Chapter7BloodCirculation血液循环PPT文档.ppt

Heart(心脏):Muscle-pump,dynamic organ.(肌肉泵,动力器官)Artery(动脉):The vessel which can guide blood to leave heart and flow into tissues.(引导血液离开心脏流向各组织器官的管道).exchange.(进行物质交换的场所),Vein(静脉):The vessel which can guide blood to return heart.(引导血液回心的管道)Capillary(毛细血管):The place of substance,Section 2 The Structures and Functions of Myocardium(心肌的结构与机能特性),1.Autorhythmicity(自动节律性),Def:The ability of an excitable cell to rhythmically initiate its own action potentials(组织细胞能自动发生节律性兴奋的特性)衡量指标:The frequency of automatic excitation(自动兴奋的频率),2.Functional Synplasm（机能合胞体）,Structure basis:Intercalated disc(闰盘)心肌的机能合体性 The phenomenon of all or none in the myocardial（心肌收缩的“全或无”现象）,3.Specific Conduction System(特殊传导系统),The types of myocardium cell(心肌细胞的类型):(1)Normal myocardium(普通的心肌细胞):工作细胞(非自律细胞),包括心房肌、心室肌,具兴奋性,传导性,收缩性,无自律性,working cardiac cell(non-autorhythmic cell)：include atrial muscle and ventricular muscle,have excitability,conductivity,and contractibility,non-autorhythmicity.,(2)Specific myocardium(特殊分化的心肌细胞):自律细胞和非自律细胞,包括P细胞、浦肯野氏细胞与结区细胞,自律细胞有兴奋性,自律性和传导性,基本无收缩性,具有产生和传导节律性兴奋的能力,Rhythmic cell and non-autorhythmic cell,include P cell and Purkinje cell,have excitability,autorhythmicity and conductivity,no contractibility,also have capacity to produce and conduct rhythmic excitation,Sino-artrial node(S-A node,窦房结)Artrio-ventricular node(A-V node,房室结)atrioventricular bundle 0.05m/s and bilateral bundles(房室束及左右束支)2-5m/s Purkinje fiber(浦肯野氏纤维)2-5m/s Fig.7-14 atrioventricular delay(房室延搁)and its significance:,Pacemaker(正常起搏点)：S-A node,right atrium intine wall(窦房结,右心房内壁)Latent pacemaker(潜在起搏点):A kind of autorhythmic tissue which dont express autorhythmicity in normal circumstances.(正常情况下不表现本身自律性的自律组织),Ectopic pacemaker(异位起搏点):The latent pacemaker which can control cardiac excitation and palmus in abnormal circumstances.(异常情况下控制心脏兴奋和跳动的潜在起搏点)Artificial pacemaker(人工起博器),4.The AP of myocardial cell-bioeletricity phenomenon of myocardial cell(心肌细胞的AP-心肌细胞的生物电现象),(1)Different from the skeletal muscle.(不同于骨骼肌)(2)Different types of myocardial cell have different transmembrane potential extent,persistent time,wave forms and mechanism.(不同的心肌细胞，其跨膜电位的幅度、持续 时间、波形、产生机制亦不相同),Mechanism of AP:,0期:去极,钠内流(快通道)1期:快速复极初期,钾通过瞬时性外向钾外流通道外流,膜内电位降至0mv左右2期:缓慢复极期又叫平台期,钙和少量钠通过慢通道的 内流与少量钾外流相持,3期:快速复极末期,膜对钾的通透性 升高,钾外流 膜电位由0mv 降至-90mv4期:静息期 细胞膜的离子转运机能 加强Mechanism:,5.The refractory period of the heart(心脏的不应期),(1)Absolute refractory period&effective refractory period,ARP&ERP(绝对不应期与有效不应期):0-55mv,-60mv,cant generate AP.AP,(2)Relative refractory period,RRP(相对不应期):-60-80mv,threshold intensity(阈强度),can cause AP.