呼吸系統(tǒng)呼吸生理respiratory physiology英五

1、Respiratory PhysiologyDr. Youmin Hu: 63846590-776542: jyOffice：Room 413, Building fourthObjectives of RespiratoryPhysiologySection1: Pulmonary Ventilation Section2: Respiratory GasesExchangeSection3: Oxygen and Carbon Dioxide Transport in BloodSection4: Regulation of Respiratory MovementSection1:Pul

2、monary VentilationVentilation: movement of airo and out ofgsI.Drive of Ventilation1. Respiratory Movement-the original driveof pulmonary ventilation(original drive)(Expiration)Expiratory muscles：(Inspiration)Inspiratory muscles:隔肌diaphragm、肋間外肌externalercostals肋間內(nèi)肌 ernalercostals腹肌abdominisabdominal

3、 respiration vs thoracic respirationEupnea(平靜呼吸） vs forced breathingBreathing rate is 10-20 breaths / minute at rest（Eupnea）, 40 - 45 atadults （ forced breathing）um exercise inInspiration uses external ercostals and diaphragmExpiration is passive at rest （Eupnea）, but usesernalercostals andabdominal

4、s during severe respiratory load（ forced breathing）2.rapulmonary Prere and Its ChangesDuring Respiration (direct drive)Eupnea:inspiration: -2 -1mmHgexpiration:1 2mmHgDeep breathing:inspiration: -100 -30mmHgexpiration:60 140mmHgArtifil RespirationCPR(cardiopulmonaryresusciion)s of Pulmonary Ventilati

5、on ：ProRespiratory muscle contraction& relaxation(original drive)Expan& recoil of the thoraxpleuralg expand & recoilrapulmonary prere changes(direct drive)Air moveso & out ofgs3.rapleural negative Pre(維持肺擴張狀態(tài)的重要條件)rerapleural prereis the prere of thefluidbethe thin spacen thegpleura and the chestwal

6、l pleura.Its always negativepleuralprererapleural negative prereEnd quiet inspiration: -5 -10mmHgEnd quiet expiration: -3 -5mmHg The Formation ofrapleural negative Prerenatural volume of chest cagethe fluid in pleural space(兩層胸膜間漿液的分子凝聚力)g volumerapleural pre= alveolar pre recoil force of= - 肺回縮力rer

7、e - g Physiologic Significance ofrapleuralnegative Prere Stretches (inflates) thegs Benefits to the return of venousblood and lymphp(氣胸)othoraxII.Including:of Ventilation(彈性阻力)Elastic70%(非彈性阻力) 30%-elastic（R）順應(yīng)性）ElasticCompliance（C,C=1/RC=V/ P (L/cmH2O)distensibility (擴張性)1.gs ElasticRL =gs recoil f

8、orcome from：1.1gs Elasticthe elastic forof theg tie (1/3)surface tenof the fluidt lines the inside wallof the alveoli (2/3)Surface TenLaw of Laplace: Prere in alveoli isdirectly proportional tosurface ten; andAir Flowinversely proportional toradius of alveoli. Prere in smalleralveolus would be great

9、ern in larger alveolus, ifExpandCollapsesurface tensame in both.were thePulmonary Surfactant(肺表面活性物質(zhì),PS)Phospholiproduced by alveolar type II cells肺泡型細(xì)胞及呼吸性細(xì)支氣管的Clara細(xì)胞和DPPC（dipalmitoylphosphatidylcholine，二棕櫚酰卵磷脂）SP (surfactant-assoprotein)（SP-A、SP-B、SP-C、SP-D）PS: 脂類和蛋白混合物tedSurfactant prevents alve

10、olar collapse Physiology Importance of PSPS decreaserface tenwhich:increases pulmonary compliance , reduinspiratory Rredumatendency for alveoli to collapseains the dryness of the alveoli, preventsthe edema of the alveoli缺陷新生兒呼吸窘迫綜合征（infant respiratory distress syndrome）或稱透明膜病（hyaline membrane diseas

