Medicine-Respiratory Physiology lectures.pdf

7/25/2019 Medicine-Respiratory Physiology lectures.pdf

1/379

. MDPhD [email protected]

htt : www.molcellbiolu atras.net

20122013

1


2/379

https://eclass.upatras.gr/courses/MED823/

Koeppen BMandStantonBA(eds.).Berne&LevyPrinciplesofPhysiology,6thEdition.Mosby,MarylandHeights,MS,2009BoronWF,Boulpaep EL(eds.).MedicalPhysiology:acellularandmolecularapproach.ElsevierSaunders,Philadelphia,PA,2005.

, . .

approach.McGrawHill,NewYork,NY,2011.PaulevZubieta (eds.).NewHumanPhysiology|2ndEdn:htt ://www.zuniv.net/ h siolo /book/index.htm

WestJB.AWebbasedcourseoflecturesinrespiratoryphysiology.Advan Physiol Edu 2011;35:249251(freely

availableathttp://meded.ucsd.edu/ifp/jwest/)

WestJB.Internetbasedcourseonpulmonarypathophysiology.Advan inPhysiol Edu 36:12,2012.(freelyavailableathttp://meded.ucsd.edu/ifp/jwest/ )

20122013

2


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.

.

3.

4.

5. 6.

7.

20122013

3


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20122013

4


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20122013

5


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20122013

6


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20122013

7


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2

1:34 2

~1:1000

20122013

8


9/379

(2) (CO2)

20122013

9


10/379

20122013

10


11/379

1. ( )2.

3.

4.

(1:3) 250ml 4000ml.

2012201311


12/379

Boyle

x =

Charles

/ =1 1= 2 2 1 1= 2 2

2012201312


13/379

P r

L

Poiseuil le=

= 8 xx/ x4

2012201313


14/379

2

C2

1

Fick= x(1 2) / 1 2 =

2012201314


15/379

P = KhC

Henry= Henry x

2012201315


16/379

P =P +P +P +...P

Dalton=

2012201316


17/379

,2ER =

2=VO2/DO2

=0,25

RQ R =VCO2/VO2~0,8

=DO2

=VO2=

=VCO2= C2

= 2

2012201317


18/379

( )

C H O + x + /4 - z/2 O ---> x CO + /2 H O

RQ R = VCO2/VO2

= + -

: 0,7 < R < 1,0

~ ,

/H/C

= .

(z ~ 0): R = 0,7

2012201318


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,partialpressure,P (mmHg cmH2O) ,fraction,F( )

, ,

P=FxPtot

P=Fx760mmHg

2012201319


20/379

2012201320


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o = mm gFtot=1,00

=

Ptot Pp~F

Ptot Pp~F

Ptot=Pp

2012201321


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2012201322


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AB

2012201323


24/379

Cst=compliance,static= Paw=pressure,airway=

, PB=pressurebarometric= S O =saturation,mixedvenous,ox en=

PaO2=pressure,arterial,oxygen=

P(Aa)O2=pressure,alveolararterial,oxygen=

PaCO2=pressure,arterial,carbondioxide=

2012201324


25/379

VO2=flux(uptake),oxygen= VCO

2

=flux(excretion),carbondioxide=

VI=volume,inspiratory= V =volume,ex irator =

FiO2=fraction,inspired,oxygen=

VD=vo ume, ea = VA=volume,alveolar= ()

T , DLCO=diffusion,lung,carbonmonoxide=

20122013

25


26/379

~4l 5%/

~1kg 60% 40%

~ 2

~60.000

, ,

)

2012201326


27/379

370C (40mmHg) (>10m)

()

2012201327


28/379

~20mL

1015.000L

8cmH2O/L/sec ,

20122013

28


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2012201329


30/379

15min

()

2012201330


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,

2012201331


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(,)

2012201332


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2012201333


34/379

2012201334


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(mL)

>1

150(

)


36/379

5m2

5

0mL,

30cm,

20

,

70m2

,2500m

0,5

cm

2012201336


37/379

10

8

:

2012201337


38/379

8x8x8mm

10.000

:

2012201338


39/379

500.000

:

2012201339


40/379

,

/

res irator s nc tialvirus,RSV)

.

2012201340


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.

.

2012201341


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, , 2 (,

) 10 2

1 () 8

2012201342


43/379

2012201343


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()

1m

0,26ml/kgNoppen M et al. Am J Respir Crit Care Med. 2000 Sep;162:1023-6.

2012201344


45/379

() /

:0.260.1ml/kg

: ,,,,

: , ,

,,

2012201345


46/379

2012201346


47/379

. ( ) ()

.

