2022年医学专题-第1章-呼吸系统生理

祝同学们新年学习(xuéxí)进步！圆圆满满！第一页，共四十九页。Chapter1RespiratoryPhysiology

HongCao

第二页，共四十九页。Vocabulary第三页，共四十九页。vocabularyrespiratory：呼吸(hūxī)respiration：呼吸expiration：呼气inspiration：吸气respiratorycenter：呼吸中枢respiratorymuscle：呼吸肌inspiratoryneurone：吸气神经元diaphragm：膈肌第四页，共四十九页。upperairway：上呼吸道(shànghūxīdào)lung：肺pharynx：咽larynx：喉trachea：气管bronchi：支气管terminalbronchioles：终末支气管respiratorybronchioles：呼吸性支气管alveolar：肺泡vocabulary第五页，共四十九页。intrapleuralpressure：胸内压functionalresidualcapacity（FRC）：机能余气量vitalcapacity（VC）：肺活量forcedvitalcapacity（VC）：用力(yònglì)肺活量residualvolume（RV）：余气量totallungcapacity（TLC）：肺总容量closingcapacity（CC）：闭合容量theminuteventilation：每分通气量vocabulary第六页，共四十九页。arterialcarbondioxidetension：动脉血二氧化碳分压arterialoxygentension：动脉血氧分压cerebrospinalfluid：脑脊液peripheralchemoreceptor：外周化学(huàxué)感受器centralchemoreceptor：中枢化学感受器respiratoryreflex：呼吸反射

vocabulary第七页，共四十九页。laryngospasm：喉痉孪airwayobstruction：气道阻塞compliance：顺应性surfactant：表面活性物质surfacetension：表面张力(biǎomiànzhānglì)hypoxicpulmonaryvasoconstriction：缺氧性肺血管收缩vocabulary第八页，共四十九页。deadspace：无效(wúxiào)腔anatomicaldeadspace：解剖无效腔respiratoryquotient：呼吸商oxyhaemoglobindissociationcurve：

氧离曲线Haldaneeffect：Haldane效应Bohreffect：Bohr效应secondgaseffect：第二气体效应vocabulary第九页，共四十九页。1.1.1LungFunctions第十页，共四十九页。肺通气肺换气(huànqì)气体运输组织换气氧化代谢第十一页，共四十九页。LungFunctionsLungsareasiteforgasexchangewiththeexternalenvironmentRegulationacid-basebalanceLungsareadefencemechanismLungsareabloodreservoirServeabiosyntheticfunction气体(qìtǐ)交换外环境(huánjìng)酸碱平衡(pínghéng)贮血库生物合成功能第十二页，共四十九页。

1.1.2LungStructure

第十三页，共四十九页。鼻腔(bíqiāng)喉气管(qìguǎn)左主支气管右主支气管左肺右肺咽食道(shídào)膈肌第十四页，共四十九页。气管支气管细支气管终末细支气管呼吸(hūxī)性细支气管肺泡管肺泡囊

传导单位(dānwèi)呼吸单位(dānwèi)第十五页，共四十九页。肺泡(fèipào)内气体肺泡(fèipào)内气体基底膜毛细血管(máoxìxuèɡuǎn)内皮组织间隙毛细血管内血浆第十六页，共四十九页。1.2ControlofRespiration第十七页，共四十九页。中脑(zhōngnǎo)脑桥脑干呼吸(hūxī)中枢第十八页，共四十九页。颈动脉体主动脉体颈动脉窦主动脉第十九页，共四十九页。Respiration

CentralControl

PeripheralChemoreceptors

carotidandaorticbodies

Thecentralchemoreceptors

Lieinthefloorofthefourthventricleandareeithertheneuronesresponsibleforgenerationoftherespiratoryrhythmorarecloselyrelatedtothem.TheyarebestregardedassensorsofoxygendeliveryastheyrespondtobothadecreaseinPaCO2andinbloodflowrate.PeripheralControl

