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Objective:To analyze the cardiopulmonary function of stable patients with pulmonary arterial hypertension (PAH), and to explore effects of the cardiopulmonary exercise testing (CPET)-based individualized moderate-intensity exercise prescription on cardiopulmonary functional reserve and exercise capacity in patients with PAH. Methods:From April, 2018 to July, 2019, 31 stable patients with PAH (PAH group) and 32 healthy counterparts (normal group) were enrolled. All subjects underwent CPET. PAH group was assessed with 6-Minute Walking Test (6MWT), and then was divided into exercise group (n = 16) and control group (n = 15). Both groups were treated with ordinary targeted drugs, while the exercise group was additionally provided with an individualized moderate-intensity exercise prescription of △50% power treadmill training, five days a week for eight weeks. CPET and 6MWT were conducted again after intervention. Results:Before intervention, body mass, body mass index (BMI), force vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum voluntary ventilation (MVV), anaerobic threshold (AT), peak heart rate (HRpeak), peak systolic blood pressure (SBPpeak), peak load power (WRpeak), peak oxygen uptake (VO2peak), peak oxygen pulse (VO2/HRpeak), peak cardiac output (COpeak), peak minute ventilation (VEpeak), peak end-tidal carbon dioxide (PETCO2peak), peak pulse oxygen saturation (SpO2peak) and oxygen uptake efficiency plateau (OUEP) were significantly lower (t > 2.419, P < 0.05), and the rest heart rate (HRrest), peak dead space to tidal volume ratio (VD/VTpeak), minimum ventilatory equivalent for carbon dioxide (Lowest VE/VCO2) and slope of ventilatory equivalent for carbon dioxide (VE/VCO2 slope) were higher (|t| > 2.615, P < 0.05) in PAH group than in the normal group. After intervention, FEV1, MVV, VO2peak (ml/min/kg) and VO2/HRpeak decreased in the control group (t > 2.272, P < 0.05); FVC, FEV1, MVV, AT, SBPpeak, WRpeak, VO2peak, VO2/HRpeak, COpeak, VEpeak, PETCO2peak, SpO2peak and 6-Minute Walking Distance (6MWD) increased (|t| > 2.167, P < 0.05), while the average Lowest VE/VCO2 and VE/VCO2 slope decreased (t > 2.264, P < 0.05) in the exercise group. Compared with the control group, the FEV1/FVC, AT, WRpeak, VO2peak, VO2/HRpeak, COpeak and 6MWD increased in the exercise group (|t| > 2.168, P < 0.05). Conclusion:The holistic cardiopulmonary function of stable patients with PAH decreases. CPET-based individualized moderate-intensity exercise could enhance the cardiopulmonary functional reserve and exercise capacity of patients with PAH.
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<p><b>OBJECTIVE</b>Since 1987, professor Wasserman displayed cardiopulmonary exercise test starting (CPET) data as 3 rows and 3 columns 9 panels plots. Although many changes and additions, there still are some important functional parameters were not shown in 9 panels. We want to display more.</p><p><b>METHODS</b>The 100 Hz sampling data of symptom-limited maximal limit CPET was used to calculate breath-by-breath data after per second cutting technique, and then to calculate the average value of 10 s data for graphic display.</p><p><b>RESULTS</b>In new 9 plots, panels (1) - (7) use time for the "X" axis, oxygen uptake, carbon dioxide elimination, loaded power, heart rate, systolic blood pressure, diastolic blood pressure, heart rate pressure product, minute ventilation, respiratory exchange ratio, CO2 elimination ventilatory efficiency, oxygen uptake ventilatory efficiency, oxygen pulse, ST segment level and ST segment slope at V5 lead, tidal volume, respiratory rate, end tidal oxygen partial pressure, end tidal carbon dioxide partial pressure and oxygen saturation of 18 noninvasive parameters, and arterial oxygen partial pressure, arterial oxygen saturation, arterial partial pressure of carbon dioxide 3 blood gas parameters for the "Y" axis respectively. There are 3 vertical dashed lines represent dividing lines of the resting, warm-up, incremental power loading exercise and recovery period respectively. In addition, panels (1) and (4) have