乏氏动作对冠心病患者等长收缩运动时中心血流动力学的影响

观察１０名冠心病人在冠状动脉腔内成型术前后，进行等长收缩运动和乏氏动作对中心血流动力学的影响。１０名对象均为男性，平均年龄５２岁，单支血管病变伴劳力性心递交 痛，左心基本正常。运动为极量握力运动。运动中无１例病人发生临床可判断的心肌缺血，所有病人均无症状，附加乏氏动作对中心血流动力学的反应类型无明显影响。肺毛压在附加乏氏动作时增加较明显，但右房压也同时成比例增高。右房压与肺毛压变化的相关系数为０．     

麻醉犬等长收缩运动中血浆一氧化氮浓度变化及其对血流动力学的影响

目的通过麻醉犬等长收缩运动(IE)中一氧化氮(NO)变化及与注入一氧化氮合成酶(NOS)抑制剂前后IE时心血管指标变化的比较,探讨NO对IE时血流动力学变化的调节作用.方法成年健康杂种犬14只,在安静、IE 3、6、9min,恢复5、10、20min时测定NO及各项血液动力学指标;然后注入NOS抑制剂,重复原试验,测各时间点血流动力学指标.结果IE时NO浓度下降,IE 9min时下降23.6% (P＜0.05),恢复期NO浓度水平逐渐恢复.IE 9min时心率上升明显(P＜0.05)而注入NOS抑制剂后IE 9min时HR下降明显(P＜0.05).收缩压、舒张压及肺毛细血管楔嵌压在注入NOS抑制剂后三者的净增量均高于注入前(P＜0.05).在注入NOS抑制剂后总肺循环阻力、肺动脉阻力、体循环血管阻力均明显上升(P＜0.05).结论急性运动时NO浓度水平下降;NO 不但可以降低外周血管阻力也可降低肺血管阻力,从而减轻IE时的心血管负荷.     

急性心肌梗死患者分级等长收缩运动训练对心功能的影响

目的:研究分级等长收缩运动对急性心肌梗死(acutemyocardialinfarc-tion,AMI)患者心功能的影响。方法:对23例AMI患者进行分级等长收缩握力试验,应用Acu-sow-128xP-10彩色多普勒声像仪检测运动负荷20%,40%,50%的各血流动力学参数。结果:患者运动后,心率和平均动脉压较运动前显著增加,舒张充盈速度早晚期比率(E/A)、左室射血率以及左室射血分数较运动前有所降低。但是运动负荷级别为20%,及运动负荷40%时,左室射血分数运动前后差异有显著性意义(t=1.319,0.858,P<0.05);运动负荷50%时,血流动力学监测指标差异有显著性意义(t=2.508,P<0.05)。结论:AMI患者可以进行适当的等长收缩运动,运动训练中应注意安全、有效。     

急性心肌梗死患者分级等长收缩运动训练的康复护理

目的 研究分级等长收缩运动对急性心肌梗死(AMI)患者的心功能影响。方法 对23例中低危组AMI患者进行分级等长收缩握力试验,应用Acusow-128xP-10彩色多普勒声像仪检测20％、40％、50％运动负荷的各血流动力学参数。结果 患者运动后,心率和平均动脉压较运动前显著增加;舒张功能评价指标、左室射血力及左室射血分数较运动前有所降低,但20％运动负荷时无统计学差异,40％运动负荷时左室射血分数无显著差异。结论 AMI患者可以进行适当的等长收缩运动,运动训练中应注意安全、有效。     

急性心肌梗死患者分级等长收缩运动训练对心功能的影响

目的：研究分级等长收缩运动对急性心肌梗死(acute myocardial infarction，AMI)患者心功能的影响。方法：对23例AMI患者进行分级等长收缩握力试验，应用Acusow-128xP-10彩色多普勒声像仪检测运动负荷20％，40％，50％的各血流动力学参数。结果：患者运动后，心率和平均动脉压较运动前显著增加，舒张充盈速度早晚期比率(E／A)、左室射血率以及左室射血分数较运动前有所降低。但是运动负荷级别为20％，及运动负荷40％时，左室射血分数运动前后差异有显著性意义(t=1．319，0．858，P&;lt;0．05)；运动负荷50％时，血流动力学监测指标差异有显著性意义(t=2．508，P&;lt;0．05)。结论：AMI患者可以进行适当的等长收缩运动，运动训练中应注意安全、有效。     

