Respiration医疗培训课件.ppt

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1、Chapter 5 Respiration,When you can not breath, nothing else matters Slogan of the American Lung Association,1,Respiration医疗,11/4/2022,Chapter 5 RespirationWhen you,Respiration is the process by which the body takes in and utilizes oxygen (O2) and gets rid of carbon dioxide (CO2).,2,Respiration医疗,11/

2、4/2022,Respiration is the process by,An Overview of Key Steps in Respiration,3,Respiration医疗,11/4/2022,An Overview of Key Steps in Re,Respiration can be divided into four major functional events,Ventilation: Movement of air into and out of lungsGas exchange between air in lungs and bloodTransport of

3、 oxygen and carbon dioxide in the bloodInternal respiration: Gas exchange between the blood and tissues,4,Respiration医疗,11/4/2022,Respiration can be divided int,Respiratory System Functions,Gas exchange: Oxygen enters blood and carbon dioxide leavesRegulation of blood pH: Altered by changing blood c

4、arbon dioxide levelsVoice production: Movement of air past vocal folds makes sound and speechOlfaction: Smell occurs when airborne molecules drawn into nasal cavityProtection: Against microorganisms by preventing entry and removing themMetabolism: Synthesize and metabolize different compounds (Nonre

5、spiratory Function of the Lung),5,Respiration医疗,11/4/2022,Respiratory System Functions G,Section I VENTILATION,6,Respiration医疗,10/2/2022,Section I VENTILATION 6R,Occurs because the thoracic cavity changes volumeInsipiration uses external intercostals and diaphragmExpiration is passive at rest, but u

6、ses internal intercostals and abdominals during severe respiratory loadBreathing rate is 10-20 breaths / minute at rest, 40 - 45 at maximum exercise in adults,Ventilation,7,Respiration医疗,11/4/2022,Occurs because the thoracic ca,Thoracic Walls and Muscles of Respiration,8,Respiration医疗,11/4/2022,Thor

7、acic Walls and Muscles of,Thoracic Volume,9,Respiration医疗,11/4/2022,Thoracic Volume9Respiration医疗1,Pleura,10,Respiration医疗,11/4/2022,Pleura10Respiration医疗10/2/202,Pleural fluid produced by pleural membranesActs as lubricantHelps hold parietal and visceral pleural membranes together,11,Respiration医疗,

8、11/4/2022,Pleural fluid produced by pleu,I. Alveolar Pressure Changes During Respiration,12,Respiration医疗,11/4/2022,I. Alveolar Pressure Changes,Chest Wall(muscle, ribs),Principles of Breathing,Functional Unit: Chest Wall and Lung,ConductingAirways,Diaphragm(muscle),LungsGas Exchange,Follows Boyles

9、Law:Pressure (P) x Volume (V) = Constant,13,Respiration医疗,11/4/2022,Chest WallPrinciples of Breath,CW,Follows Boyles Law: PV= C,At Rest with mouth open Pb = Pi = 0,D,Pi,A,PS,Pb,Airway Open,Principle of Breathing,1,14,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CAt,CW,Follows Boyles Law: PV= C,

10、At Rest with mouth open Pb = Pi = 0Inhalation: Increase Volume of Rib cage Decrease the pleural cavity pressure- Decrease in Pressure inside (Pi) lungs,D,Pi,A,PS,Pb,Airway Open,Principle of Breathing,2,15,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CAt,CW,Follows Boyles Law: PV= C,At Rest with

11、 mouth open Pb = Pi = 0Inhalation: Pb outside is now greater than Pi- Air flows down pressure gradient Until Pi = Pb,D,Pi,A,PS,Pb,Airway Open,Principle of Breathing,3,16,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CAt,CW,Follows Boyles Law: PV= C,D,Pi,A,PS,Pb,Airway Open,At Rest with mouth ope

12、n Pb = Pi = 0Exhalation: Opposite Process Decrease Rib Cage Volume,Principle of Breathing,4,17,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CDP,CW,Follows Boyles Law: PV= C,At Rest with mouth open Pb = Pi = 0Exhalation: Opposite Process Decrease Rib Cage Volume Increase in pleural cavity pressu

