祝同學們新年學習(xuéxí)進步！圓圓滿滿！第一頁，共四十九頁。Chapter1RespiratoryPhysiology

HongCao

第二頁，共四十九頁。Vocabulary第三頁，共四十九頁。vocabularyrespiratory：呼吸(hūxī)respiration：呼吸expiration：呼氣inspiration：吸氣respiratorycenter：呼吸中樞respiratorymuscle：呼吸肌inspiratoryneurone：吸氣神經元diaphragm：膈肌第四頁，共四十九頁。upperairway：上呼吸道(shànghūxīdào)lung：肺pharynx：咽larynx：喉trachea：氣管bronchi：支氣管terminalbronchioles：終末支氣管respiratorybronchioles：呼吸性支氣管alveolar：肺泡vocabulary第五頁，共四十九頁。intrapleuralpressure：胸內壓functionalresidualcapacity（FRC）：機能余氣量vitalcapacity（VC）：肺活量forcedvitalcapacity（VC）：用力(yònglì)肺活量residualvolume（RV）：余氣量totallungcapacity（TLC）：肺總容量closingcapacity（CC）：閉合容量theminuteventilation：每分通氣量vocabulary第六頁，共四十九頁。arterialcarbondioxidetension：動脈血二氧化碳分壓arterialoxygentension：動脈血氧分壓cerebrospinalfluid：腦脊液peripheralchemoreceptor：外周化學(huàxué)感受器centralchemoreceptor：中樞化學感受器respiratoryreflex：呼吸反射

vocabulary第七頁，共四十九頁。laryngospasm：喉痙孿airwayobstruction：氣道阻塞compliance：順應性surfactant：表面活性物質surfacetension：表面張力(biǎomiànzhānglì)hypoxicpulmonaryvasoconstriction：缺氧性肺血管收縮vocabulary第八頁，共四十九頁。deadspace：無效(wúxiào)腔anatomicaldeadspace：解剖無效腔respiratoryquotient：呼吸商oxyhaemoglobindissociationcurve：

氧離曲線Haldaneeffect：Haldane效應Bohreffect：Bohr效應secondgaseffect：第二氣體效應vocabulary第九頁，共四十九頁。1.1.1LungFunctions第十頁，共四十九頁。肺通氣肺換氣(huànqì)氣體運輸組織換氣氧化代謝第十一頁，共四十九頁。LungFunctionsLungsareasiteforgasexchangewiththeexternalenvironmentRegulationacid-basebalanceLungsareadefencemechanismLungsareabloodreservoirServeabiosyntheticfunction氣體(qìtǐ)交換外環境(huánjìng)酸堿平衡(pínghéng)貯血庫生物合成功能第十二頁，共四十九頁。

1.1.2LungStructure

第十三頁，共四十九頁。鼻腔(bíqiāng)喉氣管(qìguǎn)左主支氣管右主支氣管左肺右肺咽食道(shídào)膈肌第十四頁，共四十九頁。氣管支氣管細支氣管終末細支氣管呼吸(hūxī)性細支氣管肺泡管肺泡囊

傳導單位(dānwèi)呼吸單位(dānwèi)第十五頁，共四十九頁。肺泡(fèipào)內氣體肺泡(fèipào)內氣體基底膜毛細血管(máoxìxuèɡuǎn)內皮組織間隙毛細血管內血漿第十六頁，共四十九頁。1.2ControlofRespiration第十七頁，共四十九頁。中腦(zhōngnǎo)腦橋腦干呼吸(hūxī)中樞第十八頁，共四十九頁。頸動脈體主動脈體頸動脈竇主動脈第十九頁，共四十九頁。Respiration

CentralControl

PeripheralChemoreceptors

carotidandaorticbodies

Thecentralchemoreceptors

Lieinthefloorofthefourthventricleandareeithertheneuronesresponsibleforgenerationoftherespiratoryrhythmorarecloselyrelatedtothem.TheyarebestregardedassensorsofoxygendeliveryastheyrespondtobothadecreaseinPaCO2andinbloodflowrate.PeripheralControl

