Changes in potassium content of erythrocytes during exercise in man.

Factors affecting erythrocyte K+ content and plasma electrolytes during light exercise were examined in 8 normal subjects and 27 patients with chronic obstructive lung disease. The patients were classified into bronchitis, emphysema and intermediate groups. Arterial blood was obtained during rest, after 2, 5, and 7 min. of exercise on a bicycle ergometer (30 km/h without mechanical brake), and at 10 and 20 min. during recovery for analysis of PO2, PCO2, plasma H+, Na+, K+, and Cl(-), erythrocyte K+ content and whole blood lactate. Plasma H+ increased significantly in all subjects after 2 min. of exercise and PCO2 rose in normal, bronchitis, and emphysema groups during exercise, whereas PO2 did not change significantly. Plasma K+ rose promptly after the beginning of exercise and remained at high values during exercise. The rapid rise in PCO2 was associated with a significant decrease of calculated erythrocyte K+ in patients with chronic bronchitis. Although changes in plasma H+ were dependent on both PCO2 and lactate, erythrocyte K+ changes were significantly related only to changes in PCO2. These results indicate that the decrease in erythrocyte K+ is mainly controlled by changes in arterial PCO2 during light exercise in patients with chronic bronchitis.     

Plasma and Urinary Dopamine: Studies During Fasting and Exercise and in Tetraplegic Man

Dopamine, noradrenaline and adrenaline were measured in plasma and in urine, using double-isotope derivative techniques, in 46 normal subjects and in 17 tetraplegic patients with physiologically complete cervical spinal cord transections above the sympathetic outflow. Dopamine was present in plasma in normal subjects in a concentration of 0.33 μg/1 ± 0.06 (SEM). Twenty-four hour urinary excretion of dopamine averaged 248 yg ± 22. There was a significant correlation between the 24 h urinary excretion of dopamine and of noradrenaline. In the normal subjects plasma dopamine and the urinary excretion of dopamine did not change during three days of fasting while urinary excretion of adrenaline increased twofold. In the normal subjects exercise significantly increased plasma dopamine from 0.25 μg/1 to 0.43 μg/1, but significantly decreased the urinary excretion of dopamine. Exercise significantly increased the excretion of noradrenaline. In the tetraplegic patients the plasma dopamine concentration and the urinary excretion of dopamine were lower but not significantly different from the corresponding values in the normal subjects. Plasma noradrenaline and the urinary excretion of noradrenaline and adrenaline were significantly lower in the tetraplegic patients. It is concluded that dopamine is present in human plasma in concentrations similar to that of noradrenaline. Free dopamine in plasma and urine of normal subjects is not dependent on food intake. Urinary dopamine may be derived from circulating dopamine. Urinary dopamine does not necessarily appear to reflect changes in plasma dopamine. The relationship between plasma dopamine and changes in adrenergic nervous activity deserves further investigation.     

Does Chronic Hypercapnia Entail an Adaptive Improvement of Extra-Cellular Space Buffering against Acute PCO2 Changes?*

Abstract. Schwartz and coworkers have shown recently that chronic hypercapnia entails a marked decrease of the d(H⁺)/dPCO₂ ratio in plasma, in response to acute PCO₂ changes in vivo. They have interpreted this finding as an indication of improved CO₂ buffering performance by the extracellular space, mediated by an unidentified mechanism. This hypothesis is reviewed in the light of a theoretical treatment of CO₂-titration regarding extracellular space as an isolated buffered solution.– It is concluded here that renal compensation during chronic hypercapnia without changes in the buffering properties can account for much if not all of the observed effect through the quantitative relationships governing CO₂ equilibrium. Reasons for the use of Van Slyke's "buffer value" rather than the d(H+)/dPCO₂ ratio as an analytical parameter of extracellular CO₂-buffering performance are presented by reference to the general theory of titration.     

