Phys Resp

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PHYSIOLOGY OF THE RESPIRATORY SYSTEM

Esi Afriyanti, S.Kp. M.kes

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FUNCTION • Menye'iakan O2 'an (e()*an+ CO2• Me()*an+ panas 'an *ap air

• Menin+katkan 'ara )a-ik /en0*s ret*rn1• Kesei()an+an asa( )asa• Men+ asi-kan s*ara, (enan+is, terta a, (en3i*(• Perta anan T*)*• Me()*an+, (0'ifikasi, akti/asi, n0nakti/asi 4at

t0ksik

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FUNCTION OF THE ORGAN

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FUNCTION OF THE !RONCHIAL TREE

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"ona perna#asan

• B0na k0n'*ksi ? trakea 91 – )r0nki0-*srespirat0ri*s 2

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FUNCTION OF THE AL$EOLI

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Se% penyusun a%&eo%us

• A-/e0-*s a'a-a kant*n+ *'ara )er'in'in+ tipis,'apat (en+e()an+, 'an )er)ent*k an++*r

• Ter'apat &

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• S*rfa3tant – "e3reasin+ s*rfa3e tensi0n 0f t e

a-/e0-ar a-- – C0(p0siti0n i.e. 'ipa-(it0i-

p 0sp ati'i-3 0-ine "PPC1, +-y3er0-, pr0tein, 3 0-ester0- synt eti3

– Ne )0rn )a)y HM"7R"S1 – P0siti/e 30rre-ati0n it ? T yr0i' 0,

+-*30k0rti30i', ins*-in an' s(0kin+

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Proses respirasi

9. #enti-asi par*

2. "if*si O2 'an CO2&. Transp0r O2 'an CO2

5. Re+*-asi respirasi

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$ENTILATION

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INSPIRATION

• An a3ti/e pr03ess t at nee'e' ener+y• Intera3ti0n )et een ?

– C0(p-ian3e 0rk – E-asti3 0rk – Tiss*e resistan3e 0rk – Air ay resistan3e 0rk

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COMPLIANCE

• C an+e in /0-*(e )e3a*se 3 an+e in press*re N0r(a--y ?

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ELASTIC RECOIL

• Ten' t0 )a3k t0 pre/i0*s p0siti0n.• E-asti3 re30i- 0f t e -*n+ ?

– Ten' t0 30--apse – L*n+ 30(p0siti0n F972 is e-asti3 fi)ers – Pre/ent )y s*rfa3tants

• E-asti3 re30i- 0f t e 3 est a-- ? – Ten' t0 sprin+s 0*t ar'

• 0t (*st )e eG*a-s s0 t e /0-*(e 30*-' )e0pti(*(

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AIR+AY RESISTANCE

• Para--e-e' )ran3 in+ s0 t e t0ta--y resistan3e iss(a--

• Ca*se' 0f )r0n3 030nstri3ti0n are ?

9. In3rease' /a+a- parasy(pat eti3 3a*se' )yirritati0n2. Se3reti0n 0f t e -03a--y 3 e(istry (e'iat0r

fr0( (ast 3e--, i.e ista(ine an' -e*k0triene&. In3rease' CO2 -e/e-

• Ca*se' 0f )r0n3 0'i-atati0n are ?9. A'rena-in at β 2 re3ept0r 2. Sy(pat 0(i(etik &. #IP

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TISSUE RESISTANCE

• T e a(0*nt 0f fri3ti0n if t ere isa)n0r(a-ity in t e -*n+ tiss*e, 3 est a--,'iap ra+( an' a)'0(ina- 0r+ans.