2012201347


48/379

m 500.000.000

1000/ ( 1:1) :, 9698%

:, ,

:12m:

, , ,


49/379

1. 2. 3. 4. 5. 6. CLARA7. 8.

. 10.

11. 12.

2012201349


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2012201350


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2012201351


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2012201352


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2012201353


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2012201354


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Thiberville L,Salan M,Lachkar S,DominiqueS,MorenoSwirc S,VeverBizet C,BourgHeckly G.Humaninvivo fluorescence

microimaging ofthealveolarducts andsacsduringbronchoscopy.Eur Respir J2009;33:97485.

2012201355


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2012201356


57/379

, , , ,.

( ) (

: : : ( Kultschitzky):

2012201357


58/379

2012201358


59/379

2012201359


60/379

: ,

2012201360


61/379

2012201361


62/379

7080m2

:70mL , >200mL ,

=10mmHg ,

>50m

2012201362


63/379

2012201363


64/379

3

,,, ,,. =120mmHg =80mmHg

1/3

2012201364


65/379

2012201365


66/379

2012201366


67/379

()

, (, ,

( ,

( ,,)

2012201367


68/379

()

()

(NANC) ( )

(NANC

():, P

: ,vasoac veintestinalpeptide (VIP)

2012201368


69/379

2012201369


70/379

2012201370


71/379

,

:

centralpatterngenerator(CPG)

2012201371


72/379

/

2012201372


73/379

2012201373


74/379

(35)

: 1cm, ~5cmH2O

: 10cm,

150200cmH2O

2012201374


75/379

(1

3: 3:

20122013

75


76/379

:

():

/

2012201376


77/379

.

( ), , ,

.

, GuillainBarre, ,

,

2012201377


78/379

1. .

3.

2012201378


79/379

250/ 20122013

79


80/379

A,B,

C,D,D: ( ) B,C:

20122013

80


81/379

)

Clara

2012201381


82/379

1.

2012201382

2. 3. KOHN

4. LAMBERT


83/379

2012201383


84/379

.

.

(HYALINE MEMBRANEDISEASE,

(INFANTRESPIRATORY DISTRESSSYNDROME,RDS) 1959Avery Mead

. HMD, RDS,

. .

.

.

2012201384


85/379

2012201385


86/379

4:

3 Reid1.

2. 8,

3.

16

2012201386


87/379

:

( )

)

)

(PaO2100mmHg)

20122013

87


88/379

(11)

(FVC,FEV1) 25)

2012201388


89/379

1% /

,

,

20122013

89

1


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.2.

3.

,, .4.

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20122013

90

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).8.

.

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20122013

91

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12.

13.

, .14.

20122013

92


93/379

) .

.) . .) .

A)21% 79%.

.)21% 79%.)21% 79% .E) .

20122013

93


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) .

.) . .) .

A) .

.) .) .E) .

20122013

94


95/379

) .B) .

.) .) .

;A

. .

) .

) .

20122013

95


96/379

) .

.) . .) .

A) .

.) .) .E) .

20122013

96


97/379

.

B) .

) .) .) .

A) CO2

2.B) 0,8.) 0,7 1,0.) .

E) .

20122013

97


98/379

.

B) .

.

) . .

(8848), 253mmHg.HFiO2 PO2 ,A)0,10 200mmHg )0,25 50mmHgB)0,15 250mmHg )0,30 350mmHg

)0,21 53mmHg

20122013

98


99/379

.

B) .) .

.) .) .

;A)

B) )

) )

20122013

99


100/379

. MDPhD

[email protected]


20122013

100

.


101/379

.

3.

4.

5.

6.

7.

20122013

101

:


102/379

: :

=

20122013

102

(4) (4)


103/379

( ) ( ).

(tidalvolume,VT)2.

. (inspiratory capacity,IC=VT+IRV)

(inspiratory reservevolume,IRV)

2. (functionalresidualcapacity,FRC

3.

ex irator reserve

= +

3. vitalca acit VC=VT+IRV+volume,ERV)

4. ERV)

4. =, ,

+ERV+RV=IC+FRC)

20122013

103


104/379

20122013

104

4


105/379

20122013

105

: = .

(VL = VCW)


106/379

20122013

106

1.


107/379

. 6070%TLC

3. ()

1 2

FRC

20122013

107

:V=10%TLC

:V=6070%TLC


108/379

20122013

108

1.