第四腦室(nǎoshì)呼吸(hūxī)節律頸動脈體主動脈體第二十頁，共四十九頁。1.3MechanicsofRespiration第二十一頁，共四十九頁。1.3.1LungVolumes肺容量(róngliàng)補吸氣(xīqì)量肺總容量(róngliàng)余氣量功能余氣量潮氣量補呼氣量第二十二頁，共四十九頁。1.3.2ComplianceBoththelungsandthechestwallrequireadistendingforce,usuallyexpressedasvolumechangeperunitofdistendingpressure:compliance

Thecomplianceisapproximatelylinearovermostoftherange,butislesswhenthelungissmallandnearlyfullyinflated.

Thelungexhibitshysteresis,i.e.thecompliancediffersduringinflationanddeflation.Thisisduetotheeffectofalveolarsurfactantandisabsentifthelungisinflatedwithafluid.順應性滯后肺表面活性物質第二十三頁，共四十九頁。LawofLaplace：P：回縮壓力P=2T/rT：肺泡(fèipào)表面張力r:肺泡半徑Ifthealveoliareregardedasaseriesofinterconnectedbubblesthenthenormalsurfacetensioneffectswouldensurethatthesmallerbubblesemptiedintothelarger.1.3.3Surfactant第二十四頁，共四十九頁。Infact,itdoesn’t!thepresenceofasurfaceactivematerial,secretedbythetypeIIalveolarcells,ensuresthatthisdoesnotoccur.表面活性物質第二十五頁，共四十九頁。1.3.4ResistanceTheflowofairintoandoutofthelungsisopposedbythefrictionalresistanceoftheairwaysThetypeofflowisimportant,withlaminarflowofferinglessresistancethantransitionalorturbulentflow.Laminarflowoccursatlowflowratesandinthesmallerbronchi.Inthelargerairwaysandatbranchesinthebronchialtree,turbulentflowmayoccur.Airwayresistanceisrelatedtolungvolume,decreasingasthelungexpands.Itisalsorelatedtobronchomotortoneandthethicknessofthemucosallayer.阻力(zǔlì)摩擦阻力層流(cénɡliú)湍流(tuānliú)粘膜層支氣管肌緊張(性)第二十六頁，共四十九頁。1.4MatchingofVentilation

andPerfusion第二十七頁，共四十九頁。1.4.1DistributionofPerfusionThedistributionofbloodflowwithinthelungsislargelyinfluencedbygravity.Intheerectposturethreedistinctzonesmaybedescribedasthreezones.Intheupperzone,thereisalmostnoflow.Inthemiddlezoneandthelowerzone,flowincreasesinthemoredependentareas.分配(fēnpèi)灌流(ɡuànliú)重力(zhònglì)第二十八頁，共四十九頁。1.4.2DistributionofVentilationSeveralfactorsensurethattheinspiredgasisdirectedtowardsthedependentpartsofthelungs.Themajorfactoristhecomplianceofthedifferentpartsofthelung.Thedifferentpartsofthelungareondifferentpartsofthecompliancecurve.通氣(tōngqì)順應性第二十九頁，共四十九頁。1.4.3Ventilation:perfusionratioNormalgasexchangerepuiresboththatalveoliareadequatelyventilatedandthattheyareperfusedwithpulmonarybloodatanappropriaterate.VA/Q=AlveolarventilationratePulmonarybloodflow通氣(tōngqì)/血流比值肺泡(fèipào)肺血流量第三十頁，共四十九頁。Anareaofthelungisperfusedbutinadequatelyventilated,VA/Qwillobviouslybereduced.Asaresult,thealveolarPO2fallsandthePCO2rises.Wherealveoliareventilatedbutnotproperlyperfused,VA/Qwillbeincreases.theyaddtothephysiologicaldeadspace.Intheabsenceofgasdiffusioninandoutofthepulmonaryblood,alveolarPO2risesandPCO2falls.生理無效腔第三十一頁，共四十九頁。1.4.4DeadSpaceThedeadspaceoftherespiratorysystemisthatpartwhichdoesnotparticipateingasexchange.Itcomprisestheanatomicaldeadspace,theupperairwayandtracheobronchialtreedowntotherespiratorybronchioles.Themoreusefulmeasureistheratioofdeadspace（Vd）totidalvolume（Vt）.Theratioisabout0.3undernormalcircumstances.無效(wúxiào)腔解剖(jiěpōu)無效腔支氣管樹第三十二頁，共四十九頁。1.5GasExchangeandCarriage第三十三頁，共四十九頁。肺換氣(huànqì)組織(zǔzhī)換氣第三十四頁，共四十九頁。肺泡(fèipào)組織細胞氧分子血紅蛋白(xuèhóngdànbái)氧合血紅蛋白(xuèhóngdànbái)Oxygentransport氧氣的運輸第三十五頁，共四十九頁。波爾效應第三十六頁，共四十九頁。