the horizontal dashed line represents the maximal oxygen uptake (red), oxygen uptake efficiency plateau (red) and the lowest value of carbon dioxide elimation ventilatory efficiency (blue) expected value respectively. Panel ( used heart rate and carbon dioxide elimination (as Y) against to oxygen uptake (as X); the "+" indicates intersection of the predicted maximum values of oxygen uptake and heart rate. Panel (9) used tidal volume (as Y) against over minute ventilation (as X), vertical dashed line is the measured maximum ventilatory volume, the horizontal dashed lines were the inspiratory capacity and vital capacity respectively.</p><p><b>CONCLUSION</b>New CPET 9 plots emphasizes on the integration of all circulatory, respiratory and metabolic etc functional parameters in human, and is conductive to optimization of clinical medical service and health management.</p>
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Humanos , Arterias , Análisis de los Gases de la Sangre , Presión Sanguínea , Dióxido de Carbono , Ejercicio Físico , Prueba de Esfuerzo , Estándares de Referencia , Corazón , Frecuencia Cardíaca , Salud Holística , Medicina Integrativa , Oximetría , Oxígeno , Consumo de Oxígeno , Presión Parcial , Intercambio Gaseoso Pulmonar , Volumen de Ventilación PulmonarRESUMEN
The cardiopulmonary exercise testing (CPET) is one important clinical functional testing method, which linked to all functions of respiratory, circulatory, metabolic and neurohumoral etc. The most important parameter of CPET is oxygen uptake which can reflect the core oxygen metabolic information of the human being's holistic integrative physiology. We explain why the CPET interpretation needs new philosophy of holistic integrative physiology and medicine. CPET is a unique holistic, objective, quantitative scientific evaluation skill of human function to distinguish health, sub-health and dieases, It can help us to make optimal recommendations for prevention, diagnosis and differential diagnosis, treatment evaluation, exercise rehabilitation and prognosis of many clinical diseases. However, in order to so, we needs pre-qualified and calibrated stable system, standardized clinical practice, data analysis, display illustration and interpretation principle for CPET.
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Humanos , Prueba de Esfuerzo , Estándares de ReferenciaRESUMEN
<p><b>OBJECTIVE</b>From the point of holistic integrative medicine, the D(L)CO depends on not only normal respiratory and circulatory functions, but also an optional matching between them. However, due to the limitation of traditional systemic physiology, the D(L)CO always be classified as lung functional parameter to be analyzed and interpreted. Because ignoring the circulatory system function, so it will certainly have some misunderstandings.</p><p><b>METHODS</b>Based on the Holistic Integrative Medicine, under the control of neurohumoral, respiratory, circulatory and metabolic systems work together, we discussed the diffusion function. We analyzed the change of D(L)CO in the patients with cardiac dysfunction, especially the heart failure.</p><p><b>RESULTS</b>The D(L)CO, CO gas,diffusion from lung circulating blood, depends on the normality of respiratory and circulatory systems and their matching. We analyzed the reasons of D(L)CO for characteristic pathophysiological changes of patients with heart failure.</p><p><b>CONCLUSION</b>The normal D(L)CO depends on a good matching of normal respiratory and circulatory systems. For heart failure, the respiratory and circulatory systems matching is poor. Due to dominant limitation of left ventricle pump function, pulmonary blood volume may slightly increased, but combination of all reduced pulmonary blood flow rate, thicked diffuse member and increased diffusion distance etc. suggest that patients with heart failure should have a decreased, rather than increased, D(L)CO.</p>
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Humanos , Análisis de los Gases de la Sangre , Volumen Sanguíneo , Insuficiencia Cardíaca , Pulmón , Fisiología , Circulación Pulmonar , Capacidad de Difusión Pulmonar , Pruebas de Función Respiratoria , Función Ventricular IzquierdaRESUMEN
