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        "resumen" => "<p class="elsevierStylePara"> Introducci&#243;&#58; Estudi de l&#8217;adaptaci&#243; fisiol&#242;gica de persones que respiren aire enrarit en un avenc&#46;</p> <p class="elsevierStylePara"> Objectiu&#58; Investigar la capacitat aritmog&#232;nica de l&#8217;aire enrarit i les alteracions del sistema nervi&#243;s aut&#242;nom &#40;simp&#224;tic i parasimp&#224;tic&#41;&#46; Establir uns nivells de tall m&#233;s enll&#224; dels quals cal prendre mesures preventives&#46;</p> <p class="elsevierStylePara"> M&#232;tode&#58; Vint-i-cinc espele&#242;legs&#44; 6 dels quals pertanyien a cossos professionals de rescat&#44; foren&#160; sotmesos a controls en rep&#242;s a l&#8217;exterior&#44; respirant aire de composici&#243; normal &#40;AN&#41;&#44; a un control subterrani&#44; tamb&#233; en rep&#242;s&#44; respirant aire enrarit d&#8217;origen natural &#40;AE&#41; en un espai confinat &#40;O<span class="elsevierStyleInf">2</span>&#58; 13&#44;38 &#177; 1&#44;5&#37; i CO<span class="elsevierStyleInf">2</span>&#58; 2&#44;23 &#177; 0&#44;31&#37;&#41;&#46; Monitorats mitjan&#231;ant control Holter card&#237;ac i pressi&#243; arterial&#46;</p> <p class="elsevierStylePara"> Resultats&#58; Pols card&#237;ac en rep&#242;s &#40;AN&#58; 81&#44;9 &#177; 15&#44;1 batecs vs&#46; AE&#58; 83&#44;8 &#177; 17&#44;3 batecs en AE&#59; p &#8804; 0&#44;58&#41;&#46; Pressi&#243; arterial sist&#242;lica &#40;AN&#58; 130&#44;3 &#177; 17&#44;2 mmHg vs&#46; AE&#58; 140&#44;2 &#177; 21&#44;3 mmHg&#59; p &#8804; 0&#44;0003&#41;&#46; Pressi&#243; arterial diast&#242;lica &#40;AN&#58; 78&#44;2 &#177; 11&#44;0 mmHg vs&#46; AE&#58; 85&#44;5 &#177; 11&#44;2 mmHg&#59; p &#8804; 0&#44;0002&#41;&#46; Variabilitat card&#237;aca&#58; RMSSD &#40;AN&#58; 25&#44;9 &#177; 13&#44;8 ms vs&#46; AE&#58; 36&#44;9 &#177; 17&#44;8 ms&#59; p &#8804; 0&#44;003&#41;&#59; NN50 &#40;AN&#58; 49&#44;0 &#177; 66&#44;2 batecs vs&#46; AE&#58; 111&#44;7 &#177; 102&#44;8 batecs&#59; p &#8804; 0&#44;003&#41;&#59; pNN50 &#40;7&#44;5 &#177; 11&#44;3&#37; en AN vs&#46; 15&#44;9 &#177; 15&#44;8&#37; en AE&#59; p &#8804; 0&#44;0013&#41;&#46; An&#224;lisi de Fourier&#58; TP &#40;AN&#58; 1&#46;759&#44;5 ms<span class="elsevierStyleSup">2</span> vs&#46; AE&#58; 2&#46;611&#44;5 ms<span class="elsevierStyleSup">2</span>&#59; p &#60; 0&#44;04&#41;&#59; HF &#40;AN&#58; 301&#44;5 &#177; 329&#44;4 ms<span class="elsevierStyleSup">2</span> vs&#46; AE&#58; 662&#44;3 &#177; 762&#44;8 ms<span class="elsevierStyleSup">2</span>&#59; p &#8804; 0&#44;02&#41;&#46; Es detecta un increment d&#8217;esdeveniments ar&#237;tmics en comparar l&#8217;hora que inclou la prova 1 &#40;H<span class="elsevierStyleInf">AN</span>&#41; amb aire de proporcions normals versus l&#8217;hora que inclou la prova 2 &#40;H<span class="elsevierStyleInf">AE</span>&#41; amb aire enrarit&#46; Hi ha clara correlaci&#243; estad&#237;stica d&#8217;esdeveniments ar&#237;tmics en ambdues situacions&#58; &#40;batecs ect&#242;pics en AE&#41; &#61; 2&#44;9859 &#215; &#40;batecs ect&#242;pics en AN&#41; &#43; 1&#44;5622&#59; n &#61; 24&#59; r &#61; 0&#44;814&#59; p &#60; 0&#44;0001&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; L&#8217;exposici&#243; a l&#8217;aire enrarit en rep&#242;s de nom&#233;s 10 min provoca una resposta pressora de la pressi&#243; arterial sist&#242;lica i diast&#242;lica&#44; comparada amb l&#8217;aire normal&#46; La variabilitat card&#237;aca&#44; en situaci&#243; de rep&#242;s estandarditzada&#44; mostra una resposta de tipus parasimp&#224;tic&#44; amb augment dels par&#224;metres rMSSD i HF quan els subjectes estan sotmesos a una atmosfera d&#8217;aire enrarit&#46; En aquest cas&#44; compost per un 13&#37; d&#8217;O<span class="elsevierStyleInf">2</span> i un 2&#44;5&#37; de CO<span class="elsevierStyleInf">2</span>&#46; En l&#8217;aire enrarit&#44; com en el de l&#8217;avenc estudiat&#44; els subjectes presentaven el triple de fen&#242;mens ar&#237;tmics que quan feien una tasca amb una c&#224;rrega similar en aire est&#224;ndard&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> Introduction&#58; Study of physiological adaptation in people breathing rarefied