ENchapter8respirationRespiration(呼吸.ppt

Chapter 8 Respiration (呼 吸) Respiration: The sum of processes that accomplish ongoing passive movement of O2 from the atmosphere to the tissues, as well as the continual passive movement of metabolically produced CO2 from the tissues to the atmosphere. (机体与环境之间的气体交换) External respiration (外呼吸): Gas exchange in lung between environment and blood. (外界环境与血液在肺部实现的气体交换.) Internal respiration (内呼吸): Gas exchange between blood and histocyte by tissue fluid. (血液通过组织液与组织细胞之间的气体交换.) The process of respiration (呼吸环节)： 1 External respiration (外呼吸) 2 Gas transport in blood (气体在血中的运输) 3 Internal respiration (内呼吸) Section 1 Human respiratory organ and pulmonary ventilation (人的呼吸器官与肺通气) Pulmonary ventilation (肺通气): The volume of air breathed in and out in one minute; equal tidal volume times respiratory rate. (肺与外界之间的气体交换过程.) 1.1 Structure of pulmonary ventilation (肺通气的结构基础) 1.1.1 Respiratory tract (呼吸道) nose, pharynx, larynx (鼻 咽 喉) upper respiratory tract (上呼吸道) trachea, bronchus, bronchiole, terminal, bronchiole (气管、 支气管、 细支气管 、 终末细支气管 ) inferior respiratory tract (下呼吸道) respiratory bronchiole, alveolar duct, alveolar sac, pulmonary alveoli (呼吸性细支气管、肺泡管、肺泡囊 、 肺泡)Fig 8-2 Anatomical dead space (解剖死腔) Neural regulation (N调控): Sympathetic nerve(交感N) Vagus nerve (迷走N) 1.1.2 Pulmonary alveoli (肺泡) 1.1.2 Pulmonary alveoli (肺泡) Surface tension (表面张力) 液气界面 Function: reducing the fluid surface; (使液体表面积缩小) P=2T/r P: 回缩力(液泡内压力) T: surface tension (表面张力) r: vacuole radius (液泡半径) Decrease surface tension, when inspiration, it can reduce energy that used to inflate lung ; when expiration ,it can prevent pulmonary alveoli from collapse, especially for small pulmonary alveoli. (降低表面张力,吸气时,减少扩张肺所作的功,呼气时防 止肺泡萎陷,特别是小肺泡的萎陷.) Maintain stability of pulmonary alveoli cubage Higher DPPCs density of small pulmonary alveoli, smaller T. (维持大小肺泡容积稳定.小肺泡DPPC密度大，T较小) The function of pulmonary surfactant (肺表面活性物质作用)： 肺泡型细胞分泌的二棕榈酰卵磷脂 DPPC Visceral layer pleurac 1. Pleurac cavity (胸膜腔) (脏层 胸膜) wall layer pleurac (壁层胸膜) intrapleural pressure (胸内负压): 1.1.3 Throax and pleurac cavity (胸廓与胸膜腔) Throax (胸廓): vertebral column, sternum, costal bone and intercostals. (脊柱,胸骨,肋骨,及肋间肌) Forming of intrathoracic pressure (胸内负压形成) 以胸膜腔密闭且含浆液为条件. Throax growth lung growth Throax cubage lung cubage Lung is expanded by throax. Lung contraction intrathoracic pressure (胸廓生长 ) (肺生长) (胸廓容积) (肺容积) (胸廓将肺拉大) (肺回缩)(胸内负压) 2. Breathing muscle (呼吸肌) Include: diaphragm, intercostals, breathing assistant muscle. (膈肌,肋间肌 及呼吸辅助肌 ) Function: the power of pulmonary ventilation (肺通气的动力) Diaphragm (膈肌): inspiration muscle(吸气肌) abdominal breathing (腹式呼吸): diaphragm(膈肌) Fig 8-9 external intercostalis: inspiration muscle Intercostals internal intercostalis: expiration muscle Thoracic breathing (胸式呼吸): Mixed breathing (混合式呼吸): (肋间肌) (肋间外肌: 吸气肌) (肋间内肌: 呼气肌) Eupnea (平静呼吸): 平静吸气: 吸气肌收缩 平静呼气: 吸气肌舒张 平静吸气: 主动过程 平静呼气: 被动过程 Forced breathing (用力呼吸) Forced inspiration: inspiration muscle is contracted. (用力吸气: 吸气肌收缩) Forced expiration: inspiration muscle is relaxed, expiration muscle is contracted. (用力呼气: 吸气肌舒张,呼气肌收缩) Forced breathing: Both inspiration and expiration are active process. (用力呼吸: 呼和吸均为主动过程) 1.2 The principle of pulmonary ventilation (肺通气原理) Power: movement of breathing muscle (动力:呼吸肌的运动) inspiration muscle is contracted thorax is expanded lung is expanded 肺内压大气压 inspiration thorax shrink 肺缩小 肺内压大气压 expiration (呼气) (吸气肌收缩) (胸廓扩大)(肺扩大) (吸气) 吸气肌舒张 (胸廓缩小) Respiration movement (original power) Intrathoracic pressure changes ( indirect power ) Changes of intrapulmonary pressure and atmospheric pressure (direct power) Pulmonary ventilation 呼吸运动（原动力） 胸内压变化（间接动力） 肺内压与大气压差变化（直接动力） 肺通气 1.3 Pulmonary capacity(肺容量) 1. Tidal volume ,TV (潮气量) 400-500ml 2. Inspiratory reserve volume, IRV (补吸气量 ) 1500-1800ml 3. Expiratory reserve volume, ERV (补呼气量) 900-1200ml Inspiratory capacity, IC (深吸气量) / maximum Inspiratory volume= inspiratory reserve volume + tidal volume (最大吸气量 = 补吸气量 + 潮气量) 4. Vital capacity ,VC (肺活量) : The maximum volume of air that can be moved out during a single breath following a maximal inspiration (3500/2500 ) (最大吸气后，从肺内所能呼出的最大气量) 5. Residual volume ,RV (余气量) and functional residual capacity, FRC (功能余气量) 6. Total lung capacity ,TLC (肺总量) : Vital capacity + Residual volume (肺活量+余气量) Fig 8-11 Vital capacity (肺活量) The maximum volume of air that can be moved out during a single breath following a maximal inspiration (最 大吸气后，从肺内所能呼出的最大气量。) 意义：反映肺一次通气的最大能力. 1.4 Pulmonary ventilation volume(肺通气量) Minute ventilation volume (每分通气量) the total volume of coming or outing lung in per minute. (每分钟进或出肺的气体总量 约68L) Maximal voluntary ventilation (最大通气量) the maximum volume generated by inspiration or expiration per minute ,when doing deep and rapid breath. (尽力深快呼吸时，每分钟所能吸入或呼出的最大气量 70L以上) Ventilation storage percent = maximum _ per minute ventilation volume eupnea ventilation volume maximum ventilation volume *100% 最大 _ 每分平静 通 气 通气量 通气量 贮 量 = * 100% 百分比 最大通气量 Dead space and alveolar ventilation volume (无效腔与肺泡通气量) Alveolar dead space (肺泡无效腔): The volume of air that occupies the respiratory airways as air is moved in and out and thus is not available to