名校生理学血液循环课件

1、CHAPTER 4 CIRCULATI血液循环,Prof. Wang Ting huai Department of Physiology,SECTION 3 VASCULAR PHYSIOLOGY 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,. Functional properties of different blood vessels 不同血管的功能特征 1. Artery: 动脉 A. Aorta and large artery (windkessel vessel ) 主动脉和大动脉，又称弹性贮器

2、血管,pressure reservoir 压力储存器 maintain the continual blood fluid in the artery system. 维持动脉系统内连续的血流 Low resistance vessel 低阻力血管 transport blood to every apparatus of the globle body 运送血液到全身各个器官,B. Middle artery: carry blood to arterioles (distribution vessel)中动脉 ：运送血流至小动脉,又称分配血管。,C. Small artery and a

3、rteriole resistance vessels 小动脉和微动脉阻力血管Small artery and arteriole are the main position of organism to regulate the organ blood flow and the redistribution of blood among apparatus. The diameter of resistance vessels are regulated by neurohormonal factors. 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

4、体液因素的调节 。,2. Capillary vessels: exchange vessels 毛细血管：交换血管 Blood flow from arteriole to venules by passing capillary to carry out the exchange of substances between blood and interstitial fluid. 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。,Precapillary sphincter 毛细血管前括约肌 Function: Control of inflow of capillari

5、es 作用：控制毛细血管的流入量。 A-V shunt (anastomosis) 动静脉短路（吻合） Function：Blood flows directly from arteriole to veinule through A-V shunt . 作用：血液通过动静脉吻合由微动脉直接到达微静脉。,3. Venous Vessels ( capacitance vessel) 静脉血管（容量血管） Large vein，vena cava，venule，veinule 大静脉，腔静脉，小静脉，微静脉 Blood reservoir 血液储存库（6070） Big compliance 顺

6、应性大 Low mean venous pressure 平均静脉压低(2mmHg） Venous valve 静脉瓣,. Hemodynamics 血流动力学 Blood flow, resistance to blood flow and pressure 血流量，血流阻力和血压 1. Blood flow: Blood volume passing a given section in the cardiovascular system per unit time (ml/s). 血流量：单位时间流过血管某一横截面的 血量（ml/s）。,P1-P2 A. Q = R Q ：blood f

7、low（血流量） P1-P2：the dp of the two vessels ends (血管两端压力差) R: resistance of blood flow (血流阻力) B. Poiseulles law for laminar flow p pr4 F = = 阻力 8L L :血管长度 ：血液黏度 r veinule：血管半径,The mode of blood flowing in the blood vessels can be classified into Laminar flow and turbulent flow. 血液在血管内的流动方式可以分为层流和湍流。,Em

8、pirical equation（经验公式） Reynolds number-Reynold数: NR =DV/ (rho): density of fluid 液体密度 D: diameter of the tube 管径 V: velocity of flow 流速 NR2000 laminar flow turbulent flow 层流 湍流,Laminar flow Turbulent flow 层流 湍流 The same flow direction The different flow direction 流动方向一致 流动方向不一致 no vibration Vibratio

9、n 无振动 有振动 no sound Sound 无声音 有声音 Wasteful energy less Wasteful energy more 耗能少 耗能多,Poiseulles law for laminar flow conforms to laminar flow but turbulent flow.Under turbulent flow, the blood flow is not in direct proportion to the bp of the two ends of vessels, however to its square root. 泊肃叶定律适于层流情

10、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. Resistance to blood flow: 血流阻力 P1-P2 8L F = R = R r4 Resistance comes from external friction (L, r) ,internal friction (). Total peripheral resistance is mainly determined by arterioles(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。,The blood

11、flow of organ is determined by mean arterial blood pressure and blood resistance. The diameter of arterioles is the determining factor to regulate the redistribution of blood flow of organs.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。,Blood pressure 血压 Two requirements for blood

12、 pressure formation: 血压形成的两个条件： A. Blood filling in cardiovascular system 心血管系统血液充盈 Mean circulatory filling pressure blood volume = 7mmHg vascular volume 血液容量 循环系统平均充盈压 = 7mmHg 血管容量,B. Cardiac ejection 心脏射血 kinetic energy： push the blood to flow Cardiac Contraction Energesis potential energy: vesse

13、l wall expand Cardiac relaxation：large artery elasticity recovery Percentage potential energy kinetic energy : Push blood to continuously flow forward,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,. Arterial Blood Pressure 动脉血压,1. Normal value 正常值,Normal value mmHg kPa Systolic Pressu

14、re 收缩压 100120 13.316 Diastolic Pressure 舒张压 6080 810 Pulse Pressure 脉压 3040 4.05.3 MAP 平均动脉压 100 13.3 MAP = DP + 1/3 (pulse P),A. D n fluctuating rules of blood pressure 血压的昼夜波动,Double peaks and double valley (day rhythm) 双峰双谷（日节律）,Lowest at 2 to 3 oclock in the morning 凌晨2 3时最低 One Peak during 6 to

15、 10 in the morning 上午6 10时高 Another peak during 4 to 8 in the afternoon 下午4 8时高 Lowing down after 8 oclock in the evening 晚上8时缓慢下降,B. Diagnosis criteria of hypertension 高血压的诊断标准,Catalogues SP DP Normal 120 90 prophase 120139 8089 1st phase 140159 9099 2nd phase 160 100 The JNC 7 Report JAMA.2003;289

16、:(DOI 10.1001/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 120 139 或 80 89 1 期高血压 140 159 或 90 99 2 期高血压 160 或 100,C. Pressure of different vessels of systemic circulation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,Fall of blood pressure is in direct proporti