休克再灌注期间肠粘膜pH及肠粘膜与动脉血二氧化碳分压差的变化

目的：探讨低血容量性休克及再灌注进肠粘膜ｐＨ（ｐＨｉ）及肠粘膜与动脉血二氧化碳分压（ＰＣＯ２）差（Ｐｉ－ａＣＯ２）的变化及意义。方法：采用兔低血容量性休克及主模型,通过Ｔｏｎｏｍｅｔｒｙ张力计测定半计算休克前（Ｓ０）,休克１小时（Ｓ１）及再灌注１小时（ＲＥＰ１）２小时（ＲＥＰ２）乙状结肠ｐＨｉ及Ｐｉ－ａＣＯ２、,     

女性高血压患者心肺运动试验中血压经时变化研究

目的 探讨女性高血压患者心肺运动试验中,随运动强度增加血压的经时变化及其临床意义。方法 选取本院2018年8月至2019年8月心肺运动试验排除心肌缺血,且未服用β受体阻滞剂及非二氢吡啶类钙离子拮抗剂的1级、2级高血压女性患者64例(高血压组),以及同期心肺运动试验排除心肌缺血的年龄匹配的健康女性86例(非高血压组),比较两组心肺运动试验中随运动强度增加血压的经时变化。结果 高血压组运动中静息3 min时血压、无氧阈值时血压和峰值血压均显著高于非高血压组(Z > 3.306,P<0.001)。两组峰值摄氧量无显著性差异(Z = 1.549, P > 0.05)。 结论 1级和2级高血压患者血压对运动的反应容易过度升高,在日常体育运动训练及运动康复中应关注血压的变化。     

Exercise barrier and task self-efficacy in breast cancer patients during treatment

Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task self-efficacy, and (3) associations between self-efficacy and patient age, race, and treatment type. Eighty-six female breast cancer patients recruited from a medical oncologists office completed the scales once, and 46 repeated the scales 2 weeks later. The majority were Caucasian (95%), with 26% receiving chemotherapy, 64% hormonal therapy alone, and 5% radiation/other. The mean age was 59±14 years. The Cronbachs alpha for the nine-item barrier self-efficacy scale was 0.96, with a test–retest correlation of 0.89 (p<0.001). The Cronbachs alpha for the four-item task self-efficacy scale was 0.89, with a test–retest correlation of 0.83 (p<0.001). The mean barrier self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to exercise when nauseated. The mean task self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to jog for 10 min without stopping. Although no significant associations were found between self-efficacy and participants race or treatment type, lower task self-efficacy was associated with older age (r=–0.36, p=0.001). Both self-efficacy scales demonstrated good internal consistency and test–retest reliability. Self-efficacy may be a useful target for physical activity interventions among breast cancer patients during treatment.     

复方天葡片对红细胞氧化损伤的拮抗作用

本研究旨在探究复方天葡片(compound tianpupian,TPP)及其组分对小鼠红细胞氧化损伤的保护作用。采用小鼠红细胞自氧化及过氧化氢氧化损伤模型,通过扫描电镜和分光光度计法观察TPP及其组分对红细胞氧化损伤的保护作用。结果表明,TPP明显抑制过氧化氢导致的红细胞氧化损伤,其4种组分红景天、葡萄籽提取物原花青素、刺五加提取物和茶多酚均显示了对红细胞氧化损伤的拮抗作用,其中葡萄籽原花青素的作用最强。结论:TPP对红细胞氧化损伤具有很好的拮抗作用,是一种有价值的中药复方。     

红细胞内钾与血浆钾比值(RPRP)的测定方法及其临床意义

目的探讨红细胞内钾与血浆钾比值(RPRP)的测定方法及其临床意义。方法收集111名无继发性高血压者(具不同程度腹部胀气、精神不振、四肢无力、原发性低血压等),取肘静脉血样,经样品特殊处理后用电极法测定血浆钾、红细胞内钾,计算出RPRP,用多元回归方法比较RPRP与症状之间的关系。结果RPRP与经常性腹部胀气、经常性四肢无力、经常性精神不振、原发性低血压等的回归系数分别为0.195,0.232,0.270,0.315,OR值分别为1.215(1.029~1.434,95%CI),1.261(1.059~1.503,95%CI),1.311(1.065~1.616,95%CI),1.371(1.175~1.567,95%CI)。结论RPRP是经常性腹部胀气、经常性四肢无力、经常性精神不振、原发性低血压的敏感指标,为其危险因素,RPRP的正常值上限在27.57~30.92之间。提示RPRP可能是人体细胞内外钾分布紊乱的诊断指标。     

Oxygen alert cards and controlled oxygen: preventing emergency admissions at risk of hypercapnic acidosis receiving high inspired oxygen concentrations in ambulances and A&E departments

Background

Appropriate resuscitation of hypoxic patients is fundamental in emergency admissions. To achieve this, it is standard practice of ambulance staff to administer high concentrations of oxygen to patients who may be in respiratory distress. A proportion of patients with chronic respiratory disease will become hypercapnic on this.