(3)Superanormal period,SNP(超常期):-80-90mv,threshold intensity,can cause,Fig.7-16,Significance of Long Time Effective Eefractory Period(有效不应期长的意义):,Premature systole or extrasystole&compensatory pause(期前收缩与代偿间歇)Fig.7-17,6.Electrocardiogram,ECG(心电图),Basic waveform(基本波形):P,QRS,TSignificance:P:QRS:T:P-R period Fig.7-18 7-20,Section 3 The Dynamics Change of Cardiac Cycle(心动周期的力学变化),1.Def.Cardiac cycle(心动周期):The whole cycle of systole and diastole(心脏由收缩到舒张的整个过程),2.The blood ejection process of heart(心脏的射血过程),(1)Period of atrial systole(心房收缩期):end-diastolic volume(心舒末期容积)(2)Period of ventricular systole(心室收缩期)：,Period of isovolumic contraction(等容收缩期):Semilunar valve is still closed,atrioventricular valve is closed(半月瓣仍关,房室瓣关闭),Period of rapid blood ejection(快速射血期):Semilunar valve is opened,ejectingblood(半月瓣开,射血)Period of slow blood ejection(减慢射血期):End-systolic volume(心缩末期容积),(3)Period of Ventricular Diastole(心室舒张期)：Period of isovolumic relaxation(等容舒张期):Semilunar valve is closed,atrioventricular valve is closed(半月瓣关,房室瓣仍关),Period of rapid filling(快速充盈期):Atrioventricular valve is opened.(房室瓣开),Period of reduced filling(减慢充盈期):Fig 7-22,3.Heart Sound(心音),First heart sound(第一心音):The tone is low and long,mostly caused by closing of atrioventricular valve,it is the symbol of cardiac contraction.(音调低而长,主要由于房室瓣关闭引起,标志心室收缩开始),Second heart sound(第二心音):The tone is high and short,mainly caused by the close of semilunar valve,the symbol of cardiac relaxation.(音调高而短,主要由于半月瓣关闭引起,标志心室舒张开始),Section 4 Cardiac Output and Its Regulation(心输出量及其调节),Cardiac output(心输出量):The volume of blood pumped by each ventricle per minute;equal to the stroke work output times the heart rate per minute.(一侧心室每分钟射出的血量),Cardiac Output=Heart RateStroke VolumeCO=HRSV=75 70=5250（ml）,CO(Cardiac output)quiet(安静时)：5L/min movement(运动时)：180-200 150-170 25-30L/min,Cardiac reserve(心力贮备),Maximal output(最大输出量):Maximal volume of blood pumped by each ventricle per minute.(一侧心室每分钟射出的最大血量),Cardiac reserve(心力贮备):The ability that cardiac output increases along with the need of body metabolism.(心输出量随机体代谢需要而增加的能力),Heart rate reserve(心率贮备):2-2.5 times 200 beat/min Stroke volume reserve:140ml 160(ml)15 Reserve of relaxation period 145 70 75 55 Reserve of contraction period 20,(搏出量贮备),(舒张期贮备)15 ml,(收缩期贮备)55-60 ml,1.The Regulation of Heat Rate(心率的调节),Nerve regulation(神经调节):Sympathetic nerve(交感神经)(+)Vagus nerve(迷走神经)(-)Tab.7-2Hormone regulation(激素调节):adrenal hormone 肾上腺素(+),2.Regulation of cardiac output(心搏量的调节),(1)Heterometric autoregulation(异长调节)Cardiac regulation(心脏自身的调节)Cardiac law(心脏定律)Fig 7-29,(2)Homometric Regulation(等长调节)Nerve regulation(神经调节)sympathetic nerve(交感神经)(+)vagus nerve(迷走神经)(-),Hormone regulation(激素调节)adrenal hormone(肾上腺素)(+),thyroid hormone(甲状腺素)(+),Section 5 Physiology of Blood Vessel(血管生理),1.Structures and function characters of various vessels(各类血管的结构与机能特点),一,Artery(动脉),1)Aorta(大动脉)windvessel vessel(弹性贮器血管),Function：buffering high pressure are related to continual flow of blood(缓冲高压与血流的持续流动有关)Elasticity and age(弹性与年龄):,2)Distribution vessel(分配血管)Function:Transfusing blood to organs and tissues(输送血液至器官组织),3)Arteriole(微动脉)Resistance vessel before capillary(Cap前阻力血管)Structure characters:Vessel wall is mainly smooth muscle(SM).(管壁以平滑肌为主.),Function：Regulating peripheral resistance/BP;调节外周阻力/BP calamus is small,and velocity of flow is high;(管径小,流速快),Function：,Controlling local hemoperfusion,blood flow is directly proportional to r4,and relates to continuous flow of blood.