109/379

10%TLC(6070%TLC


110/379

RV,FRCTLC

FRC TLC()

FRC TLC

( )

20122013

110

3. ()

+


111/379

FRC V>FRC

FMUS=(FL+FCW)

V=FRC,FMUS=0 RVTLC

RV()

TLC

,

)

20122013

111

( )


112/379

20122013

112

> 75%TLC


113/379

IRV ERV

RV/TLC


114/379

, , , , , , FRC

RV,TLC

TGV,thoracicgasvolume~TLC

RV,FRC

> )

20122013

114


115/379

VT

VC,FVC,FEV1,FEV1/FVC VCVT:IRV,ERV :RV,TLC,FRC

20122013

115

( TLC)


116/379

20122013

116

FRC VC = 4 L VT =


117/379

VC=4L,VT=0,5L,IRV=2,5L ERV=1L FRC . FRC ,

=0,1% V1=10L.

0,08%.

RV TLC;

;

20122013

117

C1 x V1 = C2 x (V1 + V2) V2 = FRC


118/379

C1xV1=C2x(V1+V2) V2=FRC,

FRC=C1V1/C2 V1=V1x(C1/C2 1)

= x , , = x , = , RV=FRC ERV=2,5L 1L=1,5L

= = , = ,

RV/TLC =1,5L/5,5L=0,27

0,25.

.

, , ( )

.

20122013

118

( TGV)V


119/379

P1XV=P2(VV)

V=TGVVP1,2

TGV=P2/(P1P2)xV

20122013

119

TGV VC = 4


120/379

VC 4L,VT=0,5L,IRV=2,5L ERV=1L TGV . TLC

, TGV P1=100mmHg. .

=L P1=85 mmHg.

TGV; TGV TLC ;

20122013

120

P1 x V1 = P2 x V2 V1 = TGV V2 = TGV V,


121/379

P1xV1 P2xV2 V1 TGV V2 TGV V,

P1xTGV=P2x(TGVV)

= x TGV=85mmHg/ (100mmHg 85mmHg)x 1L

= ,

OTGV 0,2L TLC . 0,2L.

20122013

121

(..


122/379

TLC= TGV

TLC< TGV

20122013

122


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20122013

123

Compliance,static,Cst =,


124/379

, FRC

,specificcompliance,Csp=Cst/V,

,elastance,Est=P/V =

=

=

20122013

124


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20122013

125


126/379

20122013

126

,V =V


127/379

PL=PAPpl ( ) PW=Ppl PB( )

PBAtmosphere Prs=PA PB(

)

PB Atmosphere

PW

20122013

127

TLC


128/379

RV

http://oac.med.jhmi.edu/res_phys/

20122013

128

CE 00


129/379

0

C

D

E

0

CD

E 0

20122013

129

.


130/379

PB=0cmH2OP =0cmH OPpl=5cmH2O

V=0L/secV=FRC

20122013130

.


131/379

PB=0cmH2OP =1 cmH OPpl=7 cmH2O

V=0,5 L/secFRC+VT>V> FRC

20122013131

.


132/379

PB=0cmH2OP =0cmH OPpl=8 cmH2O

V=0L/secV=FRC +VT

20122013132

.


133/379

PB=0cmH2OP =+1 cmH OPpl=6 cmH2O

V=+0,5 L/secFRC+VT>V> FRC

20122013133

.


134/379


V=0L/secV= FRC

20122013134

.


135/379


V=20 L/secFRC


136/379


V=0L/secV= TLC

20122013136

8.


137/379

PB=0cmH2OP =+50 cmH OPpl=+40cmH2O

V=+25L/secFRC


138/379

(PW=

ew

FRC

() ()

() RV

,

20122013138


139/379

20122013139

HEIMLICH


140/379

(airway,)

20122013140

:,

Reynolds


141/379

Reynolds

e= rv >2000

20122013141

Poiseuille (F): :


142/379

: .

: + : =( )2

P r

L R

20122013142

resistance,airways Raw


143/379

airways,Raw

8

>2mm

=1

cmH2O/L/sec

20122013143

awTLC awRV


144/379

Raw

,

RawHis,ACh,PG,TX,LT

20122013144


145/379

Raw:

20122013145

20%


146/379

80%

20122013146


147/379

20122013147

,


148/379

,

FRC

,equalpressurepoint,EPP:P

PL

=PAW

FRC


149/379

35

20122013149

0 0

EPP 2515


150/379

EPP 25

+50 +50

:

,

, ,

,

20122013150


151/379

20122013151

nsp exp ()


152/379

:

()Cd n

=

20122013

152

W=PxV


153/379

PV V

20122013153


154/379

20122013

154


155/379

20122013155


156/379

20122013156


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20122013157

. ,


158/379

,

.

, , , , .

.

. .

.

20122013

158


159/379

/

()

, (),

,

20122013159

FVC

FEV1

FEV1/FVC ~


160/379

RV ~

~

RV/TLC

Cst,Cdyn ~

W W W

f (RR)

20122013160


161/379

20122013161


162/379

20122013162

1. .