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E,PIRATION

• An passi/e pr03ess '*e t0 e-asti3 re30i- 0ft e -*n+ tiss*e an' 3 est a--

• N0 nee' ener+y• If t ere is a 'e3rease' in t e 'ia(eter 0f t e

)r0n3 ia- t en affe3t t e rate 0f e pirati0nan' ire' s0*n' appear

• An a3ti/e pr03ess -ike 'eep )reat e, *sin+an a33ess0ries 0f (*s3*-ar

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Otot Perna#asanOt0t inspirasi

Pernafasan n0r(a- ? 'iafra+(aRespirasi k*at? 'iafra+(a ; 0t0t respirasi

Ot0t respirasi9. Ot0t inspirasi *ta(a

'iafra+(a, (. inter30sta eksterna2. Ot0t ekspirasi aktif

(. re3t*s a)'0(inis, (. inter30sta-is interna-&. Ot0t inspirasi ta()a an

(. stern0k-ei'0(ast0i'e*s, (. ska-en*s, (.

serat*s anteri0r, (. -e/at0r s3ap*-ae

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Perna#asan pa-a .ayi

• K0ntak 'en+an *'ara -*ar • Asfiksia rin+an• Ran+san+an sens0ris k*-it• Hip0ksia 'an iperkapnia

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Me/anis0e perna#asan

• %'ara 3en'er*n+ )er+erak 'ari tekanantin++i ke tek. Ren'a +ra'ien tekanan1

& tekanan pa'a pernafasan /enti-asi19. tekanan at(0sfer )ar0(etrik1 ? tekananyan+ 'iti()*-kan 0-e )erat *'ara 'iat(0sfer ter a'ap )en'a 'i per(*kaan

)*(i =:< ((H+1

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2. Tekanan intra a-/e0-*s tek. Intrap*-(0na-is&. Tekanan intrap-e*ra tek. Intrat0raks1

=@: ((H+ saat istira at 5 ((H+1

Saat inspirasiRan+san+an s. frenik*s Tek Intraa-/e0-ar

t*r*n 9 ((H+ =@ ((H+1 tekintrap-e*ra t*r*n sa(pai =@5 ((H+

Saat ekspirasi tek intraa-/e-ar sa(pai =:9 ((H+ tek

intrap-e*ra =@> ((H+

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LUNG $OLUMES

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Pertu/aran 'as• TerDa'i se3ara 'if*si se'er ana (en+ik*ti

pen*r*nan +ra'ien tekanan parsia-

%'ara n0r(a- ?

= N 2, 29 O 2, CO 2, air, +as -ain =:<((H+

Se(*a setara 'en+an k0(p0sisiPN 2 8 = =:< ((H+ 8 :

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• "i i'*n+ terDa'i pen+en3eran*(i'ifikasi1 5= ((H+ 0-e *ap air

se in++a PO 2 9@< (( +, PN 2 @:& ((H+

• 'i a-/e0-*s ? PO 2 9

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Fa/tor yan' 0e0pen'aru)i -i#usier-ak* *k*( fi3k

6 8 J C. P. AM . J

6 8 ke3epatan nett0 'if*siJ C 8 +ra'ien k0nsentrasi 4atP 8 per(ea)i-itas (e()ran ter a'ap 4atA 8 -*as per(*kaan (e()ran 9

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Transportasi 'as

• Ke-ar*tan +as 'a-a( 'ara

+as Met0'e transp0rtasi 'a-a('ara

Persentaseyan+ 'ian+k*t

O2 Lar*t se3ara fisik Terikat ke e(0+-0)in

9,@>,@

CO 2 Lar*t se3ara fisik Terikat ke e(0+-0)inSe)a+ai )ikar)0nat HCO & 1

9<&<:<

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• i-a H) terikat O 2 0ksi e(0+-0)in H)O 21• i-a ti'ak terikat e(0+-0)in tere'*ksi• H) p*nya 5 tan+kai fe 5 (0-ek*- O 2• 9 +r H) (e()a a 9,&5 (- O 2

• i-a H) 'a-a( t*)* 9@ +r kapasitas O 2 'a-a( H) 9,&@ 9@ 8 2< (- n0r(a-1

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T*+as?• Cari-a 'efinisi 'an (ekanis(e efek )0 r

'an efek a-'ane (as*k 'a-a( *Dian• Ha- – a- yan+ (e(pen+ar* i k*r/a

'is0siasi 'an )a+ai(ana (ekanis(enya (as*k 'a-a( *Dian

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CONTROL OF !REATHING

• Ke3epatan ke'a-a(an )ernafas• ME"%LLA O LON ATA AN"