(控制局部血液灌流量,血流量与r4成正比 与血流持续有关),Blood pressure fall(血压降落):aorta(主大A)small artery(小A)arteriole(微A),Vein(静脉),Capacitance vessel(容量血管)Function:Contain 60-70%blood(容纳60-70%的血),Capillary(毛细血管)Exchange vessel,Structure and function characters(结构与机能特点):管壁很薄,只有一层内皮细胞和一层很薄的基膜,内皮层可有空隙,孔道等,故通透性很大,血管内的血液与血管外的组织液间能够进行物质交换.,Exchange vessel(交换血管)Function：The place where substances exchange(物质交换的场所),2.Blood Pressure and Its Measuration(血压与血压的测定),BP(血压):,The force exerted by the blood against any unit area of vessel wall(血液对单位面积血管壁的侧压力)Unit(单位):kPa/mmHg,(1)The Mensuration of Blood Pressure(血压的测定),测侧压 直接测定法血压的测定 测终端压 间接测定法,(2)The Forming of Blood Pressure(血压的形成),Basic factors：Enough blood volume in cardiovascular center(心血管内有足够的血量)Ventricular ejection(心室射血)Peripheral resistance(外周阻力),(3)Arterial blood pressure(动脉血压),Systolic pressure(收缩压)When ventricle is contracting,the maximal arterial pressure is called the systolic pressure.(心室收缩时动脉压升到的最高值)Normal(正常值):100-120 mmHg/13.3-16kPa,Diastolic pressure(舒张压)when ventricle is relaxing,the minimal arterial pressure is called diastolic pressure.(心室舒张时动脉压降到的最低值)Normal(正常值):60-80 mmHg/8-10.6 kPaBlood pressure:age,sex and others(血压与年龄,性别及其它),Effect Factors of Arterial Blood Pressure(动脉血压的影响因素),1.Stroke volume(搏出量)2.Heart rate(心率)3.Peripheral resistance(外周阻力)4.Function of elastic reserve of aorta(主 大动脉的弹性贮器作用)5.Proportion of circular volume and vascular volume(循环血量与血管容量的比例),(4)Venous Pressure&Venous Return(静脉血压和静脉回流),VP(V血压),Peripheral VP(外周V压)VP of different organs(各器官V的血压)15-20 mmHg,Central VP(中心V压)VP of main line in right atrium and thoracic cavity(右心房和胸腔内大V的血压)0-12 mmHg V return power=Peripheral VP-Central VP V回流动力=外周V压-中心V压,Systole(心脏收缩)心肌收缩力量 正变(左、右心衰)Gravity and pose(重力与体位)血液重力引起静水压 lie:VP are approximately same in different part.各处V压大致相同 stand:VP are different in different parts,各处V压大不相同,Effect factors of venous return(影响V回流的因素),Gravity and pose(重力与体位)The degree of V engorge is affected by transmura pressure.(V充盈程度受跨壁压的影响大)VP of lower parts are expanded because of the transmura pressure increased,and the blood volume are also increased.(身体低垂部分的V压因跨壁压增大而扩张,容纳血量也增多),Respiratory movement/respiratory pump(呼吸运动/呼吸泵)Inspiration(吸气)(+),Extrusion action of skeletal muscle/muscle pump(骨骼肌的挤压作用/肌泵)Muscle contraction(+)(肌肉收缩),Respiratory pump(呼吸泵)呼气时右房回心血 量减少(左房相反)吸气时右房回心血 量增多(左房相反因为 肺扩张容纳血量增多),3.Microcirculation(微循环),Def:The blood circulation in microangium between arteriole and venule.(微动脉和微静脉之间微血管中的血液循环),(1)The component of microcirculation(微循环的组成)Arteriole(微动脉);Metarteriole(后微动脉);Precapillary sphincter(毛细血管前括约肌);True capillary(真毛细血管);Thoroughfare channel(通血毛细血管);Arteriovenous anastomoses(动-静脉吻合支);Venule(微静脉)Fig 7-38,Arteriole(微动脉):Precapillary resistance vessel;master valve(毛细血管前阻力血管;总闸门)Capillary(毛细血管):Structure characters:Big area,slow velocity,high permeability(面积大,流速慢,通透性大)Fig.7-39 Function:exchange of substancesVenule(微静脉):capacitance vessel(容量血管),(2)The Methods and Mechanisms of Substance Exchange(物质交换的方式和机制),Diffusion(扩散):Concentration(浓度),Distance(距离),Area(面积),Temperature(温度),Molecular weight(分子量),Membranous permeability(膜的通透性等),Filtration and reabsorption(滤过与重吸收),Starling Hypothesis(Starling假说),Power(动力):Effective filtration pressure=(Cap pressure+colloid osmotic pressure of tissue fluid)-(colloid osmotic pressure of blood plasma+lentic pressure of tissue fluid)有效滤过压=（Cap压+组织液胶体渗透压）（血浆胶体渗透压+组织液静水压),Process(过程):Effective filtration pressure of Cap A terminal is positive,and the fluid is filtrated and forms tissue fluid;effective filtration pressure of Cap V terminal is negative,and tissue fluid returns Cap.Cap A端的有效滤过压为正值，液体滤出而成组织液；Cap V端的有效滤过压为负值，组织液回流入Cap。,Filtration and Reabsorption(滤过与重吸收),毛细血管血压 血浆胶体渗透压 组织液静水压 组织液胶体渗透压,+32-21-10+15,+14-29-10+15,动脉端,静脉端,+16,-10,组织液 淋巴液,Effect Factors of Tissue Fluid Forming(组织液生成的影响因素),Cap压 静脉回流受阻,右心衰 Cap压 组织液生成,血浆胶渗压 蛋白尿或肝功 血浆胶渗压 组织液生成,Permeability of Cap(Cap通透性),Permeability(通透性),forming of tissue fluid(组织液生成),burn,allergy(烧伤、过敏),Pinocytosis(胞饮作用),Two dimensional action(双向作用)Exchange of macromolecular protein(大分子蛋白质的交换),4.Lymph circulation(淋巴循环),(1)Component(组成):Lymphatic capillary,lymphatic vessel,lymph node.(毛细淋巴管,淋巴管,淋巴结)Permeability:lymphatic capillary capillary(毛细淋巴管通透性 毛细血管),(2)Effect Factors of Lymph Fluid Forming and Return(影响淋巴液生成与回流的因素)The pressure difference between tissue fluid and lymphatic capillary(组织液与毛细淋巴管内的压力差)Skeletal muscle movement(骨骼肌运动),(3)The Physiological Significance of Lymphatic Return(淋巴回流的生理意义),Regulating the balance of blood volume and tissue fluid volume.(调节血量与组织液量的平衡)Recycling protein of tissue fluid.(对组织液中的蛋白质的回收作用),The transportation of Chyle vessel to fat(乳糜管对脂肪的运输)Defense barrier action of lymph node(淋巴结的防御屏障作用)Macrophage(巨噬细胞)Lymphocyte(淋巴细胞),Section 6 Regulation of Cardiovascular Activity(心血管活动的调节),1.Nervous regulation(神经调节)(1)Cardiovascular innervation(心血管的N支配)Cardiac innervation(心脏的N支配),Cardiac sympathetic nerve and its regulation(心交感N及其作用):,T1-5(NE+1R)different parts of heart(NE+1R)心脏各部分 Function：正性变时变力变传导,Cardiac vagus nerve and its regulation(心迷走N及其作用):,Function：负性变时变力变传导 Vessel innervation(血管的N支配),Dorsal nucleus and ambiguous nucleus of medulla(延髓背核、疑核),(ACh+MR)different parts of heart(ACh+MR)心脏各部分,Vasoconstrictor fiber(缩血管神经纤维):The nerve fiber which can cause contraction of smooth muscle of blood vessel(能引起血管平滑肌收缩的神经纤维)Sympathetic vasoconstrictor nerve(交感缩血管N)：,T1-L2.3,NE+smooth muscle of blood vessel R(NE+血管平滑肌R),Contraction(收缩),Function:Keeping tonic contraction of blood vessel smooth muscle,peripheral resistance is increased,and the organic hemoperfusion is reduced.(维持血管壁平滑肌的紧张性收缩,外周阻力升高,该器官血液灌流量下降),Distribution density(分布密度)：blood vessel of skin blood vessel of skeletal muscle and viscus blood vessel of cardiac muscle and cerebrovascular system(皮肤血管 骨骼肌及内脏血管 心肌血管及脑血管)A V The thinner of the calibre,the higher of the distribution density.(口径愈细，分布密度愈高),Vasodilator fiber(舒血管神经纤维)：,sympathetic ACh.MR vasodilator nerve fiber parasympathetic ACh.MR vasodilator nerve fiber,(交感舒血管NF),(副交感舒血管NF),Vasodilator nerve fiber of spinal dorsal root(脊髓背根舒血管NF)Vasoactive intestinal polypeptide neuron(血管活性肠肽神经元)VIPVIPR,(2)Cardiovascular Center(心血管中枢),Concentrative site of neuron which related with cardiovascular reflex(与心血管反射有关的神经元集中的部位),Spinal cord(脊髓)Primary cardiovascular center(初级心血管中枢)脊髓的胸腰段有支配心脏和血管的交感节前N元，具紧张性活动,Bulb延髓 Basic cardiovascular center(基本心血管中枢),心迷走N元 心迷走紧张心交感N元 心交感紧张交感缩血管N元 交感缩血管紧张,Vasoconstrictor region(缩血管区)延髓头端腹外侧部 cause cardiac sympathetic tension、sympathetic vasoconstrictor tension(引起心交感紧张、交感缩血管紧张)Vasodilator region(舒血管区)延髓尾端腹外侧部 inhibit activity of vasoconstrictor region(抑制缩血管区的活动),Substitution station of afferent nerve(传入N接替站)孤束核 Inhibitory region of heart(心抑制区)Dorsal nucleus and ambiguous nucleus of bulb(延髓背核、疑核)cause cardiac vagal tension(引起心迷走紧张),Hypothalamus and cerebral cortex(下丘脑和大脑皮层),Integration(整合):Compose a uniform and interactional physiological process from various physiological effects.(是指把各种不同的生理反应组成一个统一的相互配合的生理过程),Sympathetic vasodilator N(交感舒血管N):Root in hypothalamus and cerebral cortex(源于下丘脑和大脑皮层)Defence reaction(防御反应):Hypothalamus(下丘脑),(3)Cardiovascular reflex(心血管反射)Carotid sinus、aortic arch baroreceptor reflex(颈A窦、主A弓压力感受性反射),An autonomically mediated reflex response that influences the heart and blood vessels to oppose a change in mean arterial blood pressure.(血压变化经压力感受器等反射弧活动而维持血压于稳态的反射),Blood pressure(血压),carotid sinus(颈A窦)Pressure R(压力R)aortic arch(主A弓),Sinus nerve(窦N 舌咽N),Aortic nerve(主A神经),Spinal bulb(延脑),Cardiac sympathetic tone 心交感紧张(-),sympathetic vasoconstrictor tone 交感缩血管紧张(-),cardiac vagal ton 心迷走紧张(+),Blood pressure(血压),Cardiovisceral vessel(心血管活动),压力R发放的冲动频率与A管壁扩张度（血压）呈正变关系。The significance of depressor reflex:(减压反射的意义),Chemoreceptor reflex of Carotid body and aortic body(颈A体、主A体化学感受性反射),Receptor(感受器):carotid body,aortic body(颈A体,主A体)chemoreceptor(化学感受器)Afferent nerve(传入N):glossopharyngealN(舌咽N)vagus N(迷走N),Process:,P CO2,H+,P O2,carotid body(颈A体),aortic body(主A体),chemoreceptor(化学感受器),舌咽N,迷走N,medulla(延髓),cardiovascular center 心血管中枢(+),respiration center 呼吸中枢(+),心输出量,外周阻力,血压,Significance:When the organism in hypoxia、asphyxia and low A pressure,it can regulate cardiovascular activity obviously to supply blood、oxygen for heart and brain.(意义:在低氧、窒息、A压过低、酸中毒时才对心血管动起明显调节作用以保证脑心供血供氧),2.Humoral regulation(体液调节),(1)Adrenine and norepinephrine(肾上腺素与去甲肾上腺素)Adrenine(肾上腺素)exciting R,RFunction：Heart：正性变时变力变传导(1R)BP,Blood vessel：皮肤、肾、胃肠等处血管 R兴奋致血管收缩；而骨骼肌、肝、心等处血管2R兴奋致血管舒张，外周阻力变化不大,血液重分配。（肌、心优先供血）,Excitation of blood vesselR of skin gastrointestinal and kidney leads to vessel contraction;while excitation of blood vessel 2R of skeletal muscle、liver and heart leads to vessel relaxation.The change of peripheral resistance is not obvious,and blood is redistributed.,Norepinephrine(去甲肾上腺素):,NE excitationR 1R 2R Function:,A缩致外周阻力,V缩致回心血,Blood pressure(血压),对心脏的直接正性 作用可被降压反射 的间接作用掩盖,Heart rate(心率),(2)Renin angiotensin system(肾素-血管紧张素系统)肾血流