老年高血压患者颈动脉血流动力学变化的超声特征

背景：血管超声检查动脉管壁的中内膜厚度及粥样斑块与病理学方法相关良好。目的：应用超声方法观察老年高血压患者的颈总动脉和颈内动脉的血流动力学变化，并评价脉压、左室质量指数、血管的阻力指数、切率之间的相互关系。设计：随机对照，相关分析实验。单位：江苏大学附属医院超声科。对象：选择2000—09—30／2002-03-30江苏大学附属医院超声科入选老年高血压患者54例，男33例，女21例。同期在本院超声科检查的正常血压（收缩压〈130mmHg和／或舒张压〈85mmHg）者为对照组26例．男16例．女10例。方法：彩色多普勒血流显像技术检查每例患者左室腔舒张末内径，室间隔与左室后壁的舒张末厚度，计算左室质量指数。检查双侧颈总动脉和颈内动脉的内径、中内膜厚度和收缩期血流最大峰值流速及阻力指数，计算血管的切率和斑块指数，对动脉压、左室质量指数与阻力指数和切率作线性相关分析，并与同期对照组比较。主要观察指标：①两组受检对象脉压、左室质量指数和颈总动脉斑块指数。②双侧颈总动脉和颈内动脉的内径、中内膜厚度和收缩期血流最大峰值流速及阻力指数，计算斑块指数及最大切率。结果：80例对象均进入结果分析。①老年高血压组脉压，左室质量指数，斑块发生率和斑块指数明显大于对照组[（64．36&;#177;7．44）mmHg，（45．78&;#177;8．72）mmHg；（131．47&;#177;18．73）g／m^2，（83．28&;#177;1234）g／m^2；5.62&;#177;1．78．3．44&;#177;1．10；66．7％，23．1％，（X^2=13．37，t=5．730-13．234，P〈0．01）]。②老年高血压组颈总动脉和颈内动脉的内径、中内膜厚度、阻力指数明显高于对照组[颈总动脉：（8．96&;#177;1．20）mm,（8．08&;#177;0．96）mm；（1．28&;#177;0．88）mm,（0．91&;#177;0．17）mm;0．75&;#177;0．05，0．69&;#177;0．06。颈内动脉：（6．82&;#177;1．12）mm，（5．72&;#177;0．92）mm;（1．06&;#177;0．17）mm，（0．76&;#177;0．15）mm；0．70&;#177;0．07，0．64&;#177;0．06，t=2．872～10．850．P〈0．01]，收缩期血流最大峰值流速和切率明显低于对照组[颈总动脉：（47．44&;#177;12．85）cm／s,（60．20&;#177;14．32）cm／s；（225．78&;#177;95．76）／s,（300．26&;#177;110.42）/s。颈内动脉：（41．22&;#177;10．18）cm／s，（48．64&;#177;11．58）cm／s；（268．54&;#177;112．56）／s，（324．52&;#177;121．42）／s，t=2．872-10．850，P〈0．01]。③老年高血压患者的脉压，左室质量指数及颈总动脉和颈内动脉的阻力指数、切率之间呈线性弱相关（r=0．30～0．36,P〈0．05）。结论：老年高血压患者脉压增大，左室质量指数增加，颈动脉血管扩张，中内膜增厚，阻力指数增大、切率降低，粥样斑块形成，血管壁硬度增加使顺应性下降。     

左心功能不全与乏氏动作血压反应

乏氏(Valsalva)动作在临床上常用于心脏杂音的鉴别和终止室上性心动过速.因其对动脉血压的影响在正常和非正常心功能状态存在差异,近年来国外已将其用于左心功能不全的床边诊断.本文报道 64例不同左心功能状态者做乏氏动作时血压变化.旨在了解与左室射血分数(LVEF)之间的关系,提高对左心功能不全床边诊断的认识.     

