与机械通气相关呼吸生理知识

与机械通气相关呼吸生理知识The Respiratory System与机械通气有关的呼吸生理知识与机械通气有关的呼吸生理知识2.2.肺的防御功能：肺的防御功能：肺的防御功能：肺的防御功能：3.3.肺容积划分及通气功能：肺容积划分及通气功能：肺容积划分及通气功能：肺容积划分及通气功能：4.4.肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换5.5.呼吸动力学基础呼吸动力学基础呼吸动力学基础呼吸动力学基础6.6.呼吸的调节呼吸的调节呼吸的调节呼吸的调节1.呼吸系统解剖呼吸系统解剖5/5/20242 Respiratory tractRespiratory tract NoseNose Pharynx Pharynx upper respiratory tractupper respiratory tract LarynxLarynx Trachea Trachea lower respiratory tractlower respiratory tract Bronchi Bronchi Lungs-paired organs of respirationLungs-paired organs of respiration Function:supply the body with oxygen Function:supply the body with oxygen and to get rid of excess carbon dioxide and to get rid of excess carbon dioxide resulting from cell metabolismresulting from cell metabolism呼吸系统解剖呼吸系统解剖 以环状软骨下缘为界气管以环状软骨下缘为界气管以环状软骨下缘为界气管以环状软骨下缘为界气管5/5/20243The Trachea 气管Position:Position:extends from the lower extends from the lower border of cricoid cartilage(border of cricoid cartilage(环状软环状软环状软环状软骨骨骨骨)to the level of sternal angle()to the level of sternal angle(胸胸胸胸骨角骨角骨角骨角)(between T4)(between T4T5 vertebrae)T5 vertebrae)where it divides into right and left where it divides into right and left principal bronchiprincipal bronchi Structure featuresStructure features Consists of about 15Consists of about 1520 C-20 C-shaped incomplete tracheal shaped incomplete tracheal cartilages for patency cartilages for patency connected by smooth muscle connected by smooth muscle and connectiveand connective Carina of trachea Carina of trachea 气管气管气管气管隆突隆突隆突隆突 ridge of cartilage at ridge of cartilage at bifurcationbifurcation分歧分歧分歧分歧into principal into principal bronchibronchi5/5/20244Bronchi 支气管Right principal bronchus Right principal bronchus 右主支气管右主支气管右主支气管右主支气管 Shorter,wider,and more vertical than the Shorter,wider,and more vertical than the left,is about 2.5cm long,Leaves the left,is about 2.5cm long,Leaves the extend line of the middle line of trachea at extend line of the middle line of trachea at 25253030o o angle angle Foreign bodies are therefore more likely to Foreign bodies are therefore more likely to lodge in this bronchus or one of its lodge in this bronchus or one of its branchesbranchesLeft principal bronchus Left principal bronchus 左主支气管左主支气管左主支气管左主支气管 Narrower,longer,and more horizontal than Narrower,longer,and more horizontal than the right is about 5cm long,leaves the the right is