air in a cave&#46;</p> <p class="elsevierStylePara"> Objective&#58; To investigate the arrhythmogenic capacity of rarefied air and changes the autonomic nervous system &#40;sympathetic and parasympathetic&#41;&#46; To establish cutoff levels beyond which preventive measures must be taken&#46;</p> <p class="elsevierStylePara"> Method&#58; The study included 25 cavers&#44; monitored by ECG Holter and blood pressure measurements in 2 situations at rest&#44; one outside the cave breathing normal air composition &#40;NA&#41;&#44; and the other underground&#44; breathing rarefied air of natural origin &#40;RA&#41; in a confined space &#40;O<span class="elsevierStyleInf">2</span>&#58; 13&#46;38 &#177; 1&#46;5&#37; and CO<span class="elsevierStyleInf">2</span>&#58; 2&#46;23 &#177; 0&#46;31&#37;&#41;&#46;</p> <p class="elsevierStylePara"> Results&#58; Resting heart rate &#40;NA&#58; 81&#46;9 &#177; 15&#46;1 beats per minute &#40;bpm&#41; vs&#46; RA&#58; 83&#46;8 &#177; 17&#46;3 bpm&#59; P &#8804; &#46;58&#41;&#46; Systolic blood pressure &#40;NA&#58; 130&#46;3 &#177; 17&#46;2 mmHg vs&#46; RA&#58; 140&#46;2 &#177; 21&#46;3 mmHg&#59; P &#8804; &#46;0003&#41;&#46; Diastolic blood pressure &#40;NA&#58; 78&#46;2 &#177; 11&#46;0 mmHg vs&#46; RA&#58; 85&#46;5 &#177; 11&#46;2 mmHg&#59; P &#8804; &#46;0002&#41;&#46; Heart rate variability&#58; RMSSD &#40;NA&#58; 25&#46;9 &#177; 13&#46;8 ms vs&#46; RA&#58; 36&#46;9 &#177; 17&#46;8 ms&#59; P &#8804; &#46;003&#41;&#44; NN50 &#40;NA&#58;49&#46;0 &#177; 66&#46;2 bpm vs&#46; RA&#58; 111&#46;7 &#177; 102&#46;8 bpm&#59; P &#8804; &#46;003&#41;&#59; pNN50 &#40;NA&#58; 11&#46;3 &#177; 7&#46;5&#37; vs&#46; RA&#58; 15&#46;9 &#177; 15&#46;8&#37;&#59; P &#8804; &#46;0013&#41;&#46; Fourier analysis&#58; TP &#40;NA&#58; 1&#44;759&#46;5 ms<span class="elsevierStyleSup">2</span> vs&#46; RA&#58; 2&#44;611&#46;5 ms<span class="elsevierStyleSup">2</span>&#59; P &#8804; &#46;04&#41;&#59; HF &#40;NA&#58; 301&#46;5 &#177; 329&#46;4 ms<span class="elsevierStyleSup">2</span> vs&#46; RA&#58; 662&#46;3 &#177; 762&#46;8 ms<span class="elsevierStyleSup">2</span>&#59; P &#8804; &#46;02&#41;&#46; An increase in arrhythmic events is detected when comparing the hour that included test 1 &#40;HNA&#41; in normal air with the hour that included test 2 &#40;HRA&#41; with rarefied air&#46; There is a correlation of arrhythmic events in both situations&#58; &#40;ventricular ectopic beats in RA&#41; &#61; 2&#46;9859 &#215; &#40;ventricular ectopic beats NA&#41; &#43; 1&#46;5622&#59; n &#61; 24&#59; r &#61; 0&#46;814&#59; P &#60; &#46;0001&#46;</p> <p class="elsevierStylePara"> Conclusions&#58; Exposure to RA at rest for 10 minutes causes a pressor response in systolic and diastolic blood pressure compared to normal air &#40;NA&#41;&#46; Heart rate variability in a standardized situation and rest shows a parasympathetic response&#44; with increased rMSSD and HF parameters when subjects are subjected to an atmosphere of RA&#46; In RA&#44; the subjects had three times more arrhythmic events when compared to NA&#46;</p>"
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Vol. 51. Issue 190.
Pages 40-47 (April - June 2016)
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Vol. 51. Issue 190.
Pages 40-47 (April - June 2016)
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Impacte en humans, a nivell cardiovascular, de l’aire enrarit d’una cova mediterrània
Effect of rarefied air in a Mediterranean cave at cardiovascular level in humans
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Ignasi de Yzaguirre i Mauraa, Gonzalo Graziolib, Mònica Domènech Feira-Carotc, Diego Dulanto Zabalad, Marta Sitges Carreñob, Josep Antoni Gutiérrez Rincóna
a Medicina de l’Esport, Consell Català de l’Esport, Generalitat de Catalunya, Barcelona, Espanya
b Servei de Cardiologia, Institut Clínic del Tòrax, Hospital Clínic de Barcelona, Barcelona, Espanya
c Unitat d’HTA i RCV, Medicina Interna, ICMiD, Hospital Clínic de Barcelona, Barcelona, Espanya
d Servicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Espanya
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Introducció: Estudi de l’adaptació fisiològica de persones que respiren aire enrarit en un avenc.