<p><b>OBJECTIVE</b>Systemic mechanism of neurohumoral control and regulation for human is limited.</p><p><b>METHODS</b>We used the new theory of holistic integrative physiology and medicine to approach the mechanism and pattern of neurohumoral control and regulation for life.</p><p><b>RESULTS</b>As the core of human life, there are two core axes of functions. The first one is the common goal of respiration and circulation to transport oxygen and carbon dioxide for cells, and the second one is the goal of gastrointestinal tract and circulation to transport energy material and metabolic product for cells. These two core axes maintain the metabolism. The neurohumoral regulation is holistically integrated and unified for all functions in human body. We simplified explain the mechanism of neurohumoral control and regulation life (respiration and circulation) as the example pattern of sound system.</p><p><b>CONCLUSION</b>Based upon integrated regulation of life, we described the neurohumoral pattern to control respiration and circulation.</p>
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Humanos , Circulación Sanguínea , Fisiología , Salud Holística , Medicina Integrativa , Metabolismo , Fisiología , Neurotransmisores , Fisiología , Respiración , Fenómenos Fisiológicos RespiratoriosRESUMEN
<p><b>OBJECTIVE</b>The interpretation of control and regulation of circulatory parameters in traditional physiology has some limitations. Human being is an organic, circulatory control and regulation should involve all the systems.</p><p><b>METHODS</b>Based upon the theory of holistic integrative physiology and medicine, we approach to explain the circulatory control and regulation from its purpose.</p><p><b>RESULTS</b>The main purpose of circulation is to maintain a stable metabolism of cells, i.e. transport oxygen (from lung) and nutrients (from gastrointestinal tract) to cells, and return carbon dioxide and metabolic products back for elimination. Based on this goal, all respiration and gastrointestinal digestion, absorption, urinary excretion, etc. are integrative together for regulation to maintain the supply-demand balance at any metabolic status of resting, exercise and sleep. So that, we can explain many existing problems and questions, for example: why and how the foramen ovale closed after birth; mechanism of Cheyne-Stokes respiration; blood flow redistribution during exercise; variabilities of systolic blood pressure, heart rate and autonomic tone.</p><p><b>CONCLUSION</b>The circulatory control and regulation is the integration of all systems of the body.</p>
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Humanos , Circulación Sanguínea , Fisiología , Salud Holística , Medicina IntegrativaRESUMEN
<p><b>OBJECTIVE</b>The modern systemic physiology, based on limit-understand functional classification, has significant limitation and one-sidedness. Human being is organic; we should approach the mechanism of control and regulation of breathing integrating all the systems.</p><p><b>METHODS</b>We use new theory of holistic integrative physiology and medicine to explain the mechanism of control and regulation of breathing.</p><p><b>RESULTS</b>Except the mean level information, the up-down "W" waveform information of arterial blood gas (ABG) is core signal to control and regulate breathing. In order to do so, we must integrate all systems together. New theory will help to explain some unanswered questions in physiology and medicine, for example: fetal does not breathing; how first breath generate; how respiratory rhythm and frequency generate, etc.</p><p><b>CONCLUSION</b>Breathing is the sign of life. Mechanism of control and regulation of breathing has to integrate respiration, circulation, nerves, metabolism, exercise, sleep and digestion, absorption and elimination and etc altogether.</p>
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Humanos , Salud Holística , Medicina Integrativa , Respiración , Fenómenos Fisiológicos RespiratoriosRESUMEN
Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.
