名校生理学血液循环ppt课件VIP

.,CHAPTER4CIRCULATI血液循环,Prof.WangTinghuaiDepartmentofPhysiology,.,SECTION3VASCULARPHYSIOLOGY血管生理,.,.,.,动脉,毛细血管,静脉,弹性储器血管：主动脉和大动脉分配血管：中等动脉阻力血管：小动脉和微动脉,交换血管,容量血管,.,.Functionalpropertiesofdifferentbloodvessels不同血管的功能特征1.Artery:动脉A.Aortaandlargeartery(windkesselvessel)主动脉和大动脉，又称弹性贮器血管,.,pressurereservoir压力储存器maintainthecontinualbloodfluidinthearterysystem.维持动脉系统内连续的血流Lowresistancevessel低阻力血管transportbloodtoeveryapparatusofthegloblebody运送血液到全身各个器官,.,B.Middleartery:carrybloodtoarterioles(distributionvessel)中动脉：运送血流至小动脉,又称分配血管。,.,C.Smallarteryandarterioleresistancevessels小动脉和微动脉阻力血管Smallarteryandarteriolearethemainpositionoforganismtoregulatetheorganbloodflowandtheredistributionofbloodamongapparatus.Thediameterofresistancevesselsareregulatedbyneurohormonalfactors.小动脉和微动脉是机体调节器官血流量和器官之间血液重新分配的主要部位，其血管的口径受神经体液因素的调节。,.,2.Capillaryvessels:exchangevessels毛细血管：交换血管Bloodflowfromarterioletovenulesbypassingcapillarytocarryouttheexchangeofsubstancesbetweenbloodandinterstitialfluid.血流通过毛细血管从小动脉到小静脉，完成血液和组织液的物质交换。,.,Precapillarysphincter毛细血管前括约肌Function:Controlofinflowofcapillaries作用：控制毛细血管的流入量。A-Vshunt(anastomosis)动静脉短路（吻合）Function：BloodflowsdirectlyfromarterioletoveinulethroughA-Vshunt.作用：血液通过动静脉吻合由微动脉直接到达微静脉。,.,3.VenousVessels(capacitancevessel)静脉血管（容量血管）Largevein，venacava，venule，veinule大静脉，腔静脉，小静脉，微静脉Bloodreservoir血液储存库（6070）Bigcompliance顺应性大Lowmeanvenouspressure平均静脉压低(2mmHg）Venousvalve静脉瓣,.,.Hemodynamics血流动力学Bloodflow,resistancetobloodflowandpressure血流量，血流阻力和血压1.Bloodflow:Bloodvolumepassingagivensectioninthecardiovascularsystemperunittime(ml/s).血流量：单位时间流过血管某一横截面的血量（ml/s）。,.,.,P1-P2A.Q=RQ：bloodflow（血流量）P1-P2：thedpofthetwovesselsends(血管两端压力差)R:resistanceofbloodflow(血流阻力)B.Poiseulleslawforlaminarflowppr4F=阻力8LL:血管长度：血液黏度rveinule：血管半径,.,ThemodeofbloodflowinginthebloodvesselscanbeclassifiedintoLaminarflowandturbulentflow.血液在血管内的流动方式可以分为层流和湍流。,.,.,.,Empiricalequation（经验公式）Reynoldsnumber-Reynold数:NR=DV/(rho):densityoffluid液体密度D:diameterofthetube管径V:velocityofflow流速NR2000laminarflowturbulentflow层流湍流,.,LaminarflowTurbulentflow层流湍流ThesameflowdirectionThedifferentflowdirection流动方向一致流动方向不一致novibrationVibration无振动有振动nosoundSound无声音有声音WastefulenergylessWastefulenergymore耗能少耗能多,.,Poiseulleslawforlaminarflowconformstolaminarflowbutturbulentflow.Underturbulentflow,thebloodflowisnotindirectproportiontothebpofthetwoendsofvessels,howevertoitssquareroot.泊肃叶定律适于层流情况。在湍流情况下，泊肃叶定律不再适用，血流量不是与血管两端的压力差成正比，而是与压力差的平方根成正比。,.,2.Resistancetobloodflow:血流阻力P1-P28LF=R=Rr4Resistancecomesfromexternalfriction(L,r),internalfriction().Totalperipheralresistanceismainlydeterminedbyarterioles(6070%).阻力来自外摩擦（L，r）和内摩擦(）,60-70%的总外周阻力主要来自微动脉。,.,Thebloodflowoforganisdeterminedbymeanarterialbloodpressureandbloodresistance.Thediameterofarteriolesisthedeterminingfactortoregulatetheredistributionofbloodflowoforgans.一个器官血流量的多少主要受平均动脉压和血管半径的影响。小动脉和微动脉口径的变化是调节器官血流量和器官之间血液重新分配的最主要因素。