Skip to main content

2019 | OriginalPaper | Buchkapitel

33. Physiologie der mittleren, großen und extremen Höhen

verfasst von : Univ-Prof. Dr. med. W. Domej, Univ.-Prof. Dr. i.R. G. Schwaberger

Erschienen in: Alpin- und Höhenmedizin

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Alpinistik und damit verbundene unterschiedliche Belastungsprofile stellen unter den atmosphärischen sowie klimatischen Umgebungsbedingungen eine besondere Herausforderung an das respiratorische System dar. Um der Gewebehypoxie unter Höhenbedingungen erfolgreich zu begegnen, bedarf es eines komplexen Zusammenspiels einer Reihe physiologischer regulativer Mechanismen. Eine ausreichende Funktion peripherer Chemorezeptoren (Hypoxiesensing/Glomus caroticum und Glomus aorticum) stellt dabei die Basis für eine adäquate ventilatorische Hypoxieantwort („hypoxic ventilatory response“ [HVR]) in der Höhe dar. Die Fähigkeit zu alveolärer Hyperventilation ist sehr individuell und entspricht vermutlich einer angeborenen Eigenschaft zur Hypoxieanpassung. Eine hohe HVR ist in mittleren und großen Höhen von Vorteil, in extremen Höhen führt diese jedoch zu einem rasch progressiv abnehmenden Effizienzgrad der Atmung. Die respiratorische Funktion in großen und extremen Höhen stellt letztendlich den allein leistungslimitierenden Faktor gegenüber der Kreislauflimitierung auf Normalhöhe dar.
Literatur
Zurück zum Zitat Astin TW, Penman RWB (1967) Airways obstruction due to hypoxemia in patients with chronic lung disease. Am Rev Resp Dis 95(4):567–575 Astin TW, Penman RWB (1967) Airways obstruction due to hypoxemia in patients with chronic lung disease. Am Rev Resp Dis 95(4):567–575
Zurück zum Zitat Astrom K, Cohen JE, Willett-Brozick JE, Aston CE, Baysal BE (2003) Altitude is a phenotypic modifier in hereditary paraganglioma type 1: evidence for an oxygensensing defect. Hum Genet 113(3): 228–237 Astrom K, Cohen JE, Willett-Brozick JE, Aston CE, Baysal BE (2003) Altitude is a phenotypic modifier in hereditary paraganglioma type 1: evidence for an oxygensensing defect. Hum Genet 113(3): 228–237
Zurück zum Zitat Balaban DY, Duffin J, Preiss D, Mardimae A, Vesely A, Stessarev M, Zubieta-Calleja GR, Greene ER, Macleod DB, Fisher JA (2013) The in-vivo oxyhaemoglobin dissociation curve at sea level and high altitude. Respir Physiol Neurobiol 186(1):45–52CrossRef Balaban DY, Duffin J, Preiss D, Mardimae A, Vesely A, Stessarev M, Zubieta-Calleja GR, Greene ER, Macleod DB, Fisher JA (2013) The in-vivo oxyhaemoglobin dissociation curve at sea level and high altitude. Respir Physiol Neurobiol 186(1):45–52CrossRef
Zurück zum Zitat Buskirk ER, Kollas J, Akers RF, Prokop EK, Reategui EP (1967) Maximum performance at altitude and return from altitude in conditioned runners. J Appl Physiol 23:259–266 Buskirk ER, Kollas J, Akers RF, Prokop EK, Reategui EP (1967) Maximum performance at altitude and return from altitude in conditioned runners. J Appl Physiol 23:259–266
Zurück zum Zitat Chen J, He L, Dinger B, Stensaas L, Fidone S (2002) Role of endothelin and endothelin A-type receptor in adaptation of the carotid body to chronic hypoxia. Am J Physiol Lung Cell Mol Physiol 282(6):L1314–1323CrossRef Chen J, He L, Dinger B, Stensaas L, Fidone S (2002) Role of endothelin and endothelin A-type receptor in adaptation of the carotid body to chronic hypoxia. Am J Physiol Lung Cell Mol Physiol 282(6):L1314–1323CrossRef
Zurück zum Zitat Chen J, He L, Liu X, Dinger B, Stensaas L, Fidone S (2007) Effect of endothelin receptor antagonist bosentan on chronic hypoxia-induced morphological and physiological changes in rat carotid body. Am J Physiol Lung Cell Mol Physiol 292(5):L1257–1262CrossRef Chen J, He L, Liu X, Dinger B, Stensaas L, Fidone S (2007) Effect of endothelin receptor antagonist bosentan on chronic hypoxia-induced morphological and physiological changes in rat carotid body. Am J Physiol Lung Cell Mol Physiol 292(5):L1257–1262CrossRef
Zurück zum Zitat Coe C, Pride NB (1993) Effects of correcting arterial hypoxaemia and respiratory resistance in patients with chronic obstructive pulmonary disease. Clin Sci 84(3):325–329CrossRef Coe C, Pride NB (1993) Effects of correcting arterial hypoxaemia and respiratory resistance in patients with chronic obstructive pulmonary disease. Clin Sci 84(3):325–329CrossRef
Zurück zum Zitat Cogo A, Legnani D, Allegra L (1997) Respiratory function at different altitudes. Respiration 64(6):416–421CrossRef Cogo A, Legnani D, Allegra L (1997) Respiratory function at different altitudes. Respiration 64(6):416–421CrossRef
Zurück zum Zitat Domej W, Schwaberger G, Trapp M et al (2010) Carotid body, O2-reception and paraganglioma at high altitude. In: Sumann G, Schobersberger W, Burtscher M (Hrsg) Alpinmedizinisches Jahrbuch 13. Österreichische Gesellschaft für Alpin- und Höhenmedizin, Innsbruck, S 105–114 Domej W, Schwaberger G, Trapp M et al (2010) Carotid body, O2-reception and paraganglioma at high altitude. In: Sumann G, Schobersberger W, Burtscher M (Hrsg) Alpinmedizinisches Jahrbuch 13. Österreichische Gesellschaft für Alpin- und Höhenmedizin, Innsbruck, S 105–114
Zurück zum Zitat Fowles RE, Hultgren HN (1983) Left ventricular function at high altitude examined by systolic time intervals and M-mode echocardiography. Am J Cardiol 52(7):862–866CrossRef Fowles RE, Hultgren HN (1983) Left ventricular function at high altitude examined by systolic time intervals and M-mode echocardiography. Am J Cardiol 52(7):862–866CrossRef
Zurück zum Zitat Giardina B, Mosca D, De Rosa MC (2004) The Bohr effect of haemoglobin in vertebrates: an example of molecular adaptation to different physiological requirements. Acta Physiol Scand 182(3):229–244 Giardina B, Mosca D, De Rosa MC (2004) The Bohr effect of haemoglobin in vertebrates: an example of molecular adaptation to different physiological requirements. Acta Physiol Scand 182(3):229–244
Zurück zum Zitat Goldenberg F, Richalet JP, Onnen I, Antezana AM (1992) Sleep apneas and high altitude newcomers. Int J Sports Med 13 (Suppl 1):S34–36CrossRef Goldenberg F, Richalet JP, Onnen I, Antezana AM (1992) Sleep apneas and high altitude newcomers. Int J Sports Med 13 (Suppl 1):S34–36CrossRef
Zurück zum Zitat Grocott MP, Martin DS, Levett DZ, McMorrow R, Windsor J, Montgomery HE, Caudwell Xtreme Everest Research Group (2009) Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med 360(2):140–149CrossRef Grocott MP, Martin DS, Levett DZ, McMorrow R, Windsor J, Montgomery HE, Caudwell Xtreme Everest Research Group (2009) Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med 360(2):140–149CrossRef
Zurück zum Zitat Hartmann B, Unger M, Debelic M, Hilpert P (1974) Blutgaswerte und Atemwegswiderstand bei Gesunden und Patienten mit obstruktiven Atemwegserkrankungen vor und nach Höhenadaptation. Respiration 31(1):7–20CrossRef Hartmann B, Unger M, Debelic M, Hilpert P (1974) Blutgaswerte und Atemwegswiderstand bei Gesunden und Patienten mit obstruktiven Atemwegserkrankungen vor und nach Höhenadaptation. Respiration 31(1):7–20CrossRef