.


163/379

.3.

(Prs) .4. FRC,

Prs () () .

5. .

20122013163

6. ( , ()


164/379

.

7. ( ) ,

.. .

9.

.

20122013

164

10.

.11.


165/379

.12.

.13.

.14.

.

20122013165

15. , .

16. (,

,


166/379

. , , , .

17.

. , , .

.

, .

20122013

166

(FRC))


167/379

.B

.)

.

) .

) .

20122013

167

;) .B) .

) .


168/379

) .) .

A .B) .) .

) , . , .

20122013

168

) .


169/379

. .

)

.) .)

, .

) , . , .

) .

20122013

169

) FVC FEV1, FEV1/FVC .


170/379

) FEV1 FEV1/FVC , FVC. .

) TLC RV/TLC.

) .) , .) , .) .

.

20122013170

) FVC FEV1, FEV1/FVC .

) /


171/379

) FEV1 FEV1/FVC , FVC. .

) TLC RV/TLC.

) /

.) , .) , .

.) .

20122013171


172/379

. MDPhD

[email protected]


20122013172

.

.

3.


173/379

4.

5.

6.

7.

20122013

173

2

F


174/379

F

VV

D /

V/Q

Q

D

20122013174

FiO2

FiO2

PB


175/379

PB

20122013175

,,

,


176/379

. : , ,.

. 2(12L/min)

, , .

Venturi. , Venturi.

20122013176

VENTURI

VENTURI


177/379

VENTURI 100%2 O2,

, VAIR .FiO2 , VO2. en ur

VO2,

AIR

FiO2.

20122013177

VE =VTxRR= x


178/379

V =500mlx12 min

=6lt/min Vmax =FEV1x30 min

~100 lt/min (x 15)

: PAO2 PACO2

20122013178

VE =V+VDf x V = f x V + f x VVE =V+VDVE =volume,expiratory; V

A

=volume,alveolar; V volume dead


179/379

AVD =volume,dead;

E ,VA =ventilation,alveolar;

V =ventilation dead

VE ~ 500ml

VA ~ 350 ml~

VE ~ 6L

VA ~ 4L~D D

20122013

179


180/379

20122013180


181/379

20122013181

2

P

(F) -(P)

( mmHg)

0 21 0 20 0 13 0 12 0 06


182/379

0,21

0

0,20

0

0,13

0 05

0,12

0 05

0,06

0 07

0

0,79

0,06

0,74

0,06

0,75

0,06

0,75

0,07

0,81 1,00 1,00 1,00 1,00 1,00

20122013182


183/379

AaDO2 = /4 + 4 mmHg

20122013183

PAO2 = 0,21(76047)40/0.8

= 0,21x71350

= 100 mmHg

,

PAO2 = 1,0(76047)40/0.8


184/379

PAO2 1,0(760 47) 40/0.8

= 663 mmHg

PAO2 = 0,21(57047)40/0.8 PAO2 = 0,21(42047)40/0.8

= , x

= 60 mmHg

= , x

= 28 mmHg

20122013184

1

CO2()

2


185/379

( )

PACO2 = VCO2 X (PB-PH2O)/(VE-VD)

20122013185

PaO2 = 80-100 mmHg < PAO2

PaCO = 35-45 mmHg ~ PAO2

: PaO2 < 80 mmHg


186/379

g : PaCO < 35 mmH

: PaCO2 > 45 mmHg

20122013186


187/379

20122013187

.


188/379

20122013188

2.


189/379

20122013189


190/379

20122013190

+

=


191/379

20122013191

=

.

Bohr


192/379

Bohr

()

2.

Fowler

VD

20122013192


193/379

20122013193

=

, D mL, VT=500mL 12 (f=12/min). VA V ;

,


194/379

, T1= m . VA1 VD1;

, f2=.

VA2

VD2;

VD, f VT;

20122013

194

VD =VD/VTxVE=VD/VTx(fxVT)

=150mL/500mLx12/minx500mL 1

=1800mL

=1,8LV =fxV=fx(VT VD)

=12/minx(500mL150mL)

VD2 =VD2/VT2xVE2=VD2/VT2x(f2xVT2)

=150mL/500mL x30/minx500

=4200mL

=4,2L=4500mL= 4 5 L x 2 5


195/379

=4 5 L x2 5VD1 =VD1/VT1xVE1=VD1/VT1x(f1xVT1)

=150mL/1000mLx12/minx1000mLV2 =f2xV2=f2x(VT2 VD2)

=30/minx(500mL150mL)=1800 mL

=1,8 L(~)=10500mL

=10,5 L(x2,6)

1 = 1x 1= 1x T1 D1

=12/minx(1000mL150mL)

=

=10,2 L(x2,5)

20122013195

, T

( ,VD), ,V .