老年高血压患者颈动脉血流动力学变化的超声特征

背景血管超声检查动脉管壁的中内膜厚度及粥样斑块与病理学方法相关良好. 目的应用超声方法观察老年高血压患者的颈总动脉和颈内动脉的血流动力学变化,并评价脉压、左室质量指数、血管的阻力指数、切率之间的相互关系. 设计随机对照,相关分析实验. 单位江苏大学附属医院超声科. 对象选择2000-09-30/2002-03-30江苏大学附属医院超声科入选老年高血压患者54例,男33例,女21例.同期在本院超声科检查的正常血压(收缩压＜130 mm Hg和/或舒张压＜85 mm Hg)者为对照组26例,男16例,女10例. 方法彩色多普勒血流显像技术检查每例患者左室腔舒张末内径,室间隔与左室后壁的舒张末厚度,计算左室质量指数.检查双侧颈总动脉和颈内动脉的内径、中内膜厚度和收缩期血流最大峰值流速及阻力指数,计算血管的切率和斑块指数,对动脉压、左室质量指数与阻力指数和切率作线性相关分析,并与同期对照组比较. 主要观察指标①两组受检对象脉压、左室质量指数和颈总动脉斑块指数.②双侧颈总动脉和颈内动脉的内径、中内膜厚度和收缩期血流最大峰值流速及阻力指数,计算斑块指数及最大切率. 结果80例对象均进入结果分析.①老年高血压组脉压,左室质量指数,斑块发生率和斑块指数明显大于对照组[(64.36±7.44)mm Hg,(45.78±8.72)mm Hg;(131.47±18.73)g/m2,(83.28±12.34)g/m2;5.62±1.78,3.44±1.10;66.7%,23.1%,(x213.37,t=5.730-13.234,P＜0.01)].②老年高血压组颈总动脉和颈内动脉的内径、中内膜厚度、阻力指数明显高于对照组[颈总动脉(8.96±1.20)mm,(8.08±0.96)mm;(1.28±0.88)mm,(0.91±0.17)mm;0.75±0.05,0.69±0.06.颈内动脉(6.82±1.12)mm,(5.72±0.92)mm;(1.06±0.17) mm,(0.76±0.15)mm;0.70±0.07,0.64±0.06,t=2.872～10.850,P＜0.01],收缩期血流最大峰值流速和切率明显低于对照组[颈总动脉(47.44±12.85)cm/s,(60.20±14.32)cm/s;(225.78±95.76)/s,(300.26±110.42)/s.颈内动脉(41.22±10.18)cm/s,(48.64±11.58)cm/s;(268.54±112.56)/s,(324.52±121.42)/s,t=2.872～10.850,P＜0.01].③老年高血压患者的脉压,左室质量指数及颈总动脉和颈内动脉的阻力指数、切率之间呈线性弱相关(r=0.30～0.36,P＜0.05). 结论老年高血压患者脉压增大,左室质量指数增加,颈动脉血管扩张,中内膜增厚,阻力指数增大、切率降低,粥样斑块形成,血管壁硬度增加使顺应性下降.     

Pain perception after isometric exercise in women with fibromyalgia

Hoeger Bement MK, Weyer A, Hartley S, Drewek B, Harkins AL, Hunter SK. Pain perception after isometric exercise in women with fibromyalgia.

Objective

The purpose of this study was to identify exercise protocols incorporating isometric contractions that provide pain relief in women with fibromyalgia.

Design

A before-after trial.

Setting

A physical therapy department in an academic setting.

Participants

Fifteen women (mean ± SD, 52±11y) with fibromyalgia.

Interventions

Subjects completed 4 sessions: 1 familiarization and 3 experimental. The following randomized experimental sessions involved the performance of isometric contractions with the elbow flexor muscles that varied in intensity and duration: (1) 3 maximal voluntary contractions (MVCs), (2) 25% MVC held to task failure, and (3) 25% MVC held for 2 minutes.

Main Outcome Measures

Experimental pain (pain threshold and pain rating), Fibromyalgia Impact Questionnaire, and fibromyalgia pain intensity (visual analog scale).

Results

After all 3 isometric contractions, there was considerable variability between subjects in the pain response. Based on the changes in experimental pain, subjects were divided into 3 groups (increase, decrease, no change in pain). Multiple regression analysis revealed that age, baseline experimental pain, and change in fibromyalgia pain intensity were significant predictors of the experimental pain response after the isometric contractions.

Conclusions

We identified subgroups of women with fibromyalgia based on how they perceived pain after isometric contractions. The greatest pain relief for women with fibromyalgia occurred at a younger age and in women with the greatest experimental pain before exercise. Additionally, we established a link between experimental and clinical pain relief after the performance of isometric contractions.     

Contralateral attenuation of pain after short-duration submaximal isometric exercise.

Only a small amount of research has been conducted examining whether exercise-induced hypoalgesia (EIH) occurs after isometric exercise. Thus, the purpose of this investigation was to examine whether EIH occurred in women after short-duration submaximal isometric exercise and whether the responses were restricted to the exercised hand (ipsilateral) or also occurred in the nonexercised (contralateral) hand. Fourteen healthy women (mean age = 19.5 years) completed 2 sets of submaximal (40% to 50% of max) isometric exercise consisting of squeezing a dynamometer for 2 minutes with the dominant hand. A pressure stimulus was applied to the forefinger on the dominant and nondominant hands for 2 minutes before and after isometric exercise. Participants pressed a button when the stimulus became painful, indicating pain threshold (PT), and also rated the intensity of the stimulus every 15 seconds, using a pain rating scale (PR). Results indicated that there were significant trials effects (P < .05) for PT and PR, but the main effect for hands was not significant (P > .05). PTs were found to be elevated, whereas PRs were reduced for both hands after isometric exercise. It is concluded that submaximal isometric exercise performed for 2 minutes resulted in ipsilateral and contralateral hypoalgesic responses. PERSPECTIVE: The findings from the present study demonstrated that short-duration nonexhaustive isometric exercise was associated with hypoalgesic responses in the exercised and nonexercised hands. It appears that short-duration submaximal isometric exercise resulted in generalized (ie, ipsilateral and contralateral) pain-inhibitory responses in healthy young women.     

