West John B
Dept. of Medicine 0623A, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0623, USA.
J Appl Physiol (1985). 2005 Aug;99(2):424-32. doi: 10.1152/japplphysiol.00184.2005.
The 1952 Copenhagen poliomyelitis epidemic provided extraordinary challenges in applied physiology. Over 300 patients developed respiratory paralysis within a few weeks, and the ventilator facilities at the infectious disease hospital were completely overwhelmed. The heroic solution was to call upon 200 medical students to provide round-the-clock manual ventilation using a rubber bag attached to a tracheostomy tube. Some patients were ventilated in this way for several weeks. A second challenge was to understand the gas exchange and acid-base status of these patients. At the onset of the epidemic, the only measurement routinely available in the hospital was the carbon dioxide concentration in the blood, and the high values were initially misinterpreted as a mysterious "alkalosis." However, pH measurements were quickly instituted, the Pco(2) was shown to be high, and modern clinical respiratory acid-base physiology was born. Taking a broader view, the problems highlighted by the epidemic underscored the gap between recent advances made by physiologists and their application to the clinical environment. However, the 1950s ushered in a renaissance in clinical respiratory physiology. In 1950 the coverage of respiratory physiology in textbooks was often woefully inadequate, but the decade saw major advances in topics such as mechanics and gas exchange. An important development was the translation of the new knowledge from departments of physiology to the clinical setting. In many respects, this period was therefore the beginning of modern clinical respiratory physiology.
1952年哥本哈根的脊髓灰质炎疫情给应用生理学带来了巨大挑战。在几周内，超过300名患者出现了呼吸麻痹，传染病医院的呼吸机设备完全不堪重负。英勇的解决办法是召集200名医科学生，使用连接在气管造口管上的橡胶袋进行全天候人工通气。一些患者以这种方式通气了数周。第二个挑战是了解这些患者的气体交换和酸碱状态。在疫情开始时，医院常规可进行的唯一测量是血液中的二氧化碳浓度，而高值最初被误解为一种神秘的“碱中毒”。然而，很快就开始了pH测量，结果显示Pco₂ 很高，现代临床呼吸酸碱生理学由此诞生。从更广泛的角度来看，疫情凸显的问题强调了生理学家最近取得的进展与这些进展在临床环境中的应用之间的差距。然而，20世纪50年代迎来了临床呼吸生理学的复兴。1950年，教科书中对呼吸生理学的涵盖往往严重不足，但在这十年中，诸如力学和气体交换等主题取得了重大进展。一个重要的发展是将生理学系的新知识转化到临床环境中。因此，从许多方面来看，这个时期是现代临床呼吸生理学的开端。