( VT),


196/379

( T), ( ,VD), ( ,VA).

20122013196

. VD=150mL, VT=500mL 12 (f=12/min). V V ;


197/379

, . VD=150mL, VT=2500mL 30 (f =30/min).

A VD;

20122013197

:

VD =VD/VTxVE=VD/VTx(fxVT)=150mL/500mL x12/minx500mL

=1800mL =1,8L

V =fxV=fx(VT VD)

=12/minx(500mL150mL)


198/379

=4200mL =4,2L

:

(

D = D Tx E= D Tx x T=150mL/2500mL x30/minx2500mL

,

= = , ,

V =fxV=fx(VT VD)

VD .

=70500mL =70,5L(x17)

20122013

198

1.

2.


199/379

~500mL (10% )

~

(1/10

20122013199


200/379

20122013200

1/3


201/379

( 200%

20122013201


202/379

1. :

20122013202


203/379

20122013203


204/379

2.

20122013204


205/379

3. PA

O2:

20122013205

Q


206/379

Q

20122013206


207/379

4. :

20122013207


208/379

20122013208

. . .


209/379

Pc:

p : ,

is: ,

PVR:,,

20122013209


210/379

20122013210


211/379

20122013211

SHUNT

-

-

-

100% 2


212/379

-

- 100%

20122013212

FiO2 = 0,21


213/379

,

20122013213


214/379

(SHUNT)

20122013

214

/

:VQ


215/379

Q

20122013215


216/379

20122013216

D

C2


217/379

2

T

20122013

217

PACO2 = PaCO2 = 35-45 mmHg

A 2 a 2 -shunt (2-3% )

AaDO = /4 + 4 mmHg


218/379

Pa/AO = PaO PAO

Pa/AO2 > 0,8

PaO2/FiO2

~ 500

20122013

218


219/379

20122013219

FiO2 AaDO2 a/APO2

0,21 15 0,8

, ,

0,40 26 0,8

0,50 32 0,8


220/379

0,60 40 0,8

1,00 60 0,8

20122013220

V/Q = 1


221/379

~~

~V

~Q~V/Q

~D

20122013

221

PAO2

V/Q = 1,0

70


222/379

70

40 ~

,

20122013

222

V/Q = 0,5

70


223/379

70

50

,

20122013

223

V/Q = 1


224/379

~

20122013224

V/Q = 0,5

DL = AD/T


225/379

80

20122013

225

(SHUNT)

=


226/379

~

V/Q = 1

/ V/Q = 0

20122013226

(SHUNT)


227/379

= ~

V/Q = 0,7

20122013227

V/Q

V/Q = 0,5


228/379

,

20122013

228

V/Q = 1


229/379

~

V/Q = 1

(SHOCK)

20122013229


230/379

~ ~

20122013230

PaO2 AaDO2 PaCO2 PaO2

PAO2 ~ ~

~

~


231/379

SHUNT ~ ~ SHUNT ~

~ ~

20122013231

PaO2 PaCO2

~ PAO2

(shunt)


232/379

V/Q

20122013232

40

.:

pH =7,40

PaCO2= 44mmHg

PaO2= 70mmHg AaDO2, PaO2/FiO2 Pa/AO2?

?


233/379

0 8.

20122013233

PAO2 =FiO2(PBPH2O)PaCO2/R

=0,3(76047)44/0,8

=161mmHg

PaO2/FiO2=70/0,3=233

AaDO2=PAO2 PaO2 Pa/AO2=PaO2/PAO2=16170mmHg

=81mmHg

= mm g mm g

=0,43


234/379

g

a (40/4+4mmHg=14mmHg). FiO2=0,30.

PaO2/FiO2 .ToPa/AO2 (0,75).

( shunt).

20122013234

1.

.2. (Pgas) (Fgas)

.3. .

O2,N2,

4. O2 .


235/379

. AaDO2, O2.

6. CO2

CO2.

20122013

235

7. CO2

(VA) , CO2.

. 40 mmHg.

9.

10. (VD) (VT).


236/379

. , .

12. .

20122013

236

13.

.14. 7

.15.

16. (PPA)

PLA T


237/379

PLA T .17.

..

.

20122013

237

19. (V/Q)

, .20. , V/Q 1 .

. .

22. , .

23. 8 : , PAO2,


238/379

, , ,

shunt, V/Q, .

20122013238

12 , 450

ml 150ml , ,:)2,9, 1,5 2,1.