中枢内啡肽对等长收缩运动时心血管反应的调控意义

目的　研究电刺激等长收缩运动 (IE)时的中枢内啡肽 (EOPs)对心血管反应的调控机制。方法　成年健康杂种犬 2 0只 ,体质量 ( 11± 1.8)kg ,浅麻醉下以感应电刺激腓肠肌产生最大IE ,包括单侧IE(UIE)和双侧IE(DIE)。测定心率、血压、肺毛细血管楔嵌压、肺动脉压、中心静脉压、心输出量、每搏输出量。采用放射免疫法同批测定血浆及脑脊液中亮氨酸脑啡肽 (LEK )、β 内啡肽 ( β END)、强啡肽 (DYN)含量。结果　①UIE与DIE时心率、血压、心输出量、血浆及脑脊液LEK、β END、DYN均明显增加 ( P <0 .0 1) ,每搏输出量明显下降 (P <0 .0 1) ;②UIE与DIE相比各血流动力学指标以及血浆LEK、β END、DYN净增量差异无显著性 (P >0 .0 5 ) ;③DIE时脑脊液LEK ,β END ,DYN净增量显著高于UIE( P <0 .0 1)。结论　中枢EOPs对等长收缩运动时心血管反应的调控起重要作用。     

Doppler-derived aortic flow measurements during and after heavy isometric exercise in healthy men versus men with myocardial infarction.

Doppler echocardiography is a useful noninvasive determination of left ventricular function during dynamic exercise. Scarce data are available for the use of this technique during heavy isometric exercise. Therefore, Doppler-derived aortic flow indexes were assessed during and after 50% maximal upper-body isometric exercise in 25 healthy men (aged 47 +/- 6 years) and compared with those of 22 men (aged 48 +/- 9 years) who had suffered myocardial infarction. The heart rate increased (p = 0.01) in each of the groups from a mean of 68 +/- 12 at rest to 84 +/- 11 during isometric exercise. At rest, systolic blood pressure was higher (p = 0.05) in the patients with coronary artery disease. During exercise, the patients with cardiac disease, compared with the healthy volunteers, demonstrated a lesser reduction in flow velocity integral, stroke volume, and cardiac indexes (p = 0.001). Immediately on recovery, the patients with cardiac disease, compared with the healthy group, showed significantly greater (p = 0.001) increase in stroke volume and cardiac indexes. At 3 minute's recovery, the stroke volume index continued to increase in the patients with cardiac disease, while the healthy group showed a decrease to below its resting value. Although 50% of maximal upper-body isometric exercise caused similar heart rate and systolic blood pressure responses in healthy patients and patients with cardiac disease, there were significant group differences in Doppler-derived left ventricular systolic function indexes, which were greatest on immediate and 3 minute's recovery. The results suggest that this novel isometric test may be useful in clinical testing.     

Effects of varying central command and muscle mass on the cardiovascular responses to isometric exercise

To determine if the central command signal associated with isometric exercise is mass‐dependent, 20 subjects (nine male, 11 female; 23 ± 1 years) performed four 5‐min bouts of supine isometric exercise with a large (quadriceps; LEG) and small (forearm; ARM) muscle mass. For each extremity, one bout entailed maintaining a constant force (CF; 20% maximal voluntary contraction) and the other constant electromyographic activity (CE; ~20% MVC initially). Central command was assumed to increase with CF and remain unchanged with CE. Heart rate increased more with LEG than ARM (P<0·001) and, in LEG, was higher in CF than CE at min 5 (P<0·001). Mean arterial pressure was higher in LEG (P<0·001) by min 2 and 10 ± 3 mmHg higher in LEG CF than LEG CE by min 5 (P<0·001). Ratings of perceived exertion were highest in LEG CF (P<0·001); LEG CE did not differ from ARM CE (P<0·001) by min 4. The ARM responses did not differ between CF and CE in any variable. These data suggest that muscle mass influences the central command signal during isometric exercise and central command modulates this response in larger muscle masses.     