participate in exchange of O2 and CO2 between the alveoli and atmosphere (因血流分布不均而未能发生交换的肺泡容量) Physiological dead space= anatomic dead space + alveolar dead space (生理无效腔=解剖无效腔+肺泡无效腔) Alveolar ventilation (肺泡通气量) the volume of air exchange between the atmosphere and alveoli per minute; equals (tidal volume - dead space volume) * respiratory rate 每分钟吸入肺泡的新鲜气量 = (潮气量 - 无效腔气量)* 呼吸频率 Pulmonary ventilation volume and alveolar ventilation volume (肺通气量和肺泡通气量) (time/min) (ml) (ml/min) (ml/min) 16 500 8000 5600 8 1000 8000 6800 32 250 8000 3200 呼吸频率 潮气量 肺通气量 肺泡通气量 Section 2 The Exchange and Transport of Breathing Air in Body (呼吸气体在体内的交换与运输) 2.1 The exchange of breathing air (呼吸气体的交换) Lung air exchange (肺换气): Respiratory membrane (呼吸膜) alveolar epithelium + ground membrane (肺泡上皮+基膜) Alveolar capillary blood vessel membrane (肺泡毛细血管膜) endothelial + ground membrane (毛细血管内皮+基膜) Tissue air exchange(组织换气): capillary blood vessel membrane + cell membrane (毛细血管膜+细胞膜) The principle of gas exchange (气体交换原理) Mechanism：air diffusion (气体单纯扩散) Power: partial pressure difference of air 气体分压（张力）差 分压差*扩散面积*溶解度*温度 D = 扩散距离*分子量平方根 2.1.1 Lung air exchange (肺换气) continuously proceed (持续进行) Effect factor (影响因素) : 1. Thickness of the respiratory membrane (呼吸膜厚度) 反变 It will be thicken when lung fibrosis and pulmonary edema. (肺纤维化、肺水肿时增厚) 2. The area of respiratory membrane (呼吸膜面积) 正变 Area increased when movement; (运动时面积增大) 肺不张、肺实变、肺Cap闭塞时面积减小. 3. Ventilation/perfusion ratio (通气/血流比值) 0.84 The ratio of alveolar ventilation and pulmonary blood flow in per minute. (每分肺泡通气量和每分肺血流量的比值。) 气多或血少 气少或血多 比值升高 比值降低 肺泡无效腔 A-V短路 换气效率低 2.1.2 Tissues air exchange (组织换气) The air exchange between blood and tissues (血液与组织细胞之间的气体交换过程。) 2.2 Transport of O2 and CO2 in the blood (呼吸气体在血液中的运输) The forms of O2 and CO2 in blood (O2、CO2在血中存在的形式): physical dissolution (物理溶解) chemical combination (化学结合) 2.2.1 The transport of O2 Form： physical dissolution (物理溶解) （1.5%） chemical combination (化学结合) （98.5%） The combination characters of Hb (hemoglobin) and O2 (Hb与O2结合的特征) ： 反应快、可逆、不需酶催化，主要受PO2影响 Oxygenation reaction (氧合反应) 1珠蛋白结合4个血红素，血红素中心有一个 Fe 2+， 其与组氨酸结合后，作用点才起作用 1分子Hb可结合4分子O2 Oxygen capacity of Hb (Hb 氧容量) Maximum oxygen that Hb can combined in 100ml blood. 100ml血的Hb所能结合氧的最大量 Oxygen content of Hb (Hb 氧含量) Oxygen that Hb combined in fact in 100ml blood. 100ml血的Hb实际结合氧的量 Oxygen saturation of Hb (Hb 氧饱和 度) Percentage of Hb oxygen content and Hb oxygen capacity (Hb氧含量和Hb氧容量的百分比) Oxygen dissociation curve (氧离曲 线) CO and Hb Characters of Oxygen dissociation curve (氧离曲线的特点): 1. 曲线上段的坡度小 (Po2= 60-140) 2. 曲线中段坡度较陡 (Po2= 60-40) 3. 