B)5,4,1,8 3,6.

)6,8,1,8 5,0. 8 2 6 2 2 0 .)12,0,3,4 8,6.


239/379

= = = = = , , , , 1,0, (PAO2) )50mmHg.

.)110mmHg.

) VCO2. 100mmHg

.

20122013239

.B) .) .

.

) .


240/379

) >) =


241/379

)

) .)

.) .

20122013241

.B).) .

.) .

) .B) .


242/379

)

) .) . .)

20122013242

=

, .B) FiO2.) .

.) .

) .B) .


243/379

) .) (shunt). CO2 .) O2 ().

20122013243

. MDPhD


244/379

[email protected]


20122013244

.

.

3.

4.

5.

6.


245/379

7.

20122013

245

: :


246/379

20122013246

,2ER =

2=VO2/DO2=0,25

RQ R =VCO2/VO2

~0,8


247/379

=DO2

=VO2=

=VCO2= C2

= 2

20122013247

C2


248/379

T

Fick

D

= A x/x(1 2)

20122013248

:1.

2.


249/379

20122013249

1. enry

= Henry x

P=KhC C=P/Kh

Henry's ( 298,15K)

,

O2 769.23

C2/


250/379

H2 1282.05CO2 29.41

O2 = 770/30 = 26

2 .

He 2702.7

Ne 2222.22

Ar 714.28

CO 1052.63

20122013250

2.

Graham

, 1 / 2 = 2/ 1C2/O2 = O2/ CO2 = 32/44 = 0,86


251/379

20122013251

DCO2/DO2 = 26 x

0,86 ~ 22

-

25


252/379

!!!

L

Vgas = DL x (P1-P2)

20122013252

;

1. 2.

DL = A x D / T

Vgas = DL x (P1-P2)

1 2


253/379

20122013253

()/ (V) n x

=0


254/379

N=1=20 =2 x

V=n4/3r =n4/3(x/2) =n4/3x /8=4nx /83=x /6

A=n4r2

=14(x/2)2

=4x2

/4=x2

20122013254

=3

N=8 =23 =2

r=x/4


255/379

x

V=n4/3r =84/3(x/4) = 32/3x /64=x /6=V

A=n4r2

=84(x/4)2

=32x2

/16=2x2

=2A

20122013

255

=6

N=64=26 =2 r=x/8


256/379

x

V=n4/3r =644/3(x/8) = 256/3x /512=x /6=V=V

A=n4r2

=644(x/8)2

=256x2

/64=4x2

=2A=4A

20122013

256

20112012

600 1.0x

2

)

400

(

200

.

(x3

/6)

0 0.0

= 3 ~

()

, ,

( 0) 2 0 125 2


257/379

(=0), =x2=0,125m2

8 (=3), =2x2=0,25 m2

64 (=6), =4x =0,5 m 135000000 (=27), =512x2=64 m2

= = 2= 2 ,: =2829,500000000,=85m2

20122013257

)2 CO2

2 (

CO


258/379

COO2 ,

D

20122013

258

DL;DLO2

DLCO

DLHe

:

1 2 P1 P23 4

O2 2 3


259/379

O2 2 3CO2 1 3

He 4

N2 3

CO

20122013259

CO

0,3%CO He

10

( ) ,

DLCO = VCO/(PACOPaCO)

= VCO/PACO

DLCO/VA (


260/379

DLCO/VA( )

DLCO = 20-30 mL/min/mmHgDLCO/VA = 5-8 mL/mmHg/L

20122013260

CO

0,3%CO RV TLC 10. VCO =1,5mL/min,VA=4 L/min

PACO=0,1mmHg. CO; ;

DLCO =VCO/PACO

=1,5mL/min/0,1mmH

= 15 mL/min/mmHg


261/379

=15mL/min/mmHg DLCO/VA =15mL/min/mmHg/4 L/min

=3,75mL/mmHg/L

DLCO , , .

20122013261

1. (>97%)2. (


262/379

20122013262

()2

g :x65


263/379

20122013263

1. Gower1(22)2. Gower2(22)

. 4. F(22)

1

1. A(22) (>95%)

2 A2 (22) 1 5 3 5%


264/379

2. A2(22) 1.53.5%3. F(22).

.

20122013

264

HGB 1.

2.

(CO2)

(NO)

3.


265/379

20122013265

nm (910nm)


266/379

20122013266

SaO2=9698%

PvO2=40mmHg

SvO2=75%


267/379

2 PiO2 2

20122013267

,

2(

)


268/379

)

20122013268

O BOHR

2

2,3

pH

CO2 ( Bohr) , 2


269/379

2 +

RBC

20122013269

Hgb

Hgb

P.


