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健康老年人群运动性通气过度的机械性限制因素

Mechanical constraints on exercise hyperpnea in a fit aging population.

作者信息

Johnson B D, Reddan W G, Seow K C, Dempsey J A

机构信息

John Rankin Laboratory of Pulmonary Medicine, Department of Preventive Medicine, University of Wisconsin School of Medicine, Madison 53706.

出版信息

Am Rev Respir Dis. 1991 May;143(5 Pt 1):968-77. doi: 10.1164/ajrccm/143.5_Pt_1.968.

Abstract

We studied 12 physically fit (VO2 max = 44 ml.kg-1.min-1) older subjects (age = 63 to 77 yr) who showed the usual age-related declines in lung function (i.e., reduced maximal expiratory flow rates, vital capacity and increased functional residual capacity, closing capacity, and residual volume). We measured the optimal transpulmonary pressures for maximal expiratory airflow and the capacity of the muscles of inspiration for developing pleural pressure (taking into account the effects of lung volume and flow rate). Within these mechanical constraints to ventilation we plotted tidal pleural pressure-volume loops for mild through maximal exercise according to a measured end-expiratory lung volume (EELV). We found EELV to decrease a mean of 0.26 +/- 0.09 L and maximal effective pleural pressures to be reached in nine subjects near EELV with only light to moderate exercise intensities, whereas peak inspiratory pressure was only 45% of the capacity for pressure generation. With progressive increases in exercise intensity, EELV increased, and pleural pressures encroached to a greater extent on the maximal effective pressures; however, they remained effective in the majority of subjects. During maximal exercise EELV was 0.13 +/- 0.10 L greater than resting values, 20% of the Vt reached maximal effective pressures, and 83% of the capacity for inspiratory pressure was achieved. Three subjects significantly surpassed their maximal effective expiratory pressures, and four subjects achieved 95 to 100% of the capacity for inspiratory pressure generation. These subjects also showed no further increase in ventilation while breathing 0.02 to 0.05 FICO2 at maximal exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

我们研究了12名身体健康(最大摄氧量=44 ml·kg⁻¹·min⁻¹)的老年受试者(年龄63至77岁),他们表现出与年龄相关的肺功能下降(即最大呼气流量、肺活量降低,功能残气量、闭合容量和残气量增加)。我们测量了最大呼气气流时的最佳跨肺压以及吸气肌产生胸膜腔压力的能力(考虑到肺容积和流速的影响)。在这些通气的机械限制范围内,根据测得的呼气末肺容积(EELV),绘制了从轻度到最大运动时的潮式胸膜腔压力-容积环。我们发现EELV平均下降0.26±0.09 L,9名受试者在接近EELV时仅通过轻度至中度运动强度就达到了最大有效胸膜腔压力,而吸气峰值压力仅为压力产生能力的45%。随着运动强度的逐渐增加,EELV增加,胸膜腔压力在更大程度上接近最大有效压力;然而,在大多数受试者中它们仍然有效。在最大运动时,EELV比静息值大0.13±​0.10 L,20%的潮气量达到最大有效压力,吸气压力能力的83%得以实现。三名受试者显著超过了他们的最大有效呼气压力,四名受试者达到了吸气压力产生能力的95%至100%。这些受试者在最大运动时呼吸0.02至0.05 FICO2时,通气量也没有进一步增加。(摘要截断于250字)

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