Objectives and methods

A scheme was agreed between the authors'' hospital and the local ambulance service, whereby patients with a history of previous hypercapnic acidosis with a Pao₂ >10.0 kPa—indicating that oxygen may have worsened the hypercapnia—are issued with “O₂ Alert” cards and a 24% Venturi mask. The patients are instructed to show these to ambulance and A&E staff who will then use the mask to avoid excessive oxygenation. The scheme was launched in 2001 and this paper present the results of an audit of the scheme in 2004.

Results

A total of 18 patients were issued with cards, and 14 were readmitted on 69 occasions. Sufficient documentation for auditing purposes was available for 52 of the 69 episodes. Of these audited admissions, 63% were managed in the ambulance, in line with card‐holder protocol. This figure rose to 94% in the accident and emergency department.

Conclusion

These data support the usability of such a scheme to prevent iatrogenic hypercapnia in emergency admissions.     

Exercise induces excessive normetanephrine responses in hypertensive diabetic patients

BACKGROUND: Exaggerated sympathoadrenal function has been accused of contributing to hypertension in type-2 diabetes. Recently, plasma unconjugated (free) metanephrines were reported to be stable markers of catecholamine hypersecretion. Thus, we aimed to examine whether unconjugated metanephrines are reliable markers of stress response induced by standardized cycling exercise and to identify differences in such stress responses between hypertensive and/or diabetic patients. DESIGN: Type-2 diabetic patients with (DM/H; n= 8, 50 +/- 7 years, HbA1c: 7.7 +/- 0.6%) or without hypertension (DM/N; n = 6, 48 +/- 10 years, 7.5 +/- 1.8%) and nondiabetic hypertensive patients (H; n = 8, 56 +/- 4 years) were studied during incremental cycling exercise (15 min) to 75% of individual VO(2)max and during recovery (60 min). Plasma catecholamines and unconjugated metanephrines were measured by high-performance liquid chromatography with electrochemical detection. Hormone responses were quantified from the areas under the concentration-time curves and compared with those of age-, sex- and BMI-matched healthy volunteers (CON, n= 22). RESULTS: Blood pressure responses of DM/H and H, but not DM/N, were greater than those of CON (P < 0.01), whereas heart rates increased similarly in all groups. Unconjugated normetanephrine responses were only increased (P = 0.04) in DM/H (2156 vs. 1133 pg mL(-1) min(-1) but not in DM/N (1528 vs. 1300 pg mL(-1) min(-1) and H (1960 vs. 1425 pg mL(-1) min(-1) when compared with respective CON. Unconjugated metanephrines did not change from baseline, whereas catecholamine responses were comparable in all groups. CONCLUSIONS: The excessive response of plasma unconjugated normetanephrine to cycling may serve as a marker of exaggerated sympathoadrenal function in hypertensive type-2 diabetic patients.     

吸烟对新入伍士兵运动应激时循环功能的影响

目的：观察吸烟对新入伍士兵运动应激时心率、血压和心电图的影响。方法应用分层随机整群抽样法选取100名新入伍士兵进行活动平板运动应激试验。根据不吸烟和吸烟(烟龄≥1年且吸烟≥10支/ d)将100名新入伍士兵分为非吸烟组48例和吸烟组52例。按照标准的 Bruce 方案从第3运动等级开始分别对两组进行运动应激试验,测量静息时、运动应激时每3 min 和应激恢复期每3 min 的心率、血压,以及运动应激前和应激恢复12 min 时的心电图。结果运动应激时两组心率明显升高(P <0．01),且吸烟组心率显著高于非吸烟组(P <0．01);吸烟组应激恢复3、6、9 min 心率均高于非吸烟组(P <0．01),吸烟组心率恢复至应激前水平时间显著长于非吸烟组(P <0．05)。运动应激时两组收缩压较运动应激前明显升高(P <0．01),且吸烟组高于非吸烟组(P <0．05);吸烟组应激恢复3、6、9 min 时收缩压均高于非吸烟组(P <0．01),且吸烟组收缩压恢复至应激前水平时间显著长于非吸烟组(P <0．05)。吸烟组运动应激时及应激恢复期舒张压较运动应激前无明显变化(P >0．05),非吸烟组运动应激时及应激恢复3 min时舒张压有所降低(P <0．01),且明显低于吸烟组同时间点(P <0．01)。应激前及应激后心电图异常率比较吸烟组均高于非吸烟组,但差异无统计学意义(P >0．05)。结论吸烟对新入伍士兵运动应激时心率、血压和心电图影响较大,可能引起心血管自主神经支配障碍。     