270/379

Falciparum

20122013270

%Hgb CO(/ NO), 200(200000)

H b

Hgb

PCO=1mmHg

HbCO =13%


271/379

20122013271

2 1 Hgb 4

2

, Hgb 2:

Hgb 2

2(1,34mL O2/gr Hgb)

2:CO2=1,34x Hg xSO2CaO2=1,34mL/gx15g/dL x98%

~200mL O2/L

CvO2=1,34mL/gx15g/dL x75%~150mL O2/L


272/379

/ CaO2:1. ( SaO2)2. ( Hgb)

. ,2 Hgb

20122013272

2 (2DELIVERY,DO2) ,

D2 =CaO2xCO

=1 34x H b xSaO2xHRxSV

=1,34mL/gx15g/dLx98%x70/minx70mL

~200mL/Lx5L/min

~1000mL/min

V2 =(CaO2CvO2)xCO= , x g x a v x x

=1,34mL/gx15g/dLx(98%75%)x70/minx70mL

~50mL Lx5L min

~250mL/min


273/379

2

2,O2extractionration,O2ER=SaO2SvO21000%

UthSrensenOvergaardPedersen


274/379

Coopertest

20122013274

VO2 = = (SHOCK)

= , x g x a v x x VO2, 1. Hgb

2. SaO2

:

O2ER = SaO2 - SvO2 > 25%

(CO,MetHgb)

.

4 HR

1: ()2: ()


275/379

4. HR ( )3:

5. SV

4,5: ()

20122013275

( )

C H O + x + /4 - z/2 O ---> x CO + /2 H O

RQ R = VCO2/VO2

= + -

: 0,7 < R < 1,0

~ ,

/H/C


276/379

= .

(z ~ 0): R = 0,7

20122013276

CO2

CO2


277/379

20122013277

2

Haldane

( 2 CO2)


278/379

20122013278

1. CO2,HCO3()2.

( )

. ()

4.

5.


279/379

5.

20122013279

Henderson+

asse ac


280/379

20122013280


281/379

20122013281

= H

=pH

CO2

CO2

HCO3


282/379

HCO3

20122013282

HCO3

CO2

HCO3

HCO3 CO2


283/379

CO2

HCO3

: CO2

():

20122013283

1. CO2

2. CO2

4. ( HCO3)


284/379

20122013284


285/379

20122013285

pH=7,30PaCO2=50


286/379

()

20122013286

pH=7,33PaCO2=50


287/379

()

20122013287

pH=7,20PaCO2=50


288/379

20122013288

1. ()

.

2. ( pH),

, , , .

, .

.

4.


289/379

.5.

, .

20122013289

6. ,

,

25%, 1 4 2.7.

, , .

( Bohr).

9.

Haldane).10. .


290/379

. ().

20122013290

12.

) ).13.

( ) .

, .

15.

(DLCO) .


291/379

16.

.

20122013291

17.

..

.19. O2

, , , ,

, , ,


292/379

.

20122013292

20. O2

2>60mmHg 2 2


293/379

.

20122013293

23. pH

24.

25. pH ,

26. , pH

.

28.


294/379

20122013294

80100mmHg 9698%

)40mmHg 75%

)

)80100mmHg 75%

)

)

) F


295/379

)

) )

20122013295

)

)

) ( PCO2)

) (pH)


296/379

)

) )

20122013

296

)

)

)

)

)

p 7,4

>


297/379

)pCO2


298/379

) ) )

) )

20122013298

,

)30%

50%

)70%

)90%)

) >

) =


299/379

) =

)


300/379

20122013300

.

.

3.

4.

5.

6.

7.


301/379

7.

20122013301

=

: 1.

. ,

3.

:


302/379

20122013302


303/379

20122013303

(PTC),)

(APC)(

) DRG

, IX ,

) Boetzinger (PBC)(, ,

,

)

,


304/379

, )

20122013304

A ( ):

B (): , C C ( ):

:


305/379

. (+)

C.

20122013305

/


306/379

20122013306

,

PaO2) ( PaO2)


307/379

20122013307

(..

,

(.. ,).


308/379

20122013308


309/379

(PaCO2) (+)

.


310/379

20122013310

.

,,


311/379

.

20122013

311

( )

.


312/379

20122013312


313/379

20122013313


314/379

20122013314

/ . .

()


315/379

20122013315


316/379

20122013316

)

(/mi


317/379

L 20122013

317

CHEYNESTOKES

KUSSMAUL

BIOT


318/379

20122013318


319/379

20122013319

CO2

O2

1

2

1 ( ,)


320/379

20122013320

PaCO2

VE.

VE.


321/379

20122013321

CO2

1.