PONTINE. – Pontine respiratory 'roup PR 1

• ne*r0n e pirat0ry

• Ne*r0n inspirat0ry

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Contro% o# .reat)in'

– "R -orsa% respiratory 'roup1 , • afferent fr0( (e3 ani3 an'

3 e(0re3ept0rs.• Efferent ke 'iap ra+( 'an 0t0t

interk0sta• Pa(e0a/er 2inspirasi1

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Contro% o# .reat)in' – #R &entra% respiratory 'roup 1

• ne*r0n inspirat0ry an' e pirat0ry• Inaktif pa'a saat )ernafas tenan+, pentin+ pa'a

ekspirasi aktif 0t0t interk0sta interna 'an 0t0ta)'0(en

• (en+ a()at i(p*-s ke e pirat0ry ne*r0n.

• 0t4in+er 30(p-e . – ne*r0n e pirat0ry

– Afferent fr0( i+ er 3enter – In i)it i(p*-s fr0( ne*r0n ne*r0n inspirat0ry in "Ran' #R .

– sti(*-ate ne*r0n e pirat0ry in #R .

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Afferent t0 respirati0n 3enter fr0(• Hyp0t a-a(i3• M0t0r 30rte

• 3 e(0re3ept0rs Perifer – PO 2 yan+ ekstri(, PCO 2 -e(a 1 an' pH arteria- )-00'

• Centra- 3 e(0re3ept0rs

– pH 3ere)r0spina- f-*i' H; 'ari CO 2 yan+ )era'a 'i0tak it* sen'iri 1

– CO 2 ; H 2O H 2CO & H ; ; HCO & H

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3e0oreseptor peri#er

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• L*n+ Stret3 re3ept0r – Herin+ re*er Ref-e

• L*n+ Irritant re3ept0rs – C0*+ ref-e

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Pe0eri/saan #un'si paru

• Pe(eriksaan f*n+si /enti-asi (e-ip*ti pen+*k*ran /0-*(e par* 'a-a( k0n'isistatis 'an 'ina(is,

• Pe(eriksaan pert*karan +as (e-ip*tiana-isis +as ekspirasi 'an +as 'a-a( 'ara

ter(as*k pen+*k*ran PO2, PCO2 'an PH.

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SPIROMETRI

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Cont4

• #0-*(e Ti'a- #T1 ? D*(-a *'ara yan+'apat ke-*ar (as*k par* pa'a pernafasan )iasa @

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Cont4• Kapasita- /ita- #ita- Capa3ity1 ? D*(-a

*'ara yan+ 'apat ke-*ar (as*k par* 'en+an pernafasan 'a-a( 59

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Cont4

• Kapasitas t0ta- par* T0ta- -*n+3apa3ity7TLC1 ? D*(-a se(*a *'ara t0ta-'a-a( par* @&