Zurück zum Zitat He L, Chen J, Dinger B, Stensaas L, Fidone S (2006) Effect of chronic hypoxia on prurinergic synaptic transmission in rat carotid body. J Appl Physiol 100(1):157–162CrossRef He L, Chen J, Dinger B, Stensaas L, Fidone S (2006) Effect of chronic hypoxia on prurinergic synaptic transmission in rat carotid body. J Appl Physiol 100(1):157–162CrossRef
Zurück zum Zitat Heath D, Williams DR (1989) High-altitude medicine and pathology. Butterworths, London, S 35 Heath D, Williams DR (1989) High-altitude medicine and pathology. Butterworths, London, S 35
Zurück zum Zitat Heincke K, Prommer N, Cajigal J (2003) Long-term exposure to intermittent hypoxia results in increased hemoglobin mass, reduced plasma volume, and elevated plasma levels in man. Eur J Appl Physiol 88(6):535–555CrossRef Heincke K, Prommer N, Cajigal J (2003) Long-term exposure to intermittent hypoxia results in increased hemoglobin mass, reduced plasma volume, and elevated plasma levels in man. Eur J Appl Physiol 88(6):535–555CrossRef
Zurück zum Zitat Hess W (1987) Affinity of oxygen for hemoglobin – it’s significance under physiological and pathological conditions. Anaesthesist 36(9):455–467 Hess W (1987) Affinity of oxygen for hemoglobin – it’s significance under physiological and pathological conditions. Anaesthesist 36(9):455–467
Zurück zum Zitat Hildebrandt W, Alexander S, Bärtsch P, Draöge W (2002) Effect of N-acetyl-cysteine on the hypoxic ventilarory response and erythropoetin production: linkage between plasma thiol redox state and O2-chemosensitivity. Blood 99(5):1552–1556CrossRef Hildebrandt W, Alexander S, Bärtsch P, Draöge W (2002) Effect of N-acetyl-cysteine on the hypoxic ventilarory response and erythropoetin production: linkage between plasma thiol redox state and O2-chemosensitivity. Blood 99(5):1552–1556CrossRef
Zurück zum Zitat Jaeger JJ, Sylvester JT, Cymermann A, Berberich JJ, Denniston JC, Maher JT (1979) Evidence for increased intrathoracic fluid volume in man of high altitude. J Appl Physiol 47(4):670–676CrossRef Jaeger JJ, Sylvester JT, Cymermann A, Berberich JJ, Denniston JC, Maher JT (1979) Evidence for increased intrathoracic fluid volume in man of high altitude. J Appl Physiol 47(4):670–676CrossRef
Zurück zum Zitat Joseph V, Pequignot JM (2009) Breathing at high altitude. Cell Mol Life Sci 66(22):3565–3573CrossRef Joseph V, Pequignot JM (2009) Breathing at high altitude. Cell Mol Life Sci 66(22):3565–3573CrossRef
Zurück zum Zitat Katayama K, Fujita H, Sato K, Ishida K, Iwasaki K, Miyamura M (2005) Effect of a repeated series of intermittent hypoxic exposures on ventilatory response in humans. High Alt Med Biol 6(1):50–59CrossRef Katayama K, Fujita H, Sato K, Ishida K, Iwasaki K, Miyamura M (2005) Effect of a repeated series of intermittent hypoxic exposures on ventilatory response in humans. High Alt Med Biol 6(1):50–59CrossRef
Zurück zum Zitat Konietzko N, Matthys H (1976) Kardiopulmonale Adaptation an akute Hypoxie. Klin Wochenschr 54(24):1161–1167CrossRef Konietzko N, Matthys H (1976) Kardiopulmonale Adaptation an akute Hypoxie. Klin Wochenschr 54(24):1161–1167CrossRef
Zurück zum Zitat Kwasiborski PJ, Kowalczyk P, Zielinski J, Przybylski J, Cwetsch A (2010) Role of hemoglobin affinity to oxygen in adaptation to hypoxemia. Pol Merkur Lekarski 28(166):260–264 Kwasiborski PJ, Kowalczyk P, Zielinski J, Przybylski J, Cwetsch A (2010) Role of hemoglobin affinity to oxygen in adaptation to hypoxemia. Pol Merkur Lekarski 28(166):260–264