13、re - Increase Pi,D,Pi,A,PS,Pb,Airway Open,Principle of Breathing,5,18,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CAt,CW,Follows Boyles Law: PV= C,At Rest with mouth open Pb = Pi = 0Exhalation: Opposite Process Decrease Rib Cage Volume Increase Pi Pi is greater than Pb Air flows down pressure

14、gradient Until Pi = Pb again,D,Pi,A,PS,Pb,Airway Open,Principle of Breathing,6,19,Respiration医疗,11/4/2022,CWFollows Boyles Law: PV= CAt,Mechanisms of Breathing: How do we change the volume of the rib cage ?,To Inhale is an ACTIVE process Diaphragm,External Intercostal Muscles,Both actions occur simu

15、ltaneously otherwise not effective,20,Respiration医疗,11/4/2022,Mechanisms of Breathing: How,21,Respiration医疗,11/4/2022,21Respiration医疗10/2/2022,II Resistance of the Ventilation,Elastic ResistanceInelastic Resistance,22,Respiration医疗,11/4/2022,II Resistance of the Ventilati,1. Elastic ResistanceA lung

16、 is an elastic sac. The thoracic wall is also an elastic element. So during inspiration the inspiratory muscles must expand the thoracic cage which are together with the elastic resistance.,23,Respiration医疗,11/4/2022,1. Elastic Resistance23Respira,The elastic forces can be divided into two parts:Cau

17、sed by the elastic tissue of the lung and the thoracic wall 2) Caused by surface tension of the fluid that lines the inside wall of the alveoli.The elastic forces caused by surface tension are much more complex. Surface tension accounts for about two thirds of the total elastic forces in a normal lu

18、ngs.,24,Respiration医疗,11/4/2022,The elastic forces can be divi,Surface tension (表面张力）: a measure of the attraction force of the surface molecules per unit length of the material to which they are attached,25,Respiration医疗,11/4/2022,Surface tension (表面张力）: a meas,Surface Tension,Force exerted by flui

19、d in alveoli to resist distensionLungs secrete and absorb fluid, leaving a very thin film of fluid.This film of fluid causes surface tension.H20 molecules at the surface are attracted to other H20 molecules by attractive forces.Force is directed inward, raising pressure in alveoli.,26,Respiration医疗,

20、11/4/2022,Surface TensionForce exerted b,What is Surface Tension ?,Within Fluid All forces balance,At surfaceUnbalanced forces Generate Tension,27,Respiration医疗,11/4/2022,What is Surface Tension ?Withi,Surface Tension,Law of Laplace:Pressure in alveoli is directly proportional to surface tension; an

21、d inversely proportional to radius of alveoli.Pressure in smaller alveolus would be greater than in larger alveolus, if surface tension were the same in both.,Insert fig. 16.11,28,Respiration医疗,11/4/2022,Surface TensionLaw of Laplace:,Collapse,Expand,Effect of Surface Tension on Alveoli size,Air Flo

22、w,29,Respiration医疗,11/4/2022,CollapseExpandEffect of Surfac,Surfactant (表面活性物质）,Phospholipid produced by alveolar type II cells.Lowers surface tension.Reduces attractive forces of hydrogen bonding by becoming interspersed between H20 molecules.Surface tension in alveoli is reduced.,30,Respiration医疗,

23、11/4/2022,Surfactant (表面活性物质）Phospholipi,Area dependence of Surfactant action,Increase Area,Saline,DecreaseArea,Low S/unit Area,High S/unit Area,31,Respiration医疗,11/4/2022,Area dependence of Surfactant,Surfactant prevents alveolar collapse,32,Respiration医疗,11/4/2022,Surfactant prevents alveolar c,Vo

24、lume L,RV,Pleural Pressure,0,6,0,- 30 cm H2O,- 15,3,Normal (with surfactant),Saline Filled,Without surfactant,Volume-pressure curves of lungs filled with saline and with air (with or without surfactant),33,Respiration医疗,11/4/2022,Volume LRVPleural Pressure060-,Physiology Importance of Surfactant,Red

25、uce the work of breathingStabilize alveoliPrevent collapse and sticking of alveoliMaintain the dryness of the alveoliPrevent the edema of the alveoli,34,Respiration医疗,11/4/2022,Physiology Importance of Surfa,Compliance,Distensibility (Stretchability, Elasticity):Ease with which the lungs can expand.

26、The compliance is inversely proportional to elastic resistance Change in lung volume per change in transpulmonary pressure. DV/DP100 x more distensible than a balloon.Specific compliance (比顺应性, CL）: the compliance per unit volumeCL = pulmonary compliance/residual volume,35,Respiration医疗,11/4/2022,Co

27、mplianceDistensibility (Stre,2. Inelastic ResistanceThe inelastic resistance comprises airway resistance (friction) pulmonary tissue resistance (viscosity and inertia). Of these the airway resistance is by far the more important both in health and disease. It account for 80%-90% of the inelastic res

28、istance.,36,Respiration医疗,11/4/2022,2. Inelastic Resistance36Respi,Airway Resistance,Airway resistance is the resistance to flow of air in the airways and is due to : internal friction between gas molecules2) friction between gas molecules and the walls of the airways,37,Respiration医疗,11/4/2022,Airw

29、ay ResistanceAirway resist,Types of Air Flow,38,Respiration医疗,11/4/2022,Types of Air Flow38Respiration,Laminar flow, is when concentric layers of gas flow parallel to the wall of the tube. The velocity profile obeys Poiseuilles Law,39,Respiration医疗,11/4/2022,Laminar flow is when concentr,Poiseuille

30、and Resistance,Airway Radius or diameter is KEY. radius by 1/2 resistance by 16 FOLD - think bronchodilator here!,40,Respiration医疗,11/4/2022,Poiseuille and ResistanceAirwa,The gas flow in the larger airways (nose, mouth, glottis, and bronchi) is turbulentGas flow in the smaller airway is laminarBrea

31、th sounds heard with a stethoscope reflect the turbulent airflowLaminar flow is silent,41,Respiration医疗,11/4/2022,The gas flow in the larger ai,Airway Resistance,Any factor that decreases airway diameter, or increases turbulence will increase airway resistance, eg:Rapid breathing: because air veloci

32、ty and hence turbulence increasesNarrowing airways as in asthma (哮喘）, parasympathetic stimulation, etc.Emphysema (肺气肿）, which decreases small airway diameter during forced expirationIncrease of the density and viscosity of the inspired gas also increase the airway resistance,42,Respiration医疗,11/4/20

33、22,Airway ResistanceAny factor th,Control of Airway Smooth Muscle,Neural controlAdrenergic beta receptors causing dilatationParasympathetic-muscarinic receptors causing constrictionNANC nerves (non-adrenergic, non-cholinergic)Inhibitory release VIP and NO bronchodilitationStimulatory bronchoconstric

34、tion, mucous secretion, vascular hyperpermeability, cough, vasodilation “neurogenic inflammation”,43,Respiration医疗,11/4/2022,Control of Airway Smooth Muscl,Control of Airway Smooth Muscle,Local factorshistamine binds to H1 receptors-constrictionhistamine binds to H2 receptors-dilationslow reactive s

35、ubstance of anaphylaxis (过敏反应）- constriction-allergic response to pollenProstaglandins （前列腺速） E series - dilation Prostaglandins （前列腺素）F series - constriction,44,Respiration医疗,11/4/2022,Control of Airway Smooth Muscl,Control of Airway Smooth Muscle (cont),Environmental pollutionsmoke, dust, sulfur d

36、ioxide, some acidic elements in smogElicit constriction of airwaysmediated by:parasympathetic reflexlocal constrictor responses,45,Respiration医疗,11/4/2022,Control of Airway Smooth Muscl,III Assessment of the Pulmonary Ventilation,46,Respiration医疗,10/2/2022,III Assessment of the Pulmonar,I. Pulmonary

37、 Volume and Capacity,47,Respiration医疗,10/2/2022,I. Pulmonary Volume and Capaci,48,Respiration医疗,11/4/2022,48Respiration医疗10/2/2022,Pulmonary Volumes,Tidal volume (潮气量）Volume of air inspired or expired during a normal inspiration or expiration (400 500 ml)Inspiratory reserve volume （补吸气量）Amount of ai