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Humanos , Salud Holística , Medicina Integrativa , Calidad de la Atención de SaludRESUMEN
<p><b>OBJECTIVE</b>To study the rehabilitation effects ergometry on COPD patients.</p><p><b>METHODS</b>Thirty COPD out-patients in our Hospital were randomly divided into 2 groups. Rehabilitation group, 15 patients, performed leg ergometry exercise of 80% peak Watt x 30min/d x 3d/w x 12w. Another 15 patients were control group without exercise. All patients received conventional therapy. Pulmonary function testing (PFT), cardiopulmonary exercise testing (CPET), arterial blood gas analysis (ABG), Borg and CAT sores were done at both baseline and 12 w.</p><p><b>RESULTS</b>There was no statistically difference in lung function testing, blood gas analysis and cardiopulmonary exercise test when pre- exercises between 2 sub-groups. The IC, peak VO2 and peak, W of rehabilitation group significantly increased (P < 0.05); and Borg and CAT.scores significantly decreased (P < 0.05) from baseline; and other PFT and ABG did not change (P > 0.05). While there was no difference in control group (P > 0.05).</p><p><b>CONCLUSION</b>Leg submaximal ergometry rehabilitation improves health condition and ameliorate dyspnea symptoms in COPD patients.</p>
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Humanos , Análisis de los Gases de la Sangre , Disnea , Terapéutica , Prueba de Esfuerzo , Terapia por Ejercicio , Enfermedad Pulmonar Obstructiva Crónica , Terapéutica , Pruebas de Función RespiratoriaRESUMEN
<p><b>UNLABELLED</b>Objective: In order to assess the integrative cardiopulmonary function after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD), we used symptom limited maximum cardiopulmonary exercise testing (CPET).</p><p><b>METHODS</b>All 59 patients diagnosed stable CAD by coronary angiography and echocardiography from August to December of 2014 in our hospital, were divided two groups. PCI group, 31 patients received PCI and drugs. Control group, 28 patients received drugs therapy only. All patients performed CPET before and after the treatment.</p><p><b>RESULTS</b>All patients safely completed CPET without any complications. The control group, all functional parameters were unchanged (P > 0.05). PCI group, the anaerobic threshold, peak oxygen uptake and peak oxygen pulse increased significantly (P < 0.05) from baseline,but not for others (P > 0.05). For individual analysis, PCI group had higher rates of increase (≥ 10% of baseline) in both peak oxygen uptake and peak oxygen pulse than those of control group (P < 0.05).</p><p><b>CONCLUSION</b>CPET is an objective, quantitative, safe and effective method to evaluate the clinical therapeutic efficiency. PCI can improve the integrative cardiopulmonary function in CAD patients.</p>
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Humanos , Umbral Anaerobio , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Cirugía General , Prueba de Esfuerzo , Frecuencia Cardíaca , Oxígeno , Consumo de Oxígeno , Intervención Coronaria PercutáneaRESUMEN
<p><b>OBJECTIVE</b>This study aimed to investigate the feature of D(L)CO (Diffusion Lung Capacity for Carbon Monoxide) in CHF (left ventricular heart failure) patients, underlying pathophysiological mechanism and clinical significance.</p><p><b>METHODS</b>We retrospectively studied the D(L)CO, pulmonary ventilation function, cardiopulmonary exercise testing and related clinical information in severer HF patients.</p><p><b>RESULTS</b>Peak VO2 severely decreased to 34 ± 7 percentage of predicted(%pred) and anaerobic threshold to 48 ± 11%pred in all patients. D(L)CO moderately decreased to 63 ± 12%pred and there were 25 patients lower than 80%pred. FVC, FEV1, FEV1/FVC and TLC were 75 ± 14%pred, 71 ± 17%pred, 97 ± 11%pred, and 79 ± 13%pred, which indicated borderline or mild restrictive ventilatory dysfunction. The decrease of D(L)CO was more severe than those of TLC, FEV1 and FVC.</p><p><b>CONCLUSION</b>For patients with severe CHF, cardiopulmonary exercise function is extremely limited, D(L)CO generally moderately declines and ventilation function is merely mildly limited. D(L)CO is the parameter for cardiopulmonary coupling, reflecting limitation of the cardiovascular dysfunction while without ventilatory limit.</p>