17、on to the resistance of blood flow,and the BP decreases significantly in the arteriole ,where the blood flow resistence is the biggest.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. Arterial pressure curves recorded from different sites of systemic circulation(dog) 体循环不同部位血压波波形,Arch lower abdomen iliac knee

18、 ankle主动脉弓 下腹部 髂部 膝部 踝部,ascending branch onsets later 升支起始延迟 waveshape sharper 波形变窄 amplitude higher 幅度增高 reentry wave appears 出现折返波,2. Determinants of arterial blood pressure 动脉血压的决定因素 A. arterial blood volume 动脉血容量 It is determined by ejection volume and peripheral resistance. 由心脏射血量和外周阻力决定。,B. ar

19、terial compliance 动脉顺应性 顺应性=V/p In normal condition ,the elasticity of arterial can buffer the fluctuations of BP,and change the blood ejected into arterial to continuous blood flow . 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。,If we assume that arterial compliance remains constant a

20、rterial blood pressure will depend on arterial blood volume and vascular volume.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。,Blood volume BP vascular volume,Arterial blood volume is determined by the rate of inflow and outflow of arterial system. 动脉血容量取决于动脉系统流入量与流出量 。 Rate of inflow：cardiac output 流入量：心输出量 Rate o

21、f outflow: resistance and BP 流出量: 血流阻力和动脉血压,3. Factors affecting arterial pressure影响动脉血压的因素 A. stoke volume 每搏输出量 B. heart rate 心率 C. peripheral resistance 外周阻力 D. Compliance of aorta and large artery 主动脉和大动脉的顺应性 E. circulatory blood flow 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),All the ab

22、ove-mentioned factors of influencing BP is deduced when assuming other influencing factor keeping stable.Actually , the fluctuations of BP under certain physiological condition is always the summation of many factors functions mutually. 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

23、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.Venous pressure and venous return 静脉血压和静脉回流 1. Central venous pressure 中心静脉压 （412 cm H2O） Affect factors：影响因素 A. Heart pump action 心脏泵功能 B. Venous return velocity 静脉回流速度,CVP：an index of cardiovascular function 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. Peripheral ve

24、nous pressure 外周静脉压 Effect of gravity on venous pressure 重力对静脉压的影响 Orthostatic hypotension 直立性低血压,3. Venous return and affecting factors 静脉回流及影响因素 A. Mean circulatory filling pressure 循环系统平均充盈压 B. Cardiac contractility 心肌收缩力 C. Sympathetic nerve 交感神经 D. Muscle pump 肌肉泵 E. Thoracic pump 呼吸泵,影响静脉回心血量因

25、素,V. Microcirculation 微循环,Microcirculation is the blood circulation between arteriole and veinule.The microcirculation is the place where the blood and interstitial fluid to carry out the exchange of substances. 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。,Architecture of microcirculation 微循环的结构,A. Fu

26、ndamental composition 基本构成 Arteriole metarteriole precapillary sphincter true capillary venule 微动脉后微动脉毛细血管前括约肌 真毛细血管微静脉,B. Preferential channel or thoroughfare 通血毛细血管（直捷通路） Arteriole metarteriole Preferential channel venule 微动脉后微动脉通血毛细血管微静脉 The blood flows into veins quickly through microcirculation

27、 ,and its can be easily found in skeletal muscle. 血液通过微循环迅速进入静脉，骨骼肌中多见。,C. A-V anastomosis or A-v shunt 动静脉吻合或动静脉短路 Arteriole venule 微动脉微静脉 Participate in thermoregulation 参与体温调节 infection or toxic shock open more, and the oxygen deficiency aggravate. 感染或中毒性休克时大量开放，加重组织缺氧。,Hemodynamic of microcircul

28、ation微循环的血流动力学 A. big cross section area 横截面积大 slow velocity of blood flow 血流速度缓慢The substances can be thoroughly exchanged between blood and interstitial fluid.有利于血液与组织液在毛细血管进行物质交换。,B. capillary pressure depends on precapillary resistance / postcapillary resistance. 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。 Th

29、e blood volume of microcirculation is in direct proportion to the dp of arteriole and veinule,and in inverse proportion to the whole resistance of microcirculation. 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. alternate opening and closing of capillaries. 毛细血管交替性收缩和舒张 vasomotion activity 血管舒缩活动 (510次/

30、min) Vasomotion activity is maily concerned with the metabolic activity of regional tissues .The blood flow of microcirculation conforms to the level of metabolic activity. 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. Exchange of substances between blood and interstitial fluid 血液和组织液之间的物质交换 A. Dif

31、fusion: the most important way. 扩散：最重要的方式,Lipid soluble substances: O2, CO2 脂溶性物质： O2, CO2 non-lipid soluble substances 非脂溶性物质 Rate of diffusion =(DA/a)(Co-Ci) D: diffusion coefficient D:扩散系数,B. Filtration and reabsorption 滤过和重吸收 Filtration and reabsorption play an important role in the generation o

32、f interstitial fluid. 在组织液的生成中起重要作用。 C. Pinocytosis 吞饮 The big molecules can carry out the exchange of substances through Pinocytosis. 大的分子可以通过这种方式进行物质交换。,Formation of interstitial fluid 组织液的形成About 60% of the weight of the health adult is water, in which: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）

33、4/5: 组织液和腔室内液体,A端 Pf=（30+15）-（25+10）= +10mmHg V端 Pf=（12+15）-（25+10）= - 8 mmHg,Formation of interstitial fluid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,The filtration and reabsorption of fluid through the capillary wall is determined by the difference of the strength of filtration and reabsorption. 液体通过毛细血