科索亚治疗2型糖尿病微量蛋白尿的疗效

目的探讨科索亚治疗2型糖尿病微量蛋白尿的疗效。方法随机抽取丰都县人民医院高镇分院2012年1～9月的2型糖尿病患者120例,随机分成观察组和对照组,每组各60例。对照组采取常规降糖、降脂治疗,观察组在常规治疗的基础上加用科索亚口服片,50～100mg/d。治疗2周后对比分析两组患者的尿蛋白水平。结果观察组患者显效22例,有效19例,无效19例,总有效率68.3%;对照组患者显效17例,有效19例,无效24例,总有效率60.0%。观察组治疗效果优于对照组。结论科索亚治疗2型糖尿病微量尿蛋白具有较好的临床效果,值得临床应用和推广。     

Cerebral cortical microvascular flow during and following cardiopulmonary resuscitation after short duration of cardiac arrest

AIM: To examine changes in cerebral cortical macro- and microcirculation and their relationship to the severity of brain ischaemia during and following resuscitation from a short duration of cardiac arrest. METHODS: Bilateral cranial windows were created in eight domestic pigs weighing 41+/-1 kg, exposing the frontoparietal cortex for orthogonal polarization spectral imaging together with estimation of cortical-tissue partial pressure of carbon dioxide, a quantitator of the severity of cerebral ischaemia. After 3 min of untreated ventricular fibrillation, cardiopulmonary resuscitation was begun and continued for 4 min before defibrillation. Aortic pressure, end-tidal and cortical-tissue partial pressure of carbon dioxide, and cortical microcirculatory blood flow in vessels of less and more than 20 microm in diameter were continuously measured. RESULTS: Cerebral microcirculatory blood flow progressively decreased over the 3-min interval that followed onset of ventricular fibrillation. Chest compression restored cortical microvascular flow to approximately 40% of the pre-arrest value. Following return of spontaneous circulation, microvascular flow velocity was restored to baseline values over 3 min. Reversal of cerebral ischaemia with normalisation of cerebral cortical-tissue partial pressure of carbon dioxide occurred over 7 min after resuscitation. Cortical microcirculatory blood flow in microvessels less than 20 microm was highly correlated with flow in vessels more than 20 microm together with mean aortic pressure and end-tidal partial pressure of carbon dioxide. CONCLUSION: Cerebral cortical microcirculatory flow ceased only 3 min after onset of cardiac arrest. Flow was promptly restored to 40% of its pre-arrest value after start of chest compression. After resuscitation, both macro- and microcirculatory flows were fully restored over 3 min, but cerebral ischaemia reversed more slowly.     

Type of solution and PCO2 measurement errors during tonometry

Objective: The choice of solution for gastrointestinal tonometry influences the PCO₂ measurement bias, precision and the time required for equilibration. We compared saline with buffered solutions during in vitro tonometry, with respect to systematic and accidental measurement errors and equilibration time. Design: A prospective laboratory study. Measurements: Saline, phosphate, phosphate bicarbonate and succinylated gelatin solutions were equilibrated in a specialized blood gas tonometer at PCO₂s of 2.7, 3.6, 4.5, 6.2 and 9.0 kPa, using calibration gases. Accidental errors were determined: the within-syringe decline of PCO₂ and the effects of handling errors (five up and down movements of the plunger). The PCO₂ build up in gastrointestinal tonometers was determined in 5000 ml saline baths with fixed PCO₂ levels of 2.7 and 9.0 kPa. Results: The build up of PCO₂ in phosphate bicarbonate and gelatin was about 4 and 2 times slower than in saline and phosphate, respectively, both for gas and gastrointestinal tonometers. The bias of the measured PCO₂ at equilibrium was −15 % for saline, and between −1 and 3 % for phosphate, phosphate bicarbonate and gelatin. The precision was comparable among the solutions: 2 ± 1 % for saline, 2 ± 1 % for phosphate, 1 ± 0 % for phosphate bicarbonate and 1 ± 1 % for gelatin. The accidental errors were virtually absent with phosphate bicarbonate, intermediate with gelatin and largest with saline and phosphate. Conclusion: Phosphate bicarbonate buffer and succinylated gelatin allow accurate PCO₂ measurements, but their equilibration is too slow for clinical application. The advantage of phosphate over saline solution is a smaller bias only. Thus, both saline and phosphate are currently the tonometer solutions of choice, provided that strictly anaerobic conditions are applied and the bias by the blood gas analyzer is known. Received: 5 July 1996 Accepted: 4 March 1997     

Changes in QT Interval during Exercise Testing in Patients with VVI Pacemakers

. The changes in QT intervals were studied in nine patients with normal sinus node function who had VVI pacemakers. Though PP intervals uniformly shortened during exercise, the change in QaT* intervals during exercise was variable. The correlation between PP and QaT intervals varied from case to case. A good correlation was found in only two cases (r =+0.816 or +0.897); a fair correlation was found in four cases (r =+0.672, +0.615, +0.615, or −0.669) and in the remaining three, the correlation was poor (r =+0.494, +0.467 or−0.424). In patients who are candidates for VTI pacemaker implantation, changes in QaT intervals should be assessed during exercise stress testing to determine if the intervals shorten during exercise or not.
(QaT*: Interval from the pacing spike to the apex of T-wave.)     

连续硬脊膜外阻滞麻醉对二氧化碳气腹患者内脏灌注和代谢的影响

目的 观察胸段硬膜外阻滞对二氧化碳气腹患者内脏灌注和代谢的影响。方法 26例ASAⅠ－Ⅱ级行腹腔镜胆囊切除术（laparoscopic cholecystomy, LC手术患者随机分为全身麻醉组（G）和连续硬脊膜外阻滞麻醉复合全身麻醉组（E）,监测麻醉后、气腹前即刻,气腹后30 min,气腹后60 min,放气后30 min时MAP、HR、呼气末二氧化碳分区PETCO2和胃黏膜二氧化碳分压PgCO2值,同步采动脉血行PHa、PaCO2、BE、HCO3-及乳酸值测定。计算胃黏膜pHi和胃黏膜与动脉血二氧化碳分压梯度（PCO2gap）。结果 ①G组气腹时HR、MAP均明显增高（P﹤0.05）,E组无明显变化。②与气腹前相比,两组PCO2gap、PgCO2气腹后均明显升高、pHi明显降低,G组与E组比,气腹后60 min时点存在明显差异。③两组动脉血乳酸值、PHa值、动脉血HCO3-、BE值在正常范围之内,差异无显著性。结论 气腹压在13～15 mmHg时,CO2气腹可以减少胃黏膜下灌注和代谢,胸段硬膜外阻滞有减轻气腹中胃黏膜下低灌注的作用,有利于维持血流动力学平稳。     

Effect of Volume Expansion by Hyperosmolar and Hyperoncotic Solutions under Constant Infusion of Angiotensin II on Plasma Aldosterone in Man and its Counterbalance by Potassium Administration

Abstract. The influence on plasma aldosterone of plasma volume expansion by hyperosmolar and hyperoncotic solutions and its counterbalance by potassium administration was studied in man. All experiments were done during constant infusion of angiotensin II (All) which consequently excluded changes of the endogenous renin. Hyperosmolar infusion of NaCl, mannitol and NaHCO₃ provoked an immediate fall in plasma aldosterone levels and presumably a shift of intracellular potassium to the extracellular compartment. Hyperoncotic solutions of dextran in 0.9% NaCl provoked an immediate fall in plasma aldosterone while dextran in 5% glucose provoked a delayed fall. Administration of minute amounts of potassium could prevent the fall in plasma aldosterone which followed administration of dextran solutions. The same minute amount of potassium, administered without volume expansion, increased plasma aldosterone markedly above the high levels induced by AII. – The data presented add further evidence for the important role of potassium as a mediator in aldosterone regulation. They indicate that intracellular potassium changes at the adrenal level, rather than plasma potassium concentration, probably exert the regulatory function in aldosterone biosynthesis.     

老年糖尿病患者运动锻炼情况的调查

目的了解老年糖尿病患者运动锻炼情况。方法以成都某教学医院2009年2-8月住院的老年糖尿病患者106例为调查对象,采用自行设计的问卷对老年糖尿病患者进行运动锻炼和相关知识及自我效能调查。结果35．8％的患者近1个月有运动锻炼,仅有25．5%坚持运动锻炼,43．4％的患者运动锻炼效能低,不同年龄、性别、文化水平、婚姻状况、收入、糖尿病病程与是否有锻炼行为无明显差异。结论老年糖尿病患者运动锻炼行为较差,运动锻炼相关知识缺乏,需要提高老年糖尿病患者对运动锻炼相关知识的认识,增加患者运动锻炼行为,提高患者的自我效能,提高老年人的生活质量。