2.

CO2

.

2. 3.

(..)


322/379

)

4. 20122013

322

PaO2 VE. PaO2


323/379

.

20122013323

(.., ,), (.. IV NewYorkHeart

, . ., ,) PaCO2>45mmHg.

. ,

,

.

PaO2, PaCO2


324/379

. 20122013

324

,

PaO2

(PaO2>80mmHg). ,

, , .

, .


325/379

20122013325

, .

.

, ,

.

,


326/379

. . . 20122013

326

1.

,

.

2. :

P2, PCO2 pH, PCO2 pH.3. PCO2 .

4.

.

5. .


327/379

20122013

327

6.

.7. , 2 .

8.

PO2 5060mmHg.9.

PO2 60mmHg.

10.


328/379

. 20122013

328

)

oetz nger

)

)

)


329/379

20122013329

)

)


330/379

20122013330

)

)

)

)


331/379

20122013

331

)

)

)

)


332/379

) 20122013

332

. MDPhD [email protected]



333/379

20122013333

.

.

3.

4.

5.

6.

7.


334/379

20122013334

1.

2. .

4.

5.

6.

7.

.

9. . ,

11.


335/379

20122013335

2.

,

()

( ,70%)

()


336/379

20122013336

3.

(,

,)


337/379

20122013337

4. (,

)

( ,)

( )

(,)


338/379

20122013

338

5.

( )

: , ,.


339/379

20122013339

. (

1.

2.


340/379

20122013340

30

3

(

)

.

,,

:

,/ ,


341/379

20122013341

. =1015

=5L/min

~20 C

~370C


342/379

20122013

342

.


343/379

20122013343

. /

Waldeyer

/

IgA


344/379

20122013344

IgA


345/379

20122013345

MUCOSAASSOCIATEDLYMPHOIDTISSUE,MALT

,


346/379

20122013346

IgA

IgA

, IgA ,

.


347/379

20122013

347

1

(): IgE

Fc()

():

IgE

IgE


348/379

20122013

348

(..

,

)


349/379

20122013

349

Pneumocystis jirovecii

AIDS

,

, ,,).

(..AIDS, , ,) ,


350/379

.

20122013

350

,ADULT

SYNDROME,ARDS

(,, ,)

. ,

,

.


351/379

20122013

351

1.

( ) .

2. .

3.

..

.


352/379

20122013352

) , 250 .

) .

)

)

)

)

)


353/379

20122013353

)

) )

)

) )


354/379

20122013354

;

)

)

)

) Kupfer

)

)

) Clara

) Sertoli


355/379

20122013355

. MDPhD

[email protected] : www.molcellbiolu atras.net

2012 2013


356/379

20122013356

.

.

3.

4.

5.

6.

7.

2012 2013


357/379

20122013357

. 2 B

2. 3. 4. 5.

(shunt)6.

(shunt)

7. /

8.

2012 2013


358/379

20122013358

= (shock)

VO2 =COx(CaO2 CvO2)

=1,34xHgbxHRxSV x(SaO2 SvO2)

1. Hgb (,)

. a , , e g

3. SvO2 ()

5. SV (,)

20122013


359/379

2012 2013

359

1. / PCO2

2.

PACO2=VCO2x(PB PH2O)/VA

A= E D

(

)

ACO2 CO2 B H2O E D

( )

.

20122013


360/379

2012 2013360

:

()

( ) ( )

( )

20122013


361/379

361

,

(~10%).

,

/ ,

/

20122013


362/379

362

()

>30 x~ ~ ,

).

,

( )

/ ,

, ,

20122013


363/379

363

:

( )

(,)

20122013


364/379

364

(IDIOPATHICPULMONARYFIBROSIS,IPF)

,

,

20122013

365


365/379

365

() /

:0.260.1ml/kg

,

,,,

: , ,

20122013

366


366/379

366

(INFANTRESPIRATORYDISTRESSSYNDROME,RDS)

,

20122013367


367/379

367

airway,

(

breathing,

, ,

,)

C cardiac function

( , )

20122013368


368/379

368

(90/100.000/ =9000

) ,

()

,

20122013

369


369/379

369

20122013370


370/379

20122013371


371/379

20122013372


372/379

(cysticfibrosistransmembrane,

508

20122013

373


373/379

GMCSF GMCSF

20122013

374


374/379

(SLC34A2)

()

20122013

375


375/379

1.

,

, .

2. ,

, .

3.

20122013

376


376/379

) .

) .

)

) )

)

) )

20122013

377


377/379

) ,

) ,

) , ,

, ,

20122013

378


378/379

)

) ( )

)

( ))

)

53

20122013

379


379/379

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