血浆内啡肽对等长收缩运动心血管反应的中枢调节 …

目的　研究血浆内啡肽 (EOPs)对等长收缩运动 (IE)心血管反应调节的中枢定位特点。方法儿麻组 (Polio) 15例 ,年龄 ( 63 .0± 4.4)岁 ,完整中枢神经独立作用模型。偏瘫组 (Hemi) 10例 ,年龄 ( 5 4.7±4.4)岁 ,皮层下中枢独立作用模型。两组患者非受累肢体的运动为正常神经调控模型。观察患肢 (AIE)和非受累肢最大量IE(NIE)时心率 (HR)、收缩压 (SBP)、舒张压 (DBP)、血浆亮氨酸脑啡肽 (L EK)、β 内啡肽( β END)和强啡肽 (DYN )的改变。 结果　①Polio组AIE和NIE的HR、SBP、DBP、L EK、β END和DYN均显著增高 ,AIE反应弱于NIE。②Hemi组AIE和NIE的HR、SBP、DBP、L EK、β END和DYN均显著增高 ( P <0 .0 1) ,AIE反应强于NIE( P <0 .0 5 )。结论　①中枢命令通过EOPs对IE运动心血管反应产生独立调控作用。②失去皮层中枢控制后 ,皮层下中枢兴奋性增高 ,产生较强的EOPs反应 ,以调制IE时的心血管反应。     

Changes in serum lipid and lipoprotein measures after maximal exercise in men.

Normolipidaemic, healthy male volunteers (age range 20-23 years) were studied after a session of three maximal exercises and serum lipid and lipoprotein concentrations were measured. The exercise programmes, one of which was performed each week, consisted of a triangular progressive test (TPT), a rectangular sustained test (RST) and an interval endurance test (IET). There was a significant (P less than 0.05) increase of 14% in serum total cholesterol concentrations after TPT, 9.6% after RST and 14% after IET. Serum triglyceride concentrations increased by 17% after TPT, 5.7% after RST and 8.2% after IET, but increases were not significant. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), and apolipoprotein (A-I, A-II) concentrations rose significantly (P less than 0.05) after TPT. There were also insignificant increases in AI, AII and LDL-C after RST and IET, whereas HDL-C rose significantly (P less than 0.05) after IET. It is concluded that the three maximal exercises had similar metabolic effects which were independent of the exercise duration.     

冠心病患者等长收缩运动与心肌缺血的关系

目的　探讨冠心病患者等长收缩运动与心肌缺血的关系。方法　采用超声多普勒技术 ,比较 2 0例冠心病患者和 10例正常人极量短暂等长收缩运动 (briefisometricexercise ,BIE)、极量持续等长收缩运动(sustainedisometricexercise ,SIE)与动力性运动 (dynamicexercise ,DE)时的血流动力学反应和心功能表现。 结果　有心肌缺血的冠心病患者在DE运动终点时有心肌缺血表现 ,但BIE和SIE时无相应表现。心血管反应总体趋势为 :DE时心率和两项乘积运动增量均明显高于BIE和SIE ,各组间差异不显著。正常组DE时血流动力学多数指标的运动增量均高于BIE和SIE ,但有无心肌缺血的冠心病患者之间无明显差异。结论　在同等主观用力的前提下 ,冠心病患者等长收缩运动时心肌缺血发生率低于动力性运动。等长收缩运动时较高的舒张压和较长的灌注时间对心肌缺血有一定的保护作用。等长收缩运动在冠心病康复中的应用有合理的生理学基础。     

慢性运动性中枢疲劳大鼠额叶皮质单胺类递质变化的研究

目的研究慢性运动性疲劳状态下,大鼠中枢神经系统各种单胺类递质的变化规律。方法应用慢性运动性中枢疲劳大鼠模型,取材大鼠额叶皮质,采用高效液相色谱电化学检测的方法,对实验大鼠额叶皮质组织5-羟色胺、肾上腺素、去甲肾上腺素及多巴胺的含量进行定量分析。结果与正常饲养大鼠比较,疲劳大鼠在持续训练条件下发生运动性中枢疲劳后,其额叶皮质5-羟色胺含量明显升高,同时多巴胺的含量明显下降,并在统计学出现非常显著性差异(P0.01);而同样属于单胺类神经递质的肾上腺素和去甲肾上腺素的水平则没有出现统计学差异。结论在中枢性疲劳发生时,中枢神经系统内两种重要神经递质5-羟色胺和多巴胺的水平同时发生了改变,且这两种变化的方向均为抑制性趋势,这也说明该模型大鼠形成了中枢疲劳状态,这种状态的形成引起了脑内递质水平调节机制的变化。