第四脑室(nǎoshì)呼吸(hūxī)节律颈动脉体主动脉体第二十页，共四十九页。1.3MechanicsofRespiration第二十一页，共四十九页。1.3.1LungVolumes肺容量(róngliàng)补吸气(xīqì)量肺总容量(róngliàng)余气量功能余气量潮气量补呼气量第二十二页，共四十九页。1.3.2ComplianceBoththelungsandthechestwallrequireadistendingforce,usuallyexpressedasvolumechangeperunitofdistendingpressure:compliance

Thecomplianceisapproximatelylinearovermostoftherange,butislesswhenthelungissmallandnearlyfullyinflated.

Thelungexhibitshysteresis,i.e.thecompliancediffersduringinflationanddeflation.Thisisduetotheeffectofalveolarsurfactantandisabsentifthelungisinflatedwithafluid.顺应性滞后肺表面活性物质第二十三页，共四十九页。LawofLaplace：P：回缩压力P=2T/rT：肺泡(fèipào)表面张力r:肺泡半径Ifthealveoliareregardedasaseriesofinterconnectedbubblesthenthenormalsurfacetensioneffectswouldensurethatthesmallerbubblesemptiedintothelarger.1.3.3Surfactant第二十四页，共四十九页。Infact,itdoesn’t!thepresenceofasurfaceactivematerial,secretedbythetypeIIalveolarcells,ensuresthatthisdoesnotoccur.表面活性物质第二十五页，共四十九页。1.3.4ResistanceTheflowofairintoandoutofthelungsisopposedbythefrictionalresistanceoftheairwaysThetypeofflowisimportant,withlaminarflowofferinglessresistancethantransitionalorturbulentflow.Laminarflowoccursatlowflowratesandinthesmallerbronchi.Inthelargerairwaysandatbranchesinthebronchialtree,turbulentflowmayoccur.Airwayresistanceisrelatedtolungvolume,decreasingasthelungexpands.Itisalsorelatedtobronchomotortoneandthethicknessofthemucosallayer.阻力(zǔlì)摩擦阻力层流(cénɡliú)湍流(tuānliú)粘膜层支气管肌紧张(性)第二十六页，共四十九页。1.4MatchingofVentilation

andPerfusion第二十七页，共四十九页。1.4.1DistributionofPerfusionThedistributionofbloodflowwithinthelungsislargelyinfluencedbygravity.Intheerectposturethreedistinctzonesmaybedescribedasthreezones.Intheupperzone,thereisalmostnoflow.Inthemiddlezoneandthelowerzone,flowincreasesinthemoredependentareas.分配(fēnpèi)灌流(ɡuànliú)重力(zhònglì)第二十八页，共四十九页。1.4.2DistributionofVentilationSeveralfactorsensurethattheinspiredgasisdirectedtowardsthedependentpartsofthelungs.Themajorfactoristhecomplianceofthedifferentpartsofthelung.Thedifferentpartsofthelungareondifferentpartsofthecompliancecurve.通气(tōngqì)顺应性第二十九页，共四十九页。1.4.3Ventilation:perfusionratioNormalgasexchangerepuiresboththatalveoliareadequatelyventilatedandthattheyareperfusedwithpulmonarybloodatanappropriaterate.VA/Q=AlveolarventilationratePulmonarybloodflow通气(tōngqì)/血流比值肺泡(fèipào)肺血流量第三十页，共四十九页。Anareaofthelungisperfusedbutinadequatelyventilated,VA/Qwillobviouslybereduced.Asaresult,thealveolarPO2fallsandthePCO2rises.Wherealveoliareventilatedbutnotproperlyperfused,VA/Qwillbeincreases.theyaddtothephysiologicaldeadspace.Intheabsenceofgasdiffusioninandoutofthepulmonaryblood,alveolarPO2risesandPCO2falls.生理无效腔第三十一页，共四十九页。1.4.4DeadSpaceThedeadspaceoftherespiratorysystemisthatpartwhichdoesnotparticipateingasexchange.Itcomprisestheanatomicaldeadspace,theupperairwayandtracheobronchialtreedowntotherespiratorybronchioles.Themoreusefulmeasureistheratioofdeadspace（Vd）totidalvolume（Vt）.Theratioisabout0.3undernormalcircumstances.无效(wúxiào)腔解剖(jiěpōu)无效腔支气管树第三十二页，共四十九页。1.5GasExchangeandCarriage第三十三页，共四十九页。肺换气(huànqì)组织(zǔzhī)换气第三十四页，共四十九页。肺泡(fèipào)组织细胞氧分子血红蛋白(xuèhóngdànbái)氧合血红蛋白(xuèhóngdànbái)Oxygentransport氧气的运输第三十五页，共四十九页。波尔效应第三十六页，共四十九页。