about 5cm long,leaves the extend line of the middle line of trachea at extend line of the middle line of trachea at about 40about 405050o o angle angle5/5/20245Bronchial tree支气管树 Each principal bronchus Each principal bronchus divides into lobar divides into lobar bronchi bronchi(two on the left,(two on the left,three on the right),three on the right),each each of which supplies a lobe of which supplies a lobe of lung.of lung.Each lobar bronchus Each lobar bronchus then divided into then divided into segmental bronchi,segmental bronchi,which supply specific which supply specific segments of the lung.segments of the lung.5/5/20246Weibel ER:Morphometry of the Human Lung.Berlin and New York:Springer-Verlag,1963The Airways Conducting zone:no Conducting zone:no gas exchange occursgas exchange occursAnatomic dead space Transitional zone:Transitional zone:alveoli appear,but are alveoli appear,but are not great in numbernot great in number Respiratory zone:Respiratory zone:contain the alveolar contain the alveolar sacssacs5/5/20247Bronchopulmonary segmentsBronchopulmonary segments支气管肺段支气管肺段支气管肺段支气管肺段 Wedge shaped,with the base lying peripherally and the apex Wedge shaped,with the base lying peripherally and the apex lying towards the root of lungs,ten in each lunglying towards the root of lungs,ten in each lung Each with a segmental bronchus and branches of pulmonary Each with a segmental bronchus and branches of pulmonary arteryartery The veins lie both in and between segmentsThe veins lie both in and between segments5/5/20248 段支气管继之分段支气管继之分段支气管继之分段支气管继之分为小支气管、细为小支气管、细为小支气管、细为小支气管、细支气管、终末细支气管、终末细支气管、终末细支气管、终末细支气管等。支气管等。支气管等。支气管等。最终与具有呼吸最终与具有呼吸最终与具有呼吸最终与具有呼吸功能的呼吸性细功能的呼吸性细功能的呼吸性细功能的呼吸性细支气管、肺泡管、支气管、肺泡管、支气管、肺泡管、支气管、肺泡管、肺泡囊及肺泡相肺泡囊及肺泡相肺泡囊及肺泡相肺泡囊及肺泡相连。连。连。连。5/5/20249小气道的概念及其特点小气道的概念及其特点 直径直径直径直径2mm2mm 相当于第相当于第相当于第相当于第7 7级级级级以下的小支气以下的小支气以下的小支气以下的小支气管及细支气管管及细支气管管及细支气管管及细支气管 其最小管径可其最小管径可其最小管径可其最小管径可达达达达小气道的概念小气道的概念小气道的概念小气道的概念5/5/202410小气道的概念及其特点小气道的概念及其特点 管壁菲薄，炎症易波及气道全层及周围组织管壁菲薄，炎症易波及气道全层及周围组织管壁菲薄，炎症易波及气道全层及周围组织管壁菲薄，炎症易波及气道全层及周围组织 无软骨支持，在脱离纤维鞘嵌入肺组织后，管腔通畅性不象无软骨支持，在脱离纤维鞘嵌入肺组织后，管腔通畅性不象无软骨支持，在脱离纤维鞘嵌入肺组织后，管腔通畅性不象无软骨支持，在脱离纤维鞘嵌入肺组织后，管腔通畅性不象软骨性气道，易于受胸腔的压力变化的影响软骨性气道，易于受胸腔的压力变化的影响软骨性气道，易于受胸腔的压力变化的影响软骨性气道，易于受胸腔的压力变化的影响 支气管树的分布特点，决定了分级越高，管径越细。易阻塞支气管树的分布特点，决定了分级越高，管径越细。易阻塞支气管树的分布特点，决定了分级越高，管径越细。易阻塞支气管树的分布特点，决定了分级越高，管径越细。易阻塞 总截面积却大大增加，气流速度慢，以层流为主，其阻力占总截面积却大大增加，气流速度慢，以层流为主，其阻力占总截面积却大大增加，气流速度慢，以层流为主，其阻力占总截面积却大大增加，气流速度慢，以层流为主，其阻力占气道总阻力的气道总阻力的气道总阻力的气道总阻力的20%20%，难用测总阻力法发现。