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Humanos , Análisis de los Gases de la Sangre , Insuficiencia Cardíaca , Pruebas de Función Respiratoria , Estudios Retrospectivos , Disfunción Ventricular IzquierdaRESUMEN
<p><b>OBJECTIVE</b>After performed symptom-limited maximum cardiopulmonary exercise testing (CPET) before and after acute alkalized blood, we repeated CPET with pure oxygen.</p><p><b>METHODS</b>Five volunteers, 3hr after alkalizing blood room air CPET, re-performed CPET inhaling from Douglas bag connected with pure oxygen tank. We compared with those of room air CPETs before and after alkalized blood.</p><p><b>RESULTS</b>After alkalized blood oxygen CPET had a similar response pattern as those of CPETs before and after blood alkalization. During the CPET, all breath frequency, minute ventilation and tidal volume at each stage were similar to those of CPETs before and after alkalized blood (P > 0.05),except there was a lower peak tidal volume than those of both CPETs and a slightly higher resting minute ventilation only than CPET after alkalized blood (P > 0.05). After alkalized blood, oxygen CPET, all PaO2 and SaO2 and most Hb were lower than those of both CPETs (P < 0.05). The pHa and [HCO3-]a were higher than those of CPET before alkalized blood (P < 0.05); but were not CPET after alkalized blood (P > 0.05). PaCO2 was similar to that of CPET before alkalized blood (P > 0.05), but was lower than that of CPET after alkalized blood at resting and warm-up (P < 0.05); then was similar to both CPETs at anaerobic threshold (P > 0.05); but was higher at peak exercise higher than those of both CPETs (P < 0.01). Oxygen increased 2,3 volunteers' workload and time at AT and peak exercises.</p><p><b>CONCLUSION</b>Respiratory response pattern to oxygen CPET after alkalized blood is similar to those of both CPETs before and after alkalized blood. The CPET response is dominantly depended upon metabolic rate, but not levels of pHa, PaCO2 and PaO2.</p>
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Humanos , Análisis de los Gases de la Sangre , Prueba de Esfuerzo , Oxígeno , Fenómenos Fisiológicos RespiratoriosRESUMEN
<p><b>OBJECTIVE</b>The same person's pulmonary venous blood volume, left atrial volume and stroke volume were measured by lung CT scans and cardiac CT angiography (CTA). Then their relationships were analyzed in order to investigate the mechanism of breathing control.</p><p><b>METHODS</b>As we described before, full pulmonary vascular (-0.6mm) volume was accurately calculated by three-dimensional imaging technology from lung CT scan; left atrial volume and stroke volume of left ventricle were calculated from the CTA data. Then the relationships among them were analyzed for estimation of the lung-artery time.</p><p><b>RESULTS</b>The total volume of lung and pulmonary vascular blood was 3486 ± 783 (2156-4418) ml, and the pulmonary vascular blood volume was 141 ± 20 (105-163) ml. The estimated pulmonary venous volume was 71 ± 10 (52-81) ml. Left atrial volume at the end diastolic was 97 ± 39 (53-165) ml, Stroke volume of left ventricle was 86 ± 16 (60-106) ml. Pulmonary venous volume and the left atrial volume were double of stroke volume(1.7-2.4).</p><p><b>CONCLUSION</b>The estimated lung-artery time was three heart beat.</p>
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Humanos , Volumen Sanguíneo , Atrios Cardíacos , Volumen SistólicoRESUMEN