CarbonDioxidetransportCarbondioxidepassesinareversecascadefrommitochondriatoatmosphere.Itismuchmorewatersolublethanoxygenanddiffusesmorereadily.Carbondioxideismostlycarriedinthebloodasbicarbonateion（HCO3-）.二氧化碳(èryǎnghuàtàn)的运输线粒体扩散(kuòsàn)碳酸氢根离子(lízǐ)第三十七页，共四十九页。Thehydrogenionisbufferedbyprotein,predominantlyreducedhaemoglobin（Haldaneeffect）andtheHCO3-diffusesintotheredcellinexchangeforchloride.ThereverseoccursinthelungsasCO2iseliminated.血红蛋白(xuèhóngdànbái)氢离子氯离子第三十八页，共四十九页。1.6EffectsofAnesthesiaonRespiration第三十九页，共四十九页。ControlofRespirationMechanicsofRespirationMatchingofVentilationandPerfusionGasexchangeandCarriageIncreasedOxygenConsumptionSecondGasEffect

氧耗第二气体(qìtǐ)效应第四十页，共四十九页。1.6.1ControlofRespirationThevolatileandintravenousanaesthetic

agentsandtheopioidanalgesicsalldepressrespirationanddecreasetheresponsivenesstoCO2.Otherrespiratoryresponsessuchascougharereducedduringanaesthesia.Thepatternofrespirationduringanaesthesiatendstoberegular.麻醉药镇痛药第四十一页，共四十九页。1.6.2MechanicsofRespiration

TheinductionofanaesthesiaresultsinareductionintheFRCofabout0.5litre,probablyduetocranialdisplacementofthediaphragm.Thiseffectisgreatestafterneuromuscularblockade.膈肌顶位置(wèizhi)改变肌松药麻醉(mázuì)诱导机械(jīxiè)通气第四十二页，共四十九页。1.6.3MatchingofVentilationandPerfusion

Inductionofanaesthesiadoesnotaffectthedistributionofperfusionexceptthattheincreasedintrathoracicpressureofmechanicalventilationmayreducecardiacoutputandincreaseorcreatethezoneinthelungwherealveolarpressureexceedspulmonaryarterialpressure,thusincreasingdeadspace.胸内压肺动脉压肺泡(fèipào)压第四十三页，共四十九页。Thedistributionofventilationisimpairedduringspontaneousrespirationandworsenedwithmechanicalventilationwhenthereisareductionintheventilationtothedependentpartsofthelung.自主(zìzhǔ)呼吸机械(jīxiè)通气第四十四页，共四十九页。1.6.4GasexchangeandCarriageGasexchangeisimpairedduringanaesthesiaasoutlinedaboveandoxygencarriagemaybeimpairedbythereducedcardiacoutput.ByreducingthePaCO2

hyperventilationreducesoxygendeliverybyshiftingtheoxyhaemoglobindissociationcurvetotheleft.Thea