,.,Bloodpressure血压Tworequirementsforbloodpressureformation:血压形成的两个条件：A.Bloodfillingincardiovascularsystem心血管系统血液充盈Meancirculatoryfillingpressurebloodvolume=7mmHgvascularvolume血液容量循环系统平均充盈压=7mmHg血管容量,.,B.Cardiacejection心脏射血kineticenergy：pushthebloodtoflowCardiacContractionEnergesispotentialenergy:vesselwallexpandCardiacrelaxation：largearteryelasticityrecoveryPercentagepotentialenergykineticenergy:Pushbloodtocontinuouslyflowforward,.,动能：推动血液流动心脏收缩释放能量势能：血管壁扩张心脏舒张：大动脉弹性回缩部分势能动能：推动血液继续向前流动,.,.ArterialBloodPressure动脉血压,1.Normalvalue正常值,.,NormalvaluemmHgkPaSystolicPressure收缩压10012013.316DiastolicPressure舒张压6080810PulsePressure脉压30404.05.3MAP平均动脉压10013.3MAP=DP+1/3(pulseP),.,A.Dnfluctuatingrulesofbloodpressure血压的昼夜波动,Doublepeaksanddoublevalley(dayrhythm)双峰双谷（日节律）,.,Lowestat2to3oclockinthemorning凌晨23时最低OnePeakduring6to10inthemorning上午610时高Anotherpeakduring4to8intheafternoon下午48时高Lowingdownafter8oclockintheevening晚上8时缓慢下降,.,B.Diagnosiscriteriaofhypertension高血压的诊断标准,CataloguesSPDPNormal12090prophase12013980891stphasdphase160100TheJNC7ReportJAMA.2003;289:(DOI10.1001/jama.289.19.2560.,.,高血压分类收缩压舒张压(mmHg)（mmHg)正常120和90高血压前期120139或80891期高血压140159或90992期高血压160或100,.,C.Pressureofdifferentvesselsofsystemiccirculation体循环不同血管的血压,.,平均压（mmHg）主动脉100动脉（3mm）95微动脉起始端85微动脉末端55毛细血管起始端30,.,Fallofbloodpressureisindirectproportiontotheresistanceofbloodflow,andtheBPdecreasessignificantlyinthearteriole,wherethebloodflowresistenceisthebiggest.血压降落与血流阻力成正比，在血流阻力最大的微动脉段，血压降落最为显著。,.,D.Arterialpressurecurvesrecordedfromdifferentsitesofsystemiccirculation(dog)体循环不同部位血压波波形,.,Archlowerabdomeniliackneeankle主动脉弓下腹部髂部膝部踝部,ascendingbranchonsetslater升支起始延迟waveshapesharper波形变窄amplitudehigher幅度增高reentrywaveappears出现折返波,.,2.Determinantsofarterialbloodpressure动脉血压的决定因素A.arterialbloodvolume动脉血容量Itisdeterminedbyejectionvolumeandperipheralresistance.由心脏射血量和外周阻力决定。,.,B.arterialcompliance动脉顺应性顺应性=V/pInnormalcondition,theelasticityofarterialcanbufferthefluctuationsofBP,andchangethebloodejectedintoarterialtocontinuousbloodflow.正常时，动脉的弹性对血压起“缓冲”作用，维持一定的收缩压和舒张压，使心室间断的射入动脉的血流变成动脉的连续性血流。,.,.,Ifweassumethatarterialcomplianceremainsconstantarterialbloodpressurewilldependonarterialbloodvolumeandvascularvolume.假定动脉顺应性保持恒定，则动脉血压取决于动脉血量和血管容量。,BloodvolumeBPvascularvolume,.,Arterialbloodvolumeisdeterminedbytherateofinflowandoutflowofarterialsystem.动脉血容量取决于动脉系统流入量与流出量。Rateofinflow：cardiacoutput流入量：心输出量Rateofoutflow:resistanceandBP流出量:血流阻力和动脉血压,.,3.Factorsaffectingarterialpressure影响动脉血压的因素A.stokevolume每搏输出量B.heartrate心率C.peripheralresistance外周阻力D.Complianceofaortaandlargeartery主动脉和大动脉的顺应性E.circulatorybloodflow循环血量,.,影响动脉血压的因素,影响因素,变化,收缩压,舒张压,脉压,备注,心率(40180次/分),.,Alltheabove-mentionedfactorsofinfluencingBPisdeducedwhenassumingotherinfluencingfactorkeepingstable.Actually,thefluctuationsofBPundercertainphysiologicalconditionisalwaysthesummationofmanyfactorsfunctionsmutually.上述影响动脉血压的各种因素，都是在假定其他影响因素不变的前提下，分析某一因素变化时对动脉血压可能发生的影响。实际上，某种生理情况下动脉血压的变化，往往是各种因素相互作用的总和结果。