<p><b>OBJECTIVE</b>The aim of this study is to investigate the occurrence and mechanism of Cheyne-Stokes breathing pattern in patients with heart failure.</p><p><b>METHODS</b>Fifty-six patients who performed polusomnography sleep testing at National Center of Cardiovascular Diseases Fuwai Hospital from March to May in 2015. We divided them into chronic heart failure (CHF) group and non-CHF group.</p><p><b>RESULTS</b>The occurrences of sleep apnea in two groups were high. In CHF group (n = 11) , there were 10 patients with apnea hypopnea index (AHI) > 5; and their AHI was 23.93 ±14.63. In non-CHF group (n = 45), there were 33 patients whose AHI > 5; and their AHI was 16.20 ± 18.76. The ratio of center sleep apnea to all gross sleep apnea ratio in CHF group was higher than that in non-CHF group (80.21% ± 30.55% vs 27.16% ± 35.71%, P < 0.01 ).</p><p><b>CONCLUSION</b>Based upon the new theory of holistic integrative physiology and medicine, we explain the mechanism of circulatory dysfunction induce the oscillation breathing in patients with CHF. The sleep apnea and C-S respiration in CHF should be called circulatory sleep apnea, rather than central sleep apnea.</p>
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Humanos , Respiración de Cheyne-Stokes , Enfermedad Crónica , Insuficiencia Cardíaca , Polisomnografía , Síndromes de la Apnea del Sueño , Apnea Central del SueñoRESUMEN
<p><b>OBJECTIVE</b>Because the traditional loop of breathing control and regulation effect on blood circulation, there was rare study of pulmonary vein capacity. We need a noninvasive and accurate pulmonary vascular capacity measurement and analysis method.</p><p><b>METHODS</b>Twelve normal volunteers were performed a total lung CT scan, image data analysis processing by computer software, the whole lungs from the apex to the base of lung with 40-50 layers by hand-cut, the connection between adjacent layers automatically by a computer simulation, the full pulmonary vascular (≥ 0.6 mm) were treated by high-accuracy three-dimensional imaging technology after removing the interference, and then calculate the whole lung and pulmonary vascular.</p><p><b>RESULTS</b>The whole lung of the 12 normal volunteers from the apex to the base of lung CT scan image layers was 530 ± 98 (range, 431-841). The total capacity of lung and pulmonary vascular blood was 3705 ± 857 (range, 2398-5383) ml, and the total volume of the pulmonary vascular blood was 125 ± 32 (range, 94-201) ml. The pulmonary vein vascular blood volume was 63 ± 16 (range, 47-100) ml.</p><p><b>CONCLUSION</b>The method of measuring the three-dimensional imaging of pulmonary vascular capacity by analyzing lung CT scan data is available and accurate.</p>
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Humanos , Simulación por Computador , Voluntarios Sanos , Procesamiento de Imagen Asistido por Computador , Pulmón , Tomografía Computarizada por Rayos XRESUMEN
<p><b>OBJECTIVE</b>Measures of ventilation-CO₂output relationship have been shown to be more prognostic than peak O₂uptake in assessing life expectancy in patients with chronic heart failure (CHF). Because both the ratios (VE/Vco₂) and slopes (VE-vs-Vco₂) of ventilation-co₂ output of differing durations can be used, we aim to ascertain which measurements best predicted CHF life expectancy.</p><p><b>METHODS</b>Two hundred and seventy-one CHF patients with NYHA class II-IV underwent incremental cardiopulmonary exercise testing (CPET) and were followed-up for a median duration of 479 days. Four different linear regression VE-vs- Vco₂ slopes were calculated from warm-up exercise onset to: 180 s, anaerobic threshold (AT), ventilatory compensation point (VCP); and peak exercise. Five VE/Vco₂ ratios were calculated for the following durations: rest (120 s), warm-up (30 s), AT (60 s), lowest value (90 s), and peak exercise (30 s). Death or heart transplant were considered end-points. Multiple statistical analyses were performed.