中山医科大学病理生理学课件肺部疾病

1、万用卡Respiratory FailureThe department of pathophysiologySUN HuilanO2CO2CO2ExternalrespirationcirculationInternalrespirationWhat is respiratory failureRespiratory failure is a pathological process In which the external respiratory dysfunction leads to an abnormal decrease of arterial partial pressure

2、of oxygen with or without carbon dioxide retention. How to Judge respiratory failure 1PaO2 6.6 kpa50mmHgclassification of RF：Hypoxemic(Group RF1Hypercapnic Group RF12Etiology and Pathogenesis of RF Ventilatory disorders Diffusion disordersVentilation-perfusion imbalanceAnatomic shuntEtiology and Pat

3、hogenesis of RF (1)Ventilatory disorderRestrictive Ventilatory disordersObstructive Ventilatory disordersRestrictive Ventilatory disordersParalysis of the respiratoy muscles Decreased compliance of chest wall Decreased compliance of lungsHydrothorax or pneumothoraxEtiology and Pathogenesis of RF (1)

4、大脑皮层调节呼吸肌作随意运动脑桥、延髓不随意的自主节律呼吸调节脊 髓肋间神经肋间肌肋骨、胸骨隔肌胸膜及胸膜腔胸 廓外伤、中毒出血、感染脊髓灰质炎、高位截瘫多发性神经炎重症肌无力、多发性肌炎大量腹水、上腹巨大肿物外伤、骨折气胸、大量胸腔积液Etiology and Pathogenesis of RF (1) Central airway obstruction Peripheral airway obstruction Obstructive Ventilatory disordersO2CO2CO2O2 口 鼻 喉头 肺泡 气管、支气管 肺泡膜 肺血管意外异物水肿炎症异物异物肿瘤哮喘肺水肿肺

5、泡癌炎症纤维化间质水肿休克栓塞 Central airway obstructionPeripheral airway obstructionExtrathoracic variable obstructionexpirationinspirationIntrathoracic variable obstructionexpirationinspirationnomalChronic bronchitisemphysema20 30 20 35 0102001020 20202520 2020 20Peripheral airway obstruction Blood gasLow PaO2

6、and High PaCO2Ventilatory disordersO2CO2CO2O2 口 鼻 喉头 肺泡 气管、支气管 肺泡膜 肺血管意外异物水肿炎症异物异物肿瘤哮喘肺水肿肺泡癌炎症纤维化间质水肿休克栓塞Etiology and Pathogenesis of RF (2)Area of alveolar-capillary membraneDiffusiondisordersThickness of alveolar-capillary membrane Exchenge time O2CO2alveolar-capillary membranesurfactantAlveolar e

7、pitheliumCapillary endotheliocyte Blood gasLow PaO2 and nomal PaCO2Diffusion disordersEtiology and Pathogenesis of RF (3)Local hypoventilationVA/Q Functional shunt Local hypoperfusionVA/Q Dead space like ventilationVentilation-perfusion imbalanceBlood gasLow PaO2 and Nomal or low or high PaCO2 Venti

8、lation-perfusion imbalanceBlood gasVentilation-perfusion imbalance Functional shunt Damaged lungNomallungWhole lungV/Q0.8=0.80.80.80.80.8PaO2 CaO2 PaCO2 NCaCO2 NEtiology and Pathogenesis of RF (4)Anatomic shuntabnormalanatomical shuntBe not ventilated at allPulmonary arterio-venous fistulasPulmonary

9、 edemaAtelectasisFunctional shunt and Anatomic shuntAnatomic shunt No blood gas exchangeApplying O2 cant increase PaO2Functional shuntblood gas exchange decreaseApplying O2 can increase PaO2Blood gasLow PaO2Anatomic shuntARDSadult/acute respiratory distress syndromeWhat is ARDS?ARDS is a common form

10、 of acute respiratory failure in adult that is characterized by dyspnea,hypoxia.Recognition of ARDS.History:Systemic or pulnonary insultChest radiograph:Diffuse pulnonary infiltratesRespiratorydistress:Labored breathing,tachypneaSevere hypoxemia:refractory to treatment with supplement of oxygenSeque

11、ntial development of ARDSTrauma,Shock,Infection and other causative factorPulmonary hypoperfusion and hypoxemiaDamage toepitheliumHypoxemiaDamage toendotheliumPlatelet aggregationIncreased vascular permeabilityRelease of vasoactive substancesMechamicalobstructionStagnation of bloodLeakage of fluid a

12、nd plasma into lungsNoncardiogenic pulmonary edema or hemorrhageDecreased surfactantAlveolar fillingAtelectasisPathogenesis of ARDSStimulusComplement activationPulmonary edemaLysosomal proteinaseActive oxygenPulmonary vasoconstictionArachidonic acid metabolitesEpithelial and endothelialCell damageC5

13、aSequestration of neutrophils in lungs Increased pulmonary permeabilityPulmonary hypertensionPathophysiology of ARDScausative factoralveolar-capillary membrane damageinflammationPulmonary edemaPulmonary vasoconstrictionMicrovascular thrombusDiffusiondisordersPulmonary shuntDead space ventilationAtel

14、ectasisBronchiaconstrictionHypoxemiaCOPDChronic obstructive pulmonary diseaseWhat is COPD?COPD is a kind of chronic obstructive ventilatory disorders caused by chronic bronchitis and emphysemaPathophysiology of RF in COPDCOPDPeripheral airway obstructed and convulsionsurfactant respiratory muscles f

15、ailure diffusion membrane underventilatedor Poor perfusionObstructive ventilatory disordersRestrictive ventilatory disordersDiffusion disordersVentilation-Perfusion mismatchingRespiratory FailureFunctional and Metabolic Alterations in Respiratory Failure (1)1.Metabolic acidosis K 、Cl 2.respiratory a

16、cidosis K 、Clor normal3.respiratory alkalosis K 、Cl Acid-base disturbanceFunctional and Metabolic Alterations in Respiratory Failure (2)PaO2 30mmHgPaCO2 80mmHgVentilation increaseVentilation depression60mmHg50mmHg20mmHg90mmHgmedullacarotidRespiratory system 1medullamedullaFunctional and Metabolic Al

17、terations in Respiratory Failure (2)Central depressionPaCO2Cheyne-stokes respirationCentral excitementPaCO2Respiratory system 2Functional and Metabolic Alterations in Respiratory Failure (3)Pulmonary hypertensionHypoxia、Hypercapnia 【H】 Pulmonary embolism、Pumonary ateriolitisPulmonary aterioloscleros

18、isright ventricleAfterload polycythemiaBlood viscidityHypoxia acidosisDyspneaHeart extrusionCardiovascular system chronicalHeart failureRFunctional and Metabolic Alterations in Respiratory Failure (4)acidosisHypoxiaCerebrovascularVasodilationDamage endotheliumATP NaKbumpActivity of Glutamate decarboxylaseActivity of phospholipaseMembrane potentialneurotransmittersATP Intracellular Ca2 cerebrovascularNeural cellNervous system Principles of treatment of Respiratory failure Correcting the cause Relieving the hypoxemia and hypercapnia男,32岁, 有肺结核病史，咳血水样痰 ,伴胸闷、气短、乏力。查体: