g r d, whi h con iderably contributes to thefast, large increa e in 11, i. e. to a great increasein the O2 tran port to the body tissue.In the inve tigation into the contribution of theindividual steps to the entire effect, one of thequestions which we examined was that of theincrease in 11 due to physical exertion. As a controlin the program of the 02MT quick procedure,O2 application and drug administrationwere omitted in 3 further individuals. An increasein 11, on average only slight and quicklydeclining, was then found (training effect). Theswitching process of the microcirculation withits lasting effect was not triggered by 100 Wphysical exertion alone. In contrast to there ult in Fig. 44 right, an increase in the P02-artafter strenous exercise training was generallyalso observed, if the strong physical exertionwas repeated on several consecutive daysFigure 45 gives an example of this type. Thethreshold of the switching function can becrossed and a lasting P02 effect achieved, asdocumented by part "d" of the curve shown inFig. 17, by means of strong exercise training(daily 3 h gardening) over 1-2 weeks, e.g.mowing the lawn.In older age and in the case of disease, thecapacity for high-charging of 11 by means ofstamina training or intensive sport alone isdrastically reduced. Variants of the 02MT,adapted to the individual performance capacity,are then to be chosen.1.1.8.5 The level of P02-art and 11, and its relation to the amount of circulatory reservesIn the discussion of our 02MT research the followingview has been repeatedly expressed bythroroughly competent persons. It was saidthat the aimed for increase in the P0 2 _ art couldbring about no improvement, as the gain insaturation attainable even in old age was only4 %, and the reduced P0 2 - art in old age was stillsufficient to saturate the arterial blood almostcompletely with oxygen. This view is wrong forseveral reasons:1. The gain of 4 % must be seen in relation tothe fact that the arteriovenous exhaustion ofthe O2 binding capacity of the blood is only20 %. Hence, an increase of an additional 4 %in the O2 transport means 1/5 more as comparedto the original 20 %, and that is a greatdeal in stages of weakness.2. The O2 supply to the arterial walls, necessaryfor the maintenance of a good arterialvessel system (good O2 supply to the tissue),occurs mainly due to O2 diffusion from thelumen of the arteries and is therefore determineddirectly by the P0 2 -art.3. The triggering of critical conditions, as wasalready pointed out above, does not generallyoccur when the arteriovenous saturationdifference 11 on the Hb02 dissociation curvecorresponds to the expected value for thatage under normal conditions, but when thevalue of 11, particularly when near to theminimum in the circadian cycle, sinks farbelow the expected value, due to acutetres ful events (e.g. infections, toxic stres ,reduced cardiac performance, hypoxemiaduring leep, high fever, chronic CO poisoningetc.). The more the mean level of thP and are raised the reater the cir-culatory reserves and the smaller the probabilitythat O2 deficiency crises (e.g. dizziness,Meniere's disease, collapse, attacks ofangina pectoris, myocardial infarction) willbe triggered.Figure 46, especially, the patient examples onthe left, gives a quantitative basis to the statementin the last paragraph. It is assumed in caseB that the starting level of the resting P0 2 -art is72 mmHg (9.6 kPa), which roughly correspondto the mean expected level for a 72-year-old.It follows from the further drawn scale of theHb02 saturation of the blood (standard conditions37°C, pH 7.4) that the degree of saturationis then still S02 = 93.3 %. As the furtherscale of the utilization of the O2 binding capacityof the blood shows, this corresponds to11 = 20.3 %, taking as a basis the normally applicablemixed P0 2 - ven of 40 mmHg (5.3 kPa).The numerical values named, characterizing acirculatory condition which is still just aboutgood enough, are drastically reduced when aa consequence of stressful influence a temporarydrop in the P0 2 - art and a ri e in theP02- ven are triggered. The case B in our figureshows just how severely the numerical value f11, the Po 2 _ art , and the 02 aturation of thblood can deteriorate in u h ca e . The w r ing points on the variou ale hift t d Pwithin the dangerou zone. Th ir ulatreserves converge toward z rooA much more favourable ituati nA in Fig. 46. Wh n th tarting 1 v 1re ting P0 2 - art i high (b tw n 9 ndmmHg ~ 12.7-13.3 kPa) th O 2 atur tialmo t 97 % and th h u ti n f thbindin ca a it f th b
lJrItritJ/pt¥Potient examples%mmllgutilizationof 0l -binding(Opacity. pll11eoloodCIrculation rt'~r~s%13A. YOIJIJD pallen" oro/dpalleril after O~T971009524IValue 10 be acll/ered by Ozl1Tstatus ofhosts ol'ffnst'CqaTC/,y ~ 'f)'n¢1290 23111098796;mporary reduction ilPOz-tTt f¥ 11-(m>1til Ine21-hrCfflf tina'lIIrougjlstressful p-taSSfS 1j95~~-~- ......----948. Palifnl inold a~ -1-(Expected ~vel for 72,ors) 93ltmporary redaction inPOz-tT/ or 1(/evtl in the2¥hr Qde, oaf thlVl.ig/Jsiressful processes 1)So.?~f6reaf dotget': M7 reserves)- - 8590858075605522--- -t- ----1-\70 20POrtrt.651513Rtdudlon inclirulotiJn ~ryt>sStatus of hOsts defen5/' capacityseverely redllcedlbily lileno longer frft fromph]Simlcom{iointshcrtased circulation riskNisIfofdomage to0tyJIlS through sIroin(cardiac inforc/ion elc. )Insufficiency at rest(11ftr!Sf, tlffJk~s)5010.. Rasa/1M/. Pulse mrmal680457.. Ibsa/levrl Pulse increased7573mixed vallJf 2 )40 POrven 0(normal COst)Fig. 46 Quantitative representation of the drastic reduction of the dangers of stressful events in older personsthrough permanent increase of the utilization coefficient 11 of the O 2 binding capacity of the blood. Guiding values 21 Assumption on the basis in our measurements of the reduction in P02 or 11-level during stressful events of very-artdifferent kinds.2 In subjects with a long-term very low P0 2- t (~
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