Esau S A
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
Am Rev Respir Dis. 1989 Jun;139(6):1410-7. doi: 10.1164/ajrccm/139.6.1410.
Hypoxia and hypercapnic acidosis have been shown to have a negative inotropic effect on diaphragmatic contractility. The effect of combined hypercapnia and hypoxia was studied in vitro using hamster diaphragm strips. A 12% CO2, 21% O2, and 67% N2 gas mixture was used to produce hypoxic, hypercapnic acidosis. Force-frequency curves were generated using twitches and maximal tetanic contractions produced by stimulating with 0.2-ms pulses at 10 to 120 Hz for 300 to 500 ms. Moderate fatigue was then induced by repeated submaximal contractions (25 Hz, 160 ms, at the rate of 1/s for 45 contractions). Muscle strips exposed to hypoxic, hypercapnic acidosis had a decreased force response at all frequencies. The decrease in force was not different from that seen with hypoxia alone but was significantly worse than with hypercapnia alone. In the combined hypercapnic, hypoxia solution, tension produced by stimulating at 25 Hz for 160 ms was decreased to 52 +/- 11% of control (p less than 0.001). For these submaximal contractions, hypercapnic acidosis had a greater negative inotropic effect than did hypoxia alone. With repeated contractions, tension declined at a faster rate than in control, hypoxia alone, or hypercapnia alone. In the combined hypoxic, hypercapnic solution, the time constant of relaxation (tau) was increased prior to the start of the fatigue run compared to the control (tau = 35 +/- 6 versus 45 +/- 5 ms; p less than 0.001), and the tau increased at a faster rate than in control. These studies suggest that hypoxic, hypercapnic acidosis has a greater detrimental effect on the muscle than either abnormality alone and makes the muscle more susceptible to fatigue.
缺氧和高碳酸血症酸中毒已被证明对膈肌收缩力有负性变力作用。在体外使用仓鼠膈肌条研究了高碳酸血症和缺氧联合作用的影响。使用12%二氧化碳、21%氧气和67%氮气的混合气体产生缺氧性高碳酸血症酸中毒。通过以10至120Hz的频率用0.2毫秒的脉冲刺激300至500毫秒产生的单收缩和最大强直收缩来生成力-频率曲线。然后通过重复次最大收缩(25Hz,160毫秒,以每秒1次的速率进行45次收缩)诱导中度疲劳。暴露于缺氧性高碳酸血症酸中毒的肌条在所有频率下的力反应均降低。力的降低与单独缺氧时所见的情况无差异,但明显比单独高碳酸血症时更严重。在联合高碳酸血症、缺氧溶液中,以25Hz刺激160毫秒产生的张力降至对照的52±11%(p<0.001)。对于这些次最大收缩,高碳酸血症酸中毒的负性变力作用比单独缺氧时更大。随着重复收缩,张力下降的速度比对照、单独缺氧或单独高碳酸血症时更快。在联合缺氧、高碳酸血症溶液中,与对照相比,疲劳试验开始前松弛时间常数(tau)增加(tau = 35±6对45±5毫秒;p<0.001),并且tau增加的速度比对照更快。这些研究表明,缺氧性高碳酸血症酸中毒对肌肉的有害影响比单独的任何一种异常都更大,并且使肌肉更容易疲劳。