</p><p><b>RESULTS</b>CHF patients had high lowest VE/Vco₂ (41.0 ± 9.2, 141 ± 30%pred), high VE/Vco₂ at AT (42.5 ± 10.4, 145 ± 35%pred), and high VE-vs-Vco₂ slope to VCP (37.6 ± 12.1, 126 ± 41%pred). The best predictor of death was a higher lowest VE/Vco₂ (≥ 42, ≥ 141%pred), whereas the VE-vs-Vco₂slope to VCP was less variable than other slopes. For death prognosis in 6 months, %pred values were superior: for longer times, absolute values were superior.</p><p><b>CONCLUSION</b>The increased lowest VE/Vco₂ ratio easily identifiable and simply measured during exercise, is the best measurement to assess the ventilation-co₂output relationship in prognosticating death in CHF patients.</p>
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Humanos , Dióxido de Carbono , Metabolismo , Enfermedad Crónica , Progresión de la Enfermedad , Prueba de Esfuerzo , Insuficiencia Cardíaca , Diagnóstico , Mortalidad , Esperanza de Vida , Pruebas de Función RespiratoriaRESUMEN
<p><b>OBJECTIVE</b>Exercise induced oscillatory ventilation (EIOB) during cardiopulmonary exercise testing (CPET) is associated with severity and prognosis of disease, but clinical approach for the character of EIOB due to circulatory dysfunction are seldom reported.</p><p><b>METHODS</b>This retrospective analysis of symptom-limited maximum CPET data with an increment of 10-20 W/min in 38 patients with CHF. We calculated the duration, frequency, amplitude and other parameters of EIOB.</p><p><b>RESULTS</b>There were 31 presenting with EIOB (82%) in all patients with CHF. In EIOB group, VE amplitude were (12.4 ± 4.4)L/min (accounting for 81% ± 30% of mean) and duration were (77.0 ± 20.0)s. The number of patients whose EIOB presenting at rest, exercise, recovery stage and the whole eriod were 24, 31, 4 and 4, respectively. Except VE, there were VO2, VCO2, RER and PETO2 presenting EIOB in all 31 patients; VE/VCO2, VO2/VE and breath frequency in 29 patients; PETCO2 in 26 patients; VT and VO2/HR in 25 patients; and HR in 2 patients.</p><p><b>CONCLUSION</b>EIOB may occur in any period of CPET, mostly in severe patient with CHF, and presenting in many variables. Due to it is resulted from the circulatory dysfunction, we should call it circulatory (cardiac) oscillatory breathing abnormality.</p>
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Humanos , Prueba de Esfuerzo , Insuficiencia Cardíaca , Consumo de Oxígeno , Fenómenos Fisiológicos Respiratorios , Estudios RetrospectivosRESUMEN
<p><b>OBJECTIVE</b>Basis on the dynamic changes of the ventilation and arterial blood gas parameters to symptom-limited maximum cardiopulmonary exercise testing (CPET), we further investigate the effect of alkalized blood by drinking 5% NaHCO3 on ventilation during exercise.</p><p><b>METHODS</b>After drinking 5% NaHCO3 75 ml (3.75 g) every 5 min, total dosage of 0.3 g/Kg, 5 volunteers repeated CPET. All CPET and ABG data changes were analyzed and calculated. At the same time, CPET and ABG parameters after alkalized blood were compared with those before alkalized blood (control) used paired t test.</p><p><b>RESULTS</b>After alkalized blood, CPET response patterns of parameters of ventilation, gas exchange and arterial blood gas were very similar (P > 0.05). All minute ventilation, tidal volume, respiratory rate, oxygen uptake and carbon dioxide elimination were gradually increased from resting stage (P < 0.05-0.001), according to the increase of power loading. During CPET after alkalized blood, ABG parameters were compared with those of control: hemoglobin concentrations were lower, CaCO2 and pHa were increased at all stages (P < 0.05). The PaCO2 increased trend was clear, however only significantly at warm-up from 42 to 45 mmHg (P < 0.05). Compared with those of control, only the minute ventilation was decreased from 13 to 11 L/min at resting (P < 0.05).</p><p><b>CONCLUSION</b>Even with higher mean CaCO2, PaCO2 and pHa, lower Hba and [H+]a, the CPET response patterns of ventilatory parameters after alkalized blood were similar.</p>