CarbonDioxidetransportCarbondioxidepassesinareversecascadefrommitochondriatoatmosphere.Itismuchmorewatersolublethanoxygenanddiffusesmorereadily.Carbondioxideismostlycarriedinthebloodasbicarbonateion（HCO3-）.二氧化碳(èryǎnghuàtàn)的運輸線粒體擴散(kuòsàn)碳酸氫根離子(lízǐ)第三十七頁，共四十九頁。Thehydrogenionisbufferedbyprotein,predominantlyreducedhaemoglobin（Haldaneeffect）andtheHCO3-diffusesintotheredcellinexchangeforchloride.ThereverseoccursinthelungsasCO2iseliminated.血紅蛋白(xuèhóngdànbái)氫離子氯離子第三十八頁，共四十九頁。1.6EffectsofAnesthesiaonRespiration第三十九頁，共四十九頁。ControlofRespirationMechanicsofRespirationMatchingofVentilationandPerfusionGasexchangeandCarriageIncreasedOxygenConsumptionSecondGasEffect

氧耗第二氣體(qìtǐ)效應第四十頁，共四十九頁。1.6.1ControlofRespirationThevolatileandintravenousanaesthetic

agentsandtheopioidanalgesicsalldepressrespirationanddecreasetheresponsivenesstoCO2.Otherrespiratoryresponsessuchascougharereducedduringanaesthesia.Thepatternofrespirationduringanaesthesiatendstoberegular.麻醉藥鎮痛藥第四十一頁，共四十九頁。1.6.2MechanicsofRespiration

TheinductionofanaesthesiaresultsinareductionintheFRCofabout0.5litre,probablyduetocranialdisplacementofthediaphragm.Thiseffectisgreatestafterneuromuscularblockade.膈肌頂位置(wèizhi)改變肌松藥麻醉(mázuì)誘導機械(jīxiè)通氣第四十二頁，共四十九頁。1.6.3MatchingofVentilationandPerfusion

Inductionofanaesthesiadoesnotaffectthedistributionofperfusionexceptthattheincreasedintrathoracicpressureofmechanicalventilationmayreducecardiacoutputandincreaseorcreatethezoneinthelungwherealveolarpressureexceedspulmonaryarterialpressure,thusincreasingdeadspace.胸內壓肺動脈壓肺泡(fèipào)壓第四十三頁，共四十九頁。Thedistributionofventilationisimpairedduringspontaneousrespirationandworsenedwithmechanicalventilationwhenthereisareductionintheventilationtothedependentpartsofthelung.自主(zìzhǔ)呼吸機械(jīxiè)通氣第四十四頁，共四十九頁。1.6.4GasexchangeandCarriageGasexchangeisimpairedduringanaesthesiaasoutlinedaboveandoxygencarriagemaybeimpairedbythereducedcardiacoutput.ByreducingthePaCO2

hyperventilationreducesoxygendeliverybyshiftingtheoxyhaemoglobindissociationcurvetotheleft.Thea