38、r inspired forcefully after inspiration of normal tidal volume (1500 2000 ml)Expiratory reserve volume （补呼气量）Amount of air forcefully expired after expiration of normal tidal volume (900 1200 ml)Residual volume （残气量，RV）Volume of air remaining in respiratory passages and lungs after the most forceful

39、 expiration (1500 ml in male and 1000 ml in female),49,Respiration医疗,11/4/2022,Pulmonary VolumesTidal volume,50,Respiration医疗,11/4/2022,50Respiration医疗10/2/2022,Pulmonary Capacities,A Capacity is composed of two or more volumesInspiratory capacity （深吸气量）Tidal volume plus inspiratory reserve volumeFu

40、nctional residual capacity （功能残气量, FRC）Expiratory reserve volume plus the residual volumeVital capacity （肺活量, VC）Sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume Total lung capacity （肺总量, TLC）Sum of inspiratory and expiratory reserve volumes plus the tidal volume and re

41、sidual volume,51,Respiration医疗,11/4/2022,Pulmonary CapacitiesA Capacity,52,Respiration医疗,11/4/2022,52Respiration医疗10/2/2022,RV/TLC Normally less than 0.25 Increase by the obstructive pulmonary disease (RV) Increase during the restrictive lung disease (TLC),53,Respiration医疗,11/4/2022,RV/TLC53Respirat

42、ion医疗10/2/2022,Minute and Alveolar Ventilation,Minute ventilation: Total amount of air moved into 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 ve

43、ntilation: How much air per minute enters the parts of the respiratory system in which gas exchange takes place,54,Respiration医疗,11/4/2022,Minute and Alveolar Ventilatio,Dead Space,Area where gas exchange cannot occurIncludes most of airway volumeAnatomical dead space (=150 ml)AirwaysPhysiological d

44、ead space= anatomical + non functional alveoli,55,Respiration医疗,11/4/2022,Dead SpaceArea where gas excha,Basic Structure of the Lung,NO GAS EXCHANGE,DEAD SPACE,Formula: Total Ventilation = Dead Space + Alveolar Space VT = VD + VA,56,Respiration医疗,11/4/2022,Basic Structure of the LungVDA,Physiologica

45、l = Anatomical Dead Space Dead Space +,Similar Concept: Physiological Dead Space,Diseased lungs:,Healthy Lungs:,57,Respiration医疗,11/4/2022,Physiological = Anatomica,II. Measurement of Expiratory Flow - FVC,58,Respiration医疗,10/2/2022,II. Measurement of Expiratory,FVC - forced vital capacity (cont),De

46、fines maximum volume of exchangeable air in lung (vital capacity)forced expiratory breathing maneuverrequires muscular effort and some patient trainingInitial (healthy) FVC values approx 4 litersslowly diminishes with normal aging,59,Respiration医疗,11/4/2022,FVC - forced vital capacity (c,Significant

47、ly reduced FVC suggests damage to lung tissuerestrictive lung disease (fibrosis，纤维化)constructive lung diseaseloss of functional alveolar tissue FVC volume reduction trend over time (years) is key indicatorIntra-subject variability factorsagesexheightethnicity,FVC - forced vital capacity (cont),60,Re

48、spiration医疗,11/4/2022,Significantly reduced FVC sugg,FEV1 - forced expiratory volume (1 second),Defines maximum air flow rate out of lung in initial 1 second intervalforced expiratory breathing maneuverrequires muscular effort and some patient trainingFEV1/FVC rationormal FEV1 about 3 litersFEV1 nee

49、ds to be normalized to individuals vital capacity (FVC)typical normal FEV1/FVC ratio = 3 liters/ 4 liters = 0.75,61,Respiration医疗,11/4/2022,FEV1 - forced expiratory volum,Standard screening measure for obstructive lung disease FEV1/FVC reduction trend over time (years) is key indicatorcalculate % pr

50、edicted FEV1/FVC (age and height normalized)Reduced FEV1/FVC suggests obstructive damage to lung airwaysepisodic, reversible by bronchodilator drugsprobably asthma (哮喘)continual, irreversible by bronchodilator drugsprobably COPD （chronic obstructive pulmonary disease，慢性阻塞性肺病）,FEV1 - forced expirator