Objectiu: Investigar la capacitat aritmogènica de l’aire enrarit i les alteracions del sistema nerviós autònom (simpàtic i parasimpàtic). Establir uns nivells de tall més enllà dels quals cal prendre mesures preventives.

Mètode: Vint-i-cinc espeleòlegs, 6 dels quals pertanyien a cossos professionals de rescat, foren  sotmesos a controls en repòs a l’exterior, respirant aire de composició normal (AN), a un control subterrani, també en repòs, respirant aire enrarit d’origen natural (AE) en un espai confinat (O2: 13,38 ± 1,5% i CO2: 2,23 ± 0,31%). Monitorats mitjançant control Holter cardíac i pressió arterial.

Resultats: Pols cardíac en repòs (AN: 81,9 ± 15,1 batecs vs. AE: 83,8 ± 17,3 batecs en AE; p ≤ 0,58). Pressió arterial sistòlica (AN: 130,3 ± 17,2 mmHg vs. AE: 140,2 ± 21,3 mmHg; p ≤ 0,0003). Pressió arterial diastòlica (AN: 78,2 ± 11,0 mmHg vs. AE: 85,5 ± 11,2 mmHg; p ≤ 0,0002). Variabilitat cardíaca: RMSSD (AN: 25,9 ± 13,8 ms vs. AE: 36,9 ± 17,8 ms; p ≤ 0,003); NN50 (AN: 49,0 ± 66,2 batecs vs. AE: 111,7 ± 102,8 batecs; p ≤ 0,003); pNN50 (7,5 ± 11,3% en AN vs. 15,9 ± 15,8% en AE; p ≤ 0,0013). Anàlisi de Fourier: TP (AN: 1.759,5 ms2 vs. AE: 2.611,5 ms2; p < 0,04); HF (AN: 301,5 ± 329,4 ms2 vs. AE: 662,3 ± 762,8 ms2; p ≤ 0,02). Es detecta un increment d’esdeveniments arítmics en comparar l’hora que inclou la prova 1 (HAN) amb aire de proporcions normals versus l’hora que inclou la prova 2 (HAE) amb aire enrarit. Hi ha clara correlació estadística d’esdeveniments arítmics en ambdues situacions: (batecs ectòpics en AE) = 2,9859 × (batecs ectòpics en AN) + 1,5622; n = 24; r = 0,814; p < 0,0001.