11、e）1.2gs Compliance( CL )Change ing volume per change intranspulmonary prere.100 x more distensibleCL (0.2L/cmH2O )n a balloon1）Specific Compliance (比順應(yīng)性, CL)the compliance per unit volumeCL = pulmonary compliance/residual volume2） Sic Compliance(靜態(tài)順應(yīng)性)2. Thoracic elastic R. and Cchw.A：gcapacity=67%T

12、LC(totalgcapacity)向外， 吸氣的動力向內(nèi)，吸氣的阻力無g elastic R： opes inspirationThoracic elastic R： aids or opes inspiration-elastic(非彈性阻力):Airwayis the80%-90%Airway of air(氣道阻力 )to flowhe airways and is due to :ernal friction betn gas molecules friction betngas molecules and thewalls of the airways1.Distribution

13、of Airway正常時，主要來自大氣道；但在疾病情況下，主要是小氣道阻力增大，細(xì)支氣管對氣道阻力影響很大。AirwaycmH2O/(L/s)Airway locationNormal adultCOPD suffererPharynx (咽-喉部)0.60.6Diameter 2mm Airway0.60.9Diameter 2mm Airway0.33.5Total airway R1.55.02. Contributory Factors of Airwayair velocity(氣流速度)air current forms (氣流形式)mainly airway diameter(氣

14、道管徑)Airway Radius or diameter is KEY. radius by 1/2 by 16FOLD - think bronchodilator here!Poiseuilles Law3. Affecting Factors of Airway Diameter（1）跨壁壓 Transpulmonary Prere肺實質(zhì)對氣道壁的外向放射狀牽引Neural control of airway smooth muscleVagal efferentsAch,M receptor, constrictionSymapathetic efferentsNE,2 adrene

15、rgic receptor,relaxation-cholinergic)NANC nerves (-adrenergic,O bronchodiliInhibitory release VI（4）Local factorsionProstaglandins， histamineQ: 為何支氣管哮喘等慢性阻塞性肺病患者呼氣比吸氣更為？III. Assessment of the PulmonaryVentilationSpirometer（肺量計）Pulmonary Volume(肺容積)Tidal volume，TV (潮氣量) ，400-600 mlInspiratory reserve

16、volume, IRV (補吸氣量), 1.5-2L 3）Expiratory reserve volume, ERV (補呼氣量), 900-1200 ml 4）Residual volume, RV (殘氣量), 1-1.5L，遠大于肺的自然容積（約500ml）。2. Pulmonary Capacity (肺容量)Inspiratory capacity, IC （深吸氣量）=潮氣量+補吸氣量Functional residual capacity，F(xiàn)RC (功能殘氣量) , 2300mlVital capacity，VC (肺活量),3.5(M)/2.5 L(F)4) Totalg c

17、apacity, TLC (肺總量) ,5(M)/3.5L(F)Dynamicg VolumeFVC-forced vital capacity (用力肺活量or時間肺活量)FEV-forced expiratory volumn (用力呼氣量)意義：反映肺通氣阻力的變化，F(xiàn)EV1/FVC80%評價肺通能的較好指標(biāo)?；?COPD ,asthmaFibrosis(3. Minute and Alveolar VentilationPulmonary ventilation=tidal volumebreathing rate, 6-9 Ltary ventilation(最大隨意通氣量)al v

18、oup to 150L/min通氣貯量百分比Alveolar ventilation=(tidal volume-dead space)rateanatomical dead spacealveolar dead spacePhysiologicaldead spaceMinute and Alveolar VentilationMinute ventilation: Total amount of air moved o and out of respiratory system per minuteRespiratory rate or frequency: Number of breaths taken per minuteAnatomic dead space: Part of respiratory system where gas exchange does not take placeAlveolar ventilation: How much air per minute enters the parts of the respir