肺通气2013.ppt
Chapter 7 Respiration,雾 霾,PM 2.5,Gas exchange in the lungs,Outline - Respiration,Ventilation,O2,CO2,Gas exchange In tissue,External respiration 1,Cellular respiration 3,Gas Transportation 2,O2,CO2,Section Ventilation Section Gas Exchange in the lungs in the tissue Section Gas Transportation O2 CO2 Section Regulation of Respiration,Section Ventilation,Airway Review Mechanism of ventilation 1) Power : pressure gradient 2) Intrapulmonary pressure (alveolar pressure) 3) Intrapleural pressure: negative 4) Resistance Lung capacity & ventilatory volume,The first exchange in respiratory physiology is Ventilation, the movement of air between the environment and the alveoli.,Upper,Lower,Functions of the Airway Warm and humidify the air Filter and clean the air (PM 2.5) Regulate airway resistance 2 receptor Airway smooth muscle relax,QSM,Question:,1. Power of Ventilation（肺通气动力）,肺泡压力与大气压力之差,呼吸运动,Q,2 Intrapulmonary pressure ( 肺内压 ),= Alveolar pressure,3. Intrapleural pressure (胸膜腔内压),肺脏层和壁层间的潜在腔隙，内有浆液,成因： 1.胸膜腔是一密闭的潜在腔隙前提 2.胸廓固有容积肺固有容积使肺处于被牵张状态 3.肺的弹性回缩力负压形成的直接动因,气胸（Pneumothorax）,肺弹性回缩力越大, 胸膜腔内负压越大,气胸（Pneumothorax）,吸气肌收缩 胸廓扩大 肺扩大 吸气肌舒张 吸气 肺内压大气压 呼气,Ventilation,4. Resistance of ventilation（肺通气阻力）,肺通气阻力,弹性阻力 70,非弹性阻力 30,胸廓,肺,弹性回缩力（弹力纤维）,肺泡表面张力（2/3）,气道阻力 (90%),惯性阻力,黏滞阻力,Lung compliance may change in disease state,液-气交界面使液体表面积尽量减小,Surface tension,Alveolus,半径越小回缩力越大,Surfactant：以单分子层覆于 肺泡液体分子表面,分泌：肺泡型上皮细胞 成分：二棕榈酰卵磷脂(DPPC) 作用：降低肺泡表面张力 稳定肺泡容积 降低肺回缩力/弹性阻力 防止肺水肿,P2Tr,r,Surfactant：以单分子层覆于 肺泡液体分子表面,分泌：肺泡型上皮细胞 成分：二棕榈酰卵磷脂(DPPC) 作用：降低肺泡表面张力 稳定肺泡容积 降低肺回缩力/弹性阻力 防止肺水肿,肺通气阻力,弹性阻力 70,非弹性阻力 30,胸廓,肺,弹性回缩力,惯性阻力,黏滞阻力,顺应性（compliance） C = V/P 外力作用下中空弹性组织扩张之难易 （= 1 / 弹性阻力）,Lung compliance may change in disease state,肺泡表面张力（2/3）,Airway Resistance,RA L/r4,Airway diameter is the primary determinant of RA,Q,The spirometer recording the lung volumes,5. Indices of Ventilation Function,Pulmonary Capacity Indices,潮气量 (Tidal volume) 补吸气量 (Inspiratory reserve volume) 补呼气量 (Expiratory reserve volume) 功能余气量 (Functional residual capacity) 余气量(Residual volume) 肺活量(Vital volume) 用力肺活量(Forced vital volume) 肺总容量(Tatal lung capacity),最大吸气后，用力作最快速度呼气，在一定时间内所呼出气量占肺活量的百分比。正常人第 l、2、3秒末分别为80、95、99。,每分通气量：每分钟吸入或呼出的气体总量 = VT · f （7 vs 70 L/min） 解剖无效腔：从鼻至终末支气管，气体不与血液交换 (VD: 150 ml) 每分肺泡通气量 = (VT -VD ) · f,深慢,浅快,Ventilation Volume,每分通气量 每分肺泡通气量* Minute ventilation volume Minute alveolar ventilation volume VL = VT · f VA = (VT -VD ) · f,深慢呼吸比浅快呼吸通气效率高,(VTf 2VDf) 3200,Airway Mechanism of ventilation 1) Power : pressure gradient 2) Alveolar pressure & Intrapleural pressure: negative 3) Resistance: Elastic & Non-elastic R Compliance, Surface tension, Surfactant, Airway resistance Lung capacity & ventilatory volume,Summary,Outline,Ventilation,吸气肌,呼气肌,肋间外肌,膈肌,腹壁肌,肋间内肌,斜角肌,胸锁乳突肌,呼 吸 肌,膈肌：容积增加占45，最重要的吸气肌,上下径,腹式呼吸,横隔的上下运动,(男性),肋间外肌,前后径,左右径,胸式呼吸,肋骨上抬、胸骨前上移,(女性),胸膜腔 (Intrapleural pressure),肺脏层和壁层间的潜在腔隙，内有浆液,