Conclusions: L’exposició a l’aire enrarit en repòs de només 10 min provoca una resposta pressora de la pressió arterial sistòlica i diastòlica, comparada amb l’aire normal. La variabilitat cardíaca, en situació de repòs estandarditzada, mostra una resposta de tipus parasimpàtic, amb augment dels paràmetres rMSSD i HF quan els subjectes estan sotmesos a una atmosfera d’aire enrarit. En aquest cas, compost per un 13% d’O2 i un 2,5% de CO2. En l’aire enrarit, com en el de l’avenc estudiat, els subjectes presentaven el triple de fenòmens arítmics que quan feien una tasca amb una càrrega similar en aire estàndard.

Palabras clave:
Aire enrarit; Hipòxia; CO2; Parasimpàtic; Variabilitat cardíaca; Arítmia

Introduction: Study of physiological adaptation in people breathing rarefied air in a cave.

Objective: To investigate the arrhythmogenic capacity of rarefied air and changes the autonomic nervous system (sympathetic and parasympathetic). To establish cutoff levels beyond which preventive measures must be taken.

Method: The study included 25 cavers, monitored by ECG Holter and blood pressure measurements in 2 situations at rest, one outside the cave breathing normal air composition (NA), and the other underground, breathing rarefied air of natural origin (RA) in a confined space (O2: 13.38 ± 1.5% and CO2: 2.23 ± 0.31%).

Results: Resting heart rate (NA: 81.9 ± 15.1 beats per minute (bpm) vs. RA: 83.8 ± 17.3 bpm; P ≤ .58). Systolic blood pressure (NA: 130.3 ± 17.2 mmHg vs. RA: 140.2 ± 21.3 mmHg; P ≤ .0003). Diastolic blood pressure (NA: 78.2 ± 11.0 mmHg vs. RA: 85.5 ± 11.2 mmHg; P ≤ .0002). Heart rate variability: RMSSD (NA: 25.9 ± 13.8 ms vs. RA: 36.9 ± 17.8 ms; P ≤ .003), NN50 (NA:49.0 ± 66.2 bpm vs. RA: 111.7 ± 102.8 bpm; P ≤ .003); pNN50 (NA: 11.3 ± 7.5% vs. RA: 15.9 ± 15.8%; P ≤ .0013). Fourier analysis: TP (NA: 1,759.5 ms2 vs. RA: 2,611.5 ms2; P ≤ .04); HF (NA: 301.5 ± 329.4 ms2 vs. RA: 662.3 ± 762.8 ms2; P ≤ .02). An increase in arrhythmic events is detected when comparing the hour that included test 1 (HNA) in normal air with the hour that included test 2 (HRA) with rarefied air. There is a correlation of arrhythmic events in both situations: (ventricular ectopic beats in RA) = 2.9859 × (ventricular ectopic beats NA) + 1.5622; n = 24; r = 0.814; P < .0001.

Conclusions: Exposure to RA at rest for 10 minutes causes a pressor response in systolic and diastolic blood pressure compared to normal air (NA). Heart rate variability in a standardized situation and rest shows a parasympathetic response, with increased rMSSD and HF parameters when subjects are subjected to an atmosphere of RA. In RA, the subjects had three times more arrhythmic events when compared to NA.

Keywords:
Rarefied air; Hypoxia; CO2; Parasympathetic; Heart rate variability; Arrhythmia
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