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Humanos , Análisis de los Gases de la Sangre , Dióxido de Carbono , Prueba de Esfuerzo , Oxígeno , Consumo de Oxígeno , Respiración , Fenómenos Fisiológicos Respiratorios , Volumen de Ventilación PulmonarRESUMEN
<p><b>OBJECTIVE</b>Under the guidance of the holistic integrative physiology medicine, we reanalyzed the data during symptom-limited maximum cardiopulmonary exercise testing (CPET) in order to investigate control and regulatory mechanism of breathing.</p><p><b>METHODS</b>This study investigated 5 normal volunteers who accepted artery catheter, performed CPET room air. Continuous measured pulmonary ventilation parameters and per minute arterial blood gas (ABG) analysis sample parameters during exercise. All CPET and ABG data changes were standard analyzed and calculated.</p><p><b>RESULTS</b>With gradually increasing power, minute oxygen uptake(every breath oxygen uptake x respiratory rate = O2 paulse x heart rate) and minute ventilation (tidal volume x respiratory rate) showed nearly linear progressive increase during the CPET(compared with the rest stage, P < 0.05 - 0.001); Minute ventilation increased even more significant after the anaerobic threshold (AT) and respiratory compensation point. PaO2 was increased at recovery 2 minutes (P < 0.05); PaCO2 was decreased after anaerobic threshold 2 minutes (P < 0.05); [H+]a was increased from AT (P < 0.05), and rapidly raised at last 2 minutes, remained high at recovery. Lactate was increased rapidly from AT (compared with resting, P < 0.05); bicarbonate decreased rapidly from AT (compared with resting, P < 0.05) and it's changed direction was contrary to lactic acid.</p><p><b>CONCLUSION</b>In order to overcome the resistance of the power during exercise, metabolic rate othe body increased, respiratory change depend upon the change metabolism, and the accumulation of acidic products exacerbated respiratory reactions at high intensity exercise.</p>
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Humanos , Umbral Anaerobio , Análisis de los Gases de la Sangre , Prueba de Esfuerzo , Voluntarios Sanos , Frecuencia Cardíaca , Oxígeno , Consumo de Oxígeno , Ventilación Pulmonar , Respiración , Fenómenos Fisiológicos Respiratorios , Volumen de Ventilación PulmonarRESUMEN
<p><b>OBJECTIVE</b>Since 2011 EB-APS conference, we hypotheses that phase switching of inspiration-expiration is dominantly initiated by oscillatory information PaO2, PaCO2 and [H+] via fast peripheral chemical receptors. However, the evidence of the waveform of ABG is lack.</p><p><b>METHODS</b>Six surgery patients with normal heart function and negative Allen test, had been placed the arterial catheterization directly connected to 3 x 1 000 mm pre-heparin plastic pipe for continuous collecting arterial blood. We counted the number of heart beat for the blood collecting time, and separated the blood pipe into the heart beat numbers' short pieces using haemostatic forceps, then put pipe into iced water at once fir analyzing PaO2, PaCO2, pH and SaO2 as soon as possible. We selected two breaths cycles of waveform from each patient for data calculations of magnitudes and time interval.</p><p><b>RESULTS</b>The heart beat numbers for filling blood into pipe were 16 ± 2, and all covered more than 2 breathing cycles. Each breathing cycle is cover 5 ± 0.6 heart beat. There were significant changes of PaO2, PaCO2, [H+] a and SaO2 (i.e. the highest high values compare to the next lowest values, P < 0.05). The time interval of changing PaO2, PaCO2, [H+]a and SaO2 magnitudes were 11.28 ± 1.13 mmHg, 1.77 ± 0.89 mmHg, 1.14 ± 0.35 nmol/L and 0.52% ± 0.44% respectively.</p><p><b>CONCLUSION</b>This simple continuous beat-by-beat arterial blood sampling and ABG analyzing method is new and practicable. We obtain a clear evidence of periodic parameters ABG waveform, which following breathing cycle.</p>