,.,IV.Venouspressureandvenousreturn静脉血压和静脉回流1.Centralvenouspressure中心静脉压（412cmH2O）Affectfactors：影响因素A.Heartpumpaction心脏泵功能B.Venousreturnvelocity静脉回流速度,.,CVP：anindexofcardiovascularfunction反映心血管功能的一项指标CVP：输液量不足CVP：输液过快或心脏射血功能不全,.,2.Peripheralvenouspressure外周静脉压Effectofgravityonvenouspressure重力对静脉压的影响Orthostatichypotension直立性低血压,.,.,3.Venousreturnandaffectingfactors静脉回流及影响因素A.Meancirculatoryfillingpressure循环系统平均充盈压B.Cardiaccontractility心肌收缩力C.Sympatheticnerve交感神经D.Musclepump肌肉泵E.Thoracicpump呼吸泵,.,影响静脉回心血量因素,.,V.Microcirculation微循环,.,Microcirculationisthebloodcirculationbetweenarterioleandveinule.Themicrocirculationistheplacewherethebloodandinterstitialfluidtocarryouttheexchangeofsubstances.微循环是指微动脉和微静脉之间的血液循环。微循环是血液和组织之间进行物质交换的场所。,.,Architectureofmicrocirculation微循环的结构,A.Fundamentalcomposition基本构成Arteriolemetarterioleprecapillarysphinctertruecapillaryvenule微动脉后微动脉毛细血管前括约肌真毛细血管微静脉,.,B.Preferentialchannelorthoroughfare通血毛细血管（直捷通路）ArteriolemetarteriolePreferentialchannelvenule微动脉后微动脉通血毛细血管微静脉Thebloodflowsintoveinsquicklythroughmicrocirculation,anditscanbeeasilyfoundinskeletalmuscle.血液通过微循环迅速进入静脉，骨骼肌中多见。,.,C.A-VanastomosisorA-vshunt动静脉吻合或动静脉短路Arteriolevenule微动脉微静脉Participateinthermoregulation参与体温调节infectionortoxicshockopenmore,andtheoxygendeficiencyaggravate.感染或中毒性休克时大量开放，加重组织缺氧。,.,Hemodynamicofmicrocirculation微循环的血流动力学A.bigcrosssectionarea横截面积大slowvelocityofbloodflow血流速度缓慢Thesubstancescanbethoroughlyexchangedbetweenbloodandinterstitialfluid.有利于血液与组织液在毛细血管进行物质交换。,.,B.capillarypressuredependsonprecapillaryresistance/postcapillaryresistance.毛细血管压力取决于毛细血管前阻力与毛细血管后阻力的比值。Thebloodvolumeofmicrocirculationisindirectproportiontothedpofarterioleandveinule,andininverseproportiontothewholeresistanceofmicrocirculation.微循环的血流量与微动脉和微静脉之间的血压差成正比，与微循环中血流总阻力成反比。,.,C.alternateopeningandclosingofcapillaries.毛细血管交替性收缩和舒张vasomotionactivity血管舒缩活动(510次/min)Vasomotionactivityismailyconcernedwiththemetabolicactivityofregionaltissues.Thebloodflowofmicrocirculationconformstothelevelofmetabolicactivity.血管舒缩活动主要与局部组织的代谢活动有关。微循环的血流量和组织的代谢活动水平相适应。,.,3.Exchangeofsubstancesbetweenbloodandinterstitialfluid血液和组织液之间的物质交换A.Diffusion:themostimportantway.扩散：最重要的方式,.,Lipidsolublesubstances:O2,CO2脂溶性物质：O2,CO2non-lipidsolublesubstances非脂溶性物质Rateofdiffusion=(DA/a)(Co-Ci)D:diffusioncoefficientD:扩散系数,.,B.Filtrationandreabsorption滤过和重吸收Filtrationandreabsorptionplayanimportantroleinthegenerationofinterstitialfluid.在组织液的生成中起重要作用。C.Pinocytosis吞饮ThebigmoleculescancarryouttheexchangeofsubstancesthroughPinocytosis.大的分子可以通过这种方式进行物质交换。,.,Formationofinterstitialfluid组织液的形成About60%oftheweightofthehealthadultiswater,inwhich:正常人体重中大约60是水，其中细胞内液（5/8）1/5:血浆细胞外液（3/8）4/5:组织液和腔室内液体,.,A端Pf=（30+15）-（25+10）=+10mmHgV端Pf=（12+15）-（25+10）=-8mmHg,.,Formationofinterstitialfluid组织液的生成,EP=(Pc+if)(p+Pif)有效滤过压=（毛细血管血压+组织液胶渗压）-（血浆胶体渗透压+组织液静水压）,Pc：毛细血管血压if：组织液胶体渗透压p：血浆胶体渗透压Pif：组织液静水压,.,Thefiltrationandreabsorptionoffluidthroughthecapillarywallisdeterminedbythedifferenceofthestrengthoffiltrationandreabsorption.液体通过毛细血管壁的滤过和重吸收