曲线下段坡度最陡 Fig 8-14 Effect factors of Oxygen dissociation curve (影响氧离曲线的因素) 1. pH decreased Rightwards move (右移) 2. Temperature increased Rightwards move (右移) Fig 8-15 2.2.2 The transport of CO2 The form of transport (运输形式): Physical dissolution (物理溶解): 5% Chemical combination (化学结合) 1. bicarbonate(碳酸氢盐 ) 88% 2. carbamino acid Hb (氨基甲酸Hb) 7% 1.Transporting by the form of carbaminohemoglobin (以氨基甲酸血红蛋白形式运输) tissue HbNH2O2+CO2 HbNHCOOH+O2 lung 2. Transporting by the form of HCO3- (以HCO3- 形式运输) 碳酸酐酶 CO2+H2O H2CO3 H+HCO3- tissue H+HbO2 HHb+O2 lung tissue CO2+H2O +HbO2 HCO3-+ HHb+O2 lung Chemical combination of CO2 (CO2化学结合) 1. Bicarbonate (碳酸氢盐) （88%） 2. Carbamino acid Hb (氨基甲酸Hb) （7% ） Section 3 Respiratory Neural Regulation and Chemical Regulation (呼吸的神经调节与化学调节) The place of neuron concentration which is related to respiration. Respiratory rhythm is neurogenic(与呼吸运动有关的神经元集中的部位; 呼吸节律是神经源性的) 3.1 Respiratory center and respiratory rhythm (呼吸中枢和呼吸节律) 切除法实验 脑桥以上中枢 呼吸调整中枢 respiratory center 呼吸中枢 Medulla 延髓 Spinal cord 脊髓 Pons 脑桥 3.1.1 bulb (延髓) Basic center of respiratory rhythm (呼吸节律基本中枢) Function: 产生呼吸节律 1. Respiratory neuron (呼吸N元) 与呼吸周期相关、呈节律性放电的神经元 Dorsal respiratory group , DRG (背侧呼吸组) 主孤束核，IN为主 Ventral respiratory group , VRG (腹侧呼吸组) 主疑核与后疑核，IN，EX inactive 2. Grouping (分组) 脑桥 背侧呼吸组背侧呼吸组 IN为主 对侧膈肌 (呼 吸节律发源地?) 腹侧呼吸组 IN、EX (加强吸气, 主动呼气) 疑核 同侧咽喉呼吸辅助肌 后疑核 对侧肋间肌、腹肌、部分膈肌 3.1.2 Pons (脑桥) Regulation center of respiration (呼吸调整中枢) Function: restricting inspiration, promoting transformation from inspiration to expiration. (作用：限制吸气，促吸气向呼气转化) 3.1.3 The regulating of brain to respiratory movement (大脑对呼吸运动的调节) Cerebral cortex (大脑皮层) ( freely control 随意控制 ) 3.2 Reflex Regulation of Respiration (呼吸的反射性调节) -neural regulation of respiration (呼吸的神经调节) 3.2.1 Pulmonary stretch reflex (肺牵张反射) Definition: The aspiratory reflexible change caused by lung inflation or deflation. (由肺扩张或缩小引起的呼吸的反射性变化) Pulmonary inflation reflex (肺张反射): The reflex that inhibits inspiration when lung inflation. (肺充气或扩张时抑制吸气的反射) Pulmonary deflation reflex (肺缩反射): The reflex that promotes inspiration when lung deflation. (肺萎陷时引起吸气的反射) 1 Pulmonary inflation reflex (肺扩张反射) Lung inflation stretch R (气道平滑肌内) Medulla respiratory center 限制吸气，使吸气转向呼气 (肺扩张) (延髓呼吸中枢) 2 Pulmonary deflation reflex (肺缩小反射) Function: prevent deep expiration and pulmonary deflation (阻止呼气过深和肺不张) 3. Others 3.3 The Regulation of Chemical Factors to respiration (化学因素对呼吸的调节) 3.3.1 The regulation of CO2 效应：一定范围内A血的CO2 引起呼吸 深快 肺（泡）通气量 ； 但超过限度则有压抑呼吸甚至麻醉 效应；另外，PCO2过低可致呼吸 暂停。 Chemoreceptor (化学感受器) 1. Peripheral chemoreceptor (外周化学R)