Zurück zum Zitat Levitzky MG (1998) Pulmonary physiology, 4. Aufl. McGraw-Hill, New York, S 232–238 Levitzky MG (1998) Pulmonary physiology, 4. Aufl. McGraw-Hill, New York, S 232–238
Zurück zum Zitat Lopez-Barneo J, Lopez-Lopez JR, Urena J, Gonzalez C (1988) Chemotransduction in the carotid body: K+ current modulated by pO2 in type I chemoreceptor cells. Science 241(4865):580–582CrossRef Lopez-Barneo J, Lopez-Lopez JR, Urena J, Gonzalez C (1988) Chemotransduction in the carotid body: K+ current modulated by pO2 in type I chemoreceptor cells. Science 241(4865):580–582CrossRef
Zurück zum Zitat Mairbäurl H, Humpeler E, Schwaberger G, Pessenhofer H (1983) Training-dependent changes of red cell density and erythrocytic oxygen transport. J Appl Physiol Respir Environ Exer Physiol 55(5): 1403–1407CrossRef Mairbäurl H, Humpeler E, Schwaberger G, Pessenhofer H (1983) Training-dependent changes of red cell density and erythrocytic oxygen transport. J Appl Physiol Respir Environ Exer Physiol 55(5): 1403–1407CrossRef
Zurück zum Zitat Marugg D (1995) Lung problems in acute to subacute exposure to medium altitudes. Praxis (Bern 1994): 84(40):1101–1107 Marugg D (1995) Lung problems in acute to subacute exposure to medium altitudes. Praxis (Bern 1994): 84(40):1101–1107
Zurück zum Zitat Mazzeo RS, Wolfel EE, Butterfield GE, Reeves JT (1994) Sympathetic response during 21 days at high altitude (4,300 m) as determined by urinary and arterial catecholamines. Metabolism 43(40):1226–1232CrossRef Mazzeo RS, Wolfel EE, Butterfield GE, Reeves JT (1994) Sympathetic response during 21 days at high altitude (4,300 m) as determined by urinary and arterial catecholamines. Metabolism 43(40):1226–1232CrossRef
Zurück zum Zitat Mirrakhimov MM, Kalko TF (1988) Peripheral chemoreceptors and human adaptation to high altitude. Biomed Biochim Acta 47(1):89–91 Mirrakhimov MM, Kalko TF (1988) Peripheral chemoreceptors and human adaptation to high altitude. Biomed Biochim Acta 47(1):89–91
Zurück zum Zitat Monod J, Wyman J, Changeux J (1965) On the nature of allosteric transitions: a plausible model. J Mol Biol 12:88–118CrossRef Monod J, Wyman J, Changeux J (1965) On the nature of allosteric transitions: a plausible model. J Mol Biol 12:88–118CrossRef
Zurück zum Zitat Netzer N, Schuschnik M, Matthys H, Miles L, Steinacker J, Decker MJ, Lehmann M (1997) Sleep and respiration at an altitude of 6400 m (Aconcagua, Argentina). Pneumol 51 (Suppl 3):729–735 Netzer N, Schuschnik M, Matthys H, Miles L, Steinacker J, Decker MJ, Lehmann M (1997) Sleep and respiration at an altitude of 6400 m (Aconcagua, Argentina). Pneumol 51 (Suppl 3):729–735
Zurück zum Zitat Jones NC (1980) Blood gases and acid-base physiology, 2. Aufl. Thieme, New York, S 38 Jones NC (1980) Blood gases and acid-base physiology, 2. Aufl. Thieme, New York, S 38
Zurück zum Zitat Pugh LG (1964) Blood volume and hemoglobin concentration at altitudes above 18,000 ft. (5.500 m). J Physiol 170:344–354CrossRef Pugh LG (1964) Blood volume and hemoglobin concentration at altitudes above 18,000 ft. (5.500 m). J Physiol 170:344–354CrossRef
Zurück zum Zitat Rahn H, Hammond D (1951) Vital capacity at reduced barometric pressure. J Appl Physiol 4(9):715–724CrossRef Rahn H, Hammond D (1951) Vital capacity at reduced barometric pressure. J Appl Physiol 4(9):715–724CrossRef
Zurück zum Zitat Ramirez G, Bittle PA, Rosen R, Rabb H, Pineda D (1999) High altitude living: genetic and environmental adaptation. Aviat Space Environ Med 70(1):73–81 Ramirez G, Bittle PA, Rosen R, Rabb H, Pineda D (1999) High altitude living: genetic and environmental adaptation. Aviat Space Environ Med 70(1):73–81
