN advancement. Materials and Methods: We prospectively enrolled patients ≥1 year of age, eligible for gastric EN and without contraindications to acetaminophen. Gastric emptying was determined by the acetaminophen absorption test, specifically the area under the curve at 60 minutes (AUC₆₀). Slow EN advancement was defined as delivery of <50% of the prescribed EN 48 hours after study initiation. EN intolerance assessments (GRV, abdominal distension, emesis, loose stools, abdominal discomfort) were recorded. Results: We enrolled 20 patients, median 11 years (4.4–15.5), 50% male. Sixteen (80%) patients had delayed GE (AUC₆₀ <600 mcg·min/mL) and 7 (35%) had slow EN advancement. Median GRV (mL/kg) for patients with delayed vs normal GE was 0.43 (0.113–2.188) vs 0.89 (0.06–1.91), P = .9635. Patients with slow vs rapid EN advancement had median GRV (mL/kg) of 1.02 mL/kg (0.20–3.20) vs 0.27 mL/kg (0.06–1.62), P = .3114, and frequency of altered EN intolerance assessments of 3/7 (42.9%) vs 5/13 (38.5%), P = 1. Median AUC₆₀ for patients with slow vs rapid EN advancement was 91.74 mcg·min/mL (53.52–143.1) vs 449.5 mcg·min/mL (173.2–786.5), P = .0012. Conclusions: A majority of our study cohort had delayed GE. Bedside EN intolerance assessments, particularly GRV, did not predict delayed GE or rate of EN advancement. Delayed gastric emptying predicted slow EN advancement. Novel tests for delayed GE and EN intolerance are needed.     

Effects of lipase inhibition on gastric emptying and alcohol absorption in healthy subjects

The rate of alcohol absorption is dependent on gastric emptying (GE). As the slowing of GE by fat is dependent on lipolysis, orlistat may increase the rise in blood alcohol when alcohol is consumed with, or after, fat. The aim of the study was to evaluate the effects of orlistat on GE and blood alcohol after an alcohol-containing drink following a fat 'preload', in healthy subjects. Ten healthy males consumed 120 ml cream with or without 120 mg orlistat, 30 min before an alcohol-containing drink labelled with 20 MBq [(99 m)Tc]sulfur colloid on 2 d. GE, plasma alcohol and blood glucose were measured. GE was slightly faster with orlistat (P<0.05) compared with control. Plasma alcohol at 15 min was slightly higher with orlistat (0.034 (SEM 0.006) g/100 ml) v. control (0.029 (SEM 0.005) g/100 ml) (P<0.05), but there was no effect on the area under the curve 0-240 min. The increase in blood glucose was greater with orlistat, for example, at 15 min (1.07 (SEM 0.2) mmol/l) v. control (0.75 (SEM 0.2) mmol/l) (P=0.05). The rise in blood glucose and plasma alcohol were related (for example, at 15 min r 0.49; P=0.03). In conclusion, lipase inhibition accelerates GE of an alcohol-containing drink following a fat 'preload' with a minor increase in the initial rise in plasma alcohol.     

移居高原健康青年血清丙二醛和尿酸的变化

探讨移居高原低氧环境人体尿酸的代谢情况及氧自由基的变化。方法：对人从平进驻海拔３７００ｍ和５３８０ｍ第７天及半年的边防某部５８名官兵进行了血清丙二醛（ＭＤＡ）、尿酸（ＵＡ）和尿液尿酸（ＵＵＡ）检测,并与２０名平原健康青年对照。结果进驻海拔３７００ｍ第７天和５３８０ｍ第７天及半年ＭＤＡ和ＵＡ较平原组增高非常显著,ＵＵＡ降低显著（Ｐ〈０．０５或Ｐ〈０．０１）;３７００ｍ居住半年时ＭＤＡ和ＵＡ较平原组增