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Isti%a) siste0 perna#asan

• "yspnea ? s*sa )ernafas• Hyperpnea ? pernafasan 'a-a( se)a+ai

sta'i*( per(*-aan 'yspnea

• Apn0e ? pernafasan yan+ )er enti• Pernafasan 3 eyne st0kes ? pernafasan yan+

(*-a2 'an+ka-, (akin -a(a (akin 'a-a(

sa(pai (aksi(a- ke(*'ian 'an+ka- -a+isa(pai ak irnya )er enti

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Isti%a) siste0 perna#asan

• Pernafasan K*s(a*- ? pernafasan yan+3epat 'an 'a-a(

• Pernafasan )i0t ? pernafasan yan+ ti'akterat*r

• Asp y ia ? (ati -e(as karena kek*ran+an

0ksi+en• Hyp0ksia ? ka'ar 0ksi+en 'a-a( Darin+an

yan+ ren'a

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Normal

RV

ERV

TV

IRV

FRC

VC

Restrictive

RV

ERV

TV

IRV

FRC

VC

Obstructive

RV

ERV

TV

IRV

FRC

VC

125

100

75

50

25

0

% N

o r m a

l T L C

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@9

Gan''uan &enti%asi

• restriksi, a'a-a +an++*an pen+e()an+an par*yan+ 'itan'ai 'en+an )erk*ran+nya /0-*(e par*.Pa'a restriksi, par* (enDa'i kak* se in++a 'ayatarik ke 'a-a( -e)i )esar (aka 'in'in+ 'a'a(en+e3i-, /0-*(e par* (en+e3i- 'an i+a(enye(pit.Se)a+ai para(eter 'i*k*r K# n0r(a- K# ><92< ni-ai '*+aan, restriksi K# >< ni-ai'*+aan, iperinf-asi K# F92< ni-ai '*+aan1.Kea'aan yan+ 'apat (eni()*-kan restriksi antara-ain ke-ainan parenki( par*, ke-ainan p-e*ra,ke-ainan 'in'in+ 'a'a, ke-ainan ne*r0(*sk*-er,ke-ainan (e'iastin*( 'an ke-ainan 'iafra+(a

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@2

• 0)str*ksi, a'a-a +an++*an sa-*ran napas )aik

str*kt*r (a*p*n f*n+si yan+ (eni()*-kan per-a()atan ar*s respirasi.Pa'a ke-ainan 0)str*ksi #R, KR$ 'an KPT naik,'apat t*r*n ata* n0r(a-.

e)erapa kea'aan yan+ (eni()*-kan 0)str*ksia'a-a -*(en n0r(a- tapi a'a (assa 'a-a(-*(en seperti sekret, )en'a asin+, t*(0r1,

-*(en (e(an+ (ene)a- pa'a per0k0k, )r0n3 itis kr0nis 'an as(a1, pa'a e(fise(ase)enarnya ti'ak a'a 0)str*ksi tetapi Darin+anyan+ (enyan++a )erk*ran+

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• Kapasitas #ita- Paksa a'a-a D*(-a *'arayan+ 'iekspirasi (aksi(a- se3ara paksasete-a inspirasi (aksi(a-. Para(eter ini

)er(anfaat ter*ta(a *nt*k (en+*k*r 'erasa-iran *'ara #%o51 ekspirasi yan+ 'i-ak*kan

'en+an sek*at k*atnya 'an sepanDan+ panDan+nya.

F$C 3$P

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FE$6 $EP6

• #0-*(e Ekspirasi Paksa 'etik 9 #EP91. #0-*(eeskpirasi paksa 'etik perta(a a'a-a D*(-a *'ara

yan+ 'iekspirasi (aksi(a- se3ara paksa pa'a 'etik perta(a. Pa'a 0ran+ n0r(a- -a(a eskpirasi )erkisar antara 5–@ 'etik 'an pa'a 'etik perta(a(a(p* (en+e-*arkan a a pernapasan se)esar

>< K# nya. Peni-aian a'anya 0)str*ksi pernapasan )er'asarkan atas )esarnya /0-*(e pa'a 'etik perta(a

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@@

• "en+an 'e(ikian fase 'etik perta(a terse)*t-e)i pentin+ 'aripa'a fase se-anD*tnya.

Interpretasi )esarnya #EP9 ti'ak )er'asarkanni-ai a)s0-*tnya, akan tetapi )er'asarkan per)an'in+annya 'en+an #EP9 pre-i(te- ata* per)an'in+annya 'en+an K#P S0ekar(an,

9 =>1. Maka ni-ai #EP9 a'a-a• #EP9 8 #EP9 7 K#P 1 9

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FE$6 AND F$C

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F%o57&o%u0e (ur&es

Peak flow

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Pu%0onary #un(tion su00ary

Obstructive

Disease

Restrictive

Disease

FEV 1.0 "e3rease' "e3rease'

FVC "e3rease' "e3rease'

FEV 1.0 /FVC "e3rease' %n3,an+e' 0rIn3rease'

Peak Flow "e3rease' "e3rease' 0r%n3,an+e'

RV/TLC In3rease' %n3,an+e'

Phys Resp

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