Zurück zum Zitat Richalet JP, Gratadour P, Robach P, Pham I, Déchaux M, Joncquiert-Latarjet A (2005) Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension. Am J Respir Crit Care Med 171(3): 275–281CrossRef Richalet JP, Gratadour P, Robach P, Pham I, Déchaux M, Joncquiert-Latarjet A (2005) Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension. Am J Respir Crit Care Med 171(3): 275–281CrossRef
Zurück zum Zitat Roeggla G, Roeggla M, Wagner A, Laggner AN (1995) Poor ventilatory response to mild hypoxia may inhibit acclimatization at moderate altitude in elderly patients after carotid surgery. Br J Sport Med 29(2):110–112CrossRef Roeggla G, Roeggla M, Wagner A, Laggner AN (1995) Poor ventilatory response to mild hypoxia may inhibit acclimatization at moderate altitude in elderly patients after carotid surgery. Br J Sport Med 29(2):110–112CrossRef
Zurück zum Zitat Schmidt W (2002) Effects of intermittent exposure to high altitude on blood volume and erythropoetic activity. High Alt Med Biol 3:167–176CrossRef Schmidt W (2002) Effects of intermittent exposure to high altitude on blood volume and erythropoetic activity. High Alt Med Biol 3:167–176CrossRef
Zurück zum Zitat Schmidt-Kessen W, Plehn I (1965) Die Erythropoese beim Aufenthalt im Mittelgebirge. Med Welt 34:102–105 Schmidt-Kessen W, Plehn I (1965) Die Erythropoese beim Aufenthalt im Mittelgebirge. Med Welt 34:102–105
Zurück zum Zitat Schoene RB, Lahiri S, Hackett PH (1984) Relationship of hypoxic ventilatory response to exercise performance on Mount Everest. J Appl Physiol 56(6):1478–1483CrossRef Schoene RB, Lahiri S, Hackett PH (1984) Relationship of hypoxic ventilatory response to exercise performance on Mount Everest. J Appl Physiol 56(6):1478–1483CrossRef
Zurück zum Zitat Schoene RB (2001) Limits of lung function at high altitude. J Exp Biol 204(Pt18):3124–3127 Schoene RB (2001) Limits of lung function at high altitude. J Exp Biol 204(Pt18):3124–3127
Zurück zum Zitat Schwaberger G, Pessenhofer H, Mairbäurl H, Humpeler E (1983) Das Verhalten der die Sauerstoffaffinität des Hämoglobins bestimmenden Parameter bei körperlicher Belastung. In: Heck H, Hollmann W, Liesen H, Rost R (Hrsg) Sport: Leistung und Gesundheit. Dtsch. Ärzte-Verlag, Köln, S 29–33 Schwaberger G, Pessenhofer H, Mairbäurl H, Humpeler E (1983) Das Verhalten der die Sauerstoffaffinität des Hämoglobins bestimmenden Parameter bei körperlicher Belastung. In: Heck H, Hollmann W, Liesen H, Rost R (Hrsg) Sport: Leistung und Gesundheit. Dtsch. Ärzte-Verlag, Köln, S 29–33
Zurück zum Zitat Stea A, Jackson A, Macintyre L, Nurse CA (1995) Long-term modulation of inward currents in O2 chemoreceptors by chronic hypoxia and cyclic AMP in vitro. J Neurosci 15(3Pt2):2192–2202CrossRef Stea A, Jackson A, Macintyre L, Nurse CA (1995) Long-term modulation of inward currents in O2 chemoreceptors by chronic hypoxia and cyclic AMP in vitro. J Neurosci 15(3Pt2):2192–2202CrossRef
Zurück zum Zitat Storz JF, Moriyama H (2008) Mechanisms of hemoglobin adaptation to high altitude hypoxia. High Alt Med Biol 9(2):148–157CrossRef Storz JF, Moriyama H (2008) Mechanisms of hemoglobin adaptation to high altitude hypoxia. High Alt Med Biol 9(2):148–157CrossRef
Zurück zum Zitat Sutton JR, Houston CS, Coates G (1988a) Hypoxia: the tolerable limits. Benekmark press, Indianapolis Sutton JR, Houston CS, Coates G (1988a) Hypoxia: the tolerable limits. Benekmark press, Indianapolis
Zurück zum Zitat Sutton JR, Reeves JT, Wagner PD (1988b) Operation Everest II: oxygen transport during excercise at extreme simulated altitude. J Appl Physiol 64(4):1309–1321CrossRef Sutton JR, Reeves JT, Wagner PD (1988b) Operation Everest II: oxygen transport during excercise at extreme simulated altitude. J Appl Physiol 64(4):1309–1321CrossRef
Zurück zum Zitat Tenney SM, Rahn H, Stroud RC, Mithoefer JC (1953) Adaptation to high altitude: changes in lung volume during the first seven days at Mt. Evans, Colorado. J Appl Physiol 5(10):607–613CrossRef Tenney SM, Rahn H, Stroud RC, Mithoefer JC (1953) Adaptation to high altitude: changes in lung volume during the first seven days at Mt. Evans, Colorado. J Appl Physiol 5(10):607–613CrossRef
Zurück zum Zitat Wagner PD (2000) Reduced maximal cardiac output at altitude-mechanisms and significance. Respir Physiol 120(1):1–11CrossRef Wagner PD (2000) Reduced maximal cardiac output at altitude-mechanisms and significance. Respir Physiol 120(1):1–11CrossRef
Zurück zum Zitat Ward MP, Milledge JS, West JB (1989) High altitude medicine and physiology. Chapman and Hall Ltd, Philadelphia Ward MP, Milledge JS, West JB (1989) High altitude medicine and physiology. Chapman and Hall Ltd, Philadelphia
Zurück zum Zitat Weber RE (2007) High-altitude adaptations on vertebrate hemoglobine. Respir Physiol Neurobiol 158(2/3):132–142CrossRef Weber RE (2007) High-altitude adaptations on vertebrate hemoglobine. Respir Physiol Neurobiol 158(2/3):132–142CrossRef
Zurück zum Zitat West JB, Hackett PH, Maret K (1983) Pulmonary gas exchange on the summit of Mount Everest. J Appl Physiol 55(3):678–687CrossRef West JB, Hackett PH, Maret K (1983) Pulmonary gas exchange on the summit of Mount Everest. J Appl Physiol 55(3):678–687CrossRef
Zurück zum Zitat West JB, Peters R Jr, Aksnes G, Maret KH, Milledge JS, Schoene RB (1986) Nocturnal periodic breathing at altitudes of 6300 and 8050 m. J Appl Physiol 61(1):280–287CrossRef West JB, Peters R Jr, Aksnes G, Maret KH, Milledge JS, Schoene RB (1986) Nocturnal periodic breathing at altitudes of 6300 and 8050 m. J Appl Physiol 61(1):280–287CrossRef
Zurück zum Zitat Wilkinson KA, Huey K, Dinger B, He L, Fidone S, Powell FL (2010) Chronic hypoxia increases the gain of the hypoxic ventilatory response by a mechanism in the central nervous system. J Appl Physiol 109(2):424–430CrossRef Wilkinson KA, Huey K, Dinger B, He L, Fidone S, Powell FL (2010) Chronic hypoxia increases the gain of the hypoxic ventilatory response by a mechanism in the central nervous system. J Appl Physiol 109(2):424–430CrossRef
Zurück zum Zitat Wolf C, Staudenherz A, Roggla G, Waldor T (1997) Potential impact of altitude on lung function. Int Arch Occup Environ Health 69(2):106–108CrossRef Wolf C, Staudenherz A, Roggla G, Waldor T (1997) Potential impact of altitude on lung function. Int Arch Occup Environ Health 69(2):106–108CrossRef
Zurück zum Zitat Zhang M, Zhong H, Vollmer C, Nurse CA (2000) Co-release of ATP and ACh mediates hypoxic signalling at rat carotid body chemoreceptors. J Physiol 525(Pt1):143–158CrossRef Zhang M, Zhong H, Vollmer C, Nurse CA (2000) Co-release of ATP and ACh mediates hypoxic signalling at rat carotid body chemoreceptors. J Physiol 525(Pt1):143–158CrossRef
Metadaten
Titel
Physiologie der mittleren, großen und extremen Höhen
verfasst von
Univ-Prof. Dr. med. W. Domej
Univ.-Prof. Dr. i.R. G. Schwaberger
Copyright-Jahr
2019
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-56396-0_33

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.