，难用测总阻力法发现。，难用测总阻力法发现。，难用测总阻力法发现。随着小支气管的随着小支气管的随着小支气管的随着小支气管的7 7级分级分级分级分支成支成支成支成20502050根时，总截面面积上升到，约为气管的根时，总截面面积上升到，约为气管的根时，总截面面积上升到，约为气管的根时，总截面面积上升到，约为气管的8 8倍。此后，又反复分成倍。此后，又反复分成倍。此后，又反复分成倍。此后，又反复分成6 6万余根终末万余根终末万余根终末万余根终末细支气管时，总面积达到了细支气管时，总面积达到了细支气管时，总面积达到了细支气管时，总面积达到了180cm2180cm2，是气管总截面面积的，是气管总截面面积的，是气管总截面面积的，是气管总截面面积的7272倍。倍。倍。倍。平滑肌相对丰富，改变小气道口径，控制气体流量，调节通平滑肌相对丰富，改变小气道口径，控制气体流量，调节通平滑肌相对丰富，改变小气道口径，控制气体流量，调节通平滑肌相对丰富，改变小气道口径，控制气体流量，调节通气、血流比。气、血流比。气、血流比。气、血流比。检查方法：流速容积曲线测定检查方法：流速容积曲线测定检查方法：流速容积曲线测定检查方法：流速容积曲线测定 ，闭合气量测定，闭合气量测定，闭合气量测定，闭合气量测定小气道的特点小气道的特点小气道的特点小气道的特点5/5/202411支气管上皮细胞支气管上皮细胞分布于整个气道分布于整个气道分布于整个气道分布于整个气道长长长长20um20um，宽，宽，宽，宽7um7um，基底部，基底部，基底部，基底部2um2um每个细胞有纤毛每个细胞有纤毛每个细胞有纤毛每个细胞有纤毛300300余根余根余根余根纤毛长纤毛长纤毛长纤毛长7um7um，每秒钟向前摆动，每秒钟向前摆动，每秒钟向前摆动，每秒钟向前摆动1000-15001000-1500次，可推动粘液层向上运动。次，可推动粘液层向上运动。次，可推动粘液层向上运动。次，可推动粘液层向上运动。纤毛对外界敏感纤毛对外界敏感纤毛对外界敏感纤毛对外界敏感纤毛柱状上皮细胞纤毛柱状上皮细胞5/5/202412支气管上皮细胞支气管上皮细胞夹杂在纤毛柱状上皮细胞之间夹杂在纤毛柱状上皮细胞之间夹杂在纤毛柱状上皮细胞之间夹杂在纤毛柱状上皮细胞之间其数目随支气管分级增加而减少其数目随支气管分级增加而减少其数目随支气管分级增加而减少其数目随支气管分级增加而减少平均平均平均平均1mm21mm2面积有面积有面积有面积有68006800个粘液细胞个粘液细胞个粘液细胞个粘液细胞粘液细胞包括杯状细胞及小粘液颗粒细胞粘液细胞包括杯状细胞及小粘液颗粒细胞粘液细胞包括杯状细胞及小粘液颗粒细胞粘液细胞包括杯状细胞及小粘液颗粒细胞二种细胞可互相转换。二种细胞可互相转换。二种细胞可互相转换。二种细胞可互相转换。粘液细胞粘液细胞5/5/202413纤毛细胞纤毛细胞杯状细胞杯状细胞goblet cellciliated cell5/5/202414支气管上皮细胞支气管上皮细胞基底细胞为锥形或多角形基底细胞为锥形或多角形基底细胞为锥形或多角形基底细胞为锥形或多角形位于上皮基膜上，与附近细胞以桥粒相连位于上皮基膜上，与附近细胞以桥粒相连位于上皮基膜上，与附近细胞以桥粒相连位于上皮基膜上，与附近细胞以桥粒相连基底细胞分化能力强，可分裂自身、纤毛基底细胞分化能力强，可分裂自身、纤毛基底细胞分化能力强，可分裂自身、纤毛基底细胞分化能力强，可分裂自身、纤毛柱状上皮细胞及粘液细胞柱状上皮细胞及粘液细胞柱状上皮细胞及粘液细胞柱状上皮细胞及粘液细胞基底细胞基底细胞5/5/202415支气管上皮细胞支气管上皮细胞又称嗜银细胞又称嗜银细胞又称嗜银细胞又称嗜银细胞存在于各级支气管存在于各级支气管存在于各级支气管存在于各级支气管K K细胞分泌细胞分泌细胞分泌细胞分泌5-5-羟色胺、儿茶酚胺等，参与循羟色胺、儿茶酚胺等，参与循羟色胺、儿茶酚胺等，参与循羟色胺、儿茶酚胺等，参与循环及支气管平滑肌张力的调节。环及支气管平滑肌张力的调节。环及支气管平滑肌张力的调节。环及支气管平滑肌张力的调节。本身是化学感受器本身是化学感受器本身是化学感受器本身是化学感受器K细胞细胞5/5/202416支气管上皮细胞支气管上皮细胞呈柱状或立方状呈柱状或立方状呈柱状或立方状呈柱状或立方状分布细支气管以下分布细支气管以下分布细支气管以下分布细支气管以下能合成、分泌蛋白质，与能合成、分泌蛋白质，与能合成、分泌蛋白质，与能合成、分泌蛋白质，与型型型型肺泡细胞分泌的脂质共同组成肺泡细胞分泌的脂质共同组成肺泡细胞分泌的脂质共同组成肺泡细胞分泌的脂质共同组成表面活性物质，维持末梢气道表面活性物质，维持末梢气道表面活性物质，维持末梢气道表面活性物质，维持末梢气道及肺泡口径的稳定性及肺泡口径的稳定性及肺泡口径的稳定性及肺泡口径的稳定性Clara细胞细胞5/5/202417支气管上皮细胞支气管上皮细胞由由由由15-2015-20个细胞组成，呈菱形或卵圆形个细胞组成，呈菱形或卵圆形个细胞组成，呈菱形或卵圆形个细胞组成，呈菱形或卵圆形高高高高15um15um，宽，宽，宽，宽20-40um20-40um分布气道到肺泡，以细支气管分叉处最多分布气道到肺泡，以细支气管分叉处最多分布气道到肺泡，以细支气管分叉处最多分布气道到肺泡，以细支气管分叉处最多细胞内含有细胞内含有细胞内含有细胞内含有5-5-羟色胺等物质羟色胺等物质羟色胺等物质羟色胺等物质可能受中枢调节，具有内分泌功能的神经可能受中枢调节，具有内分泌功能的神经可能受中枢调节，具有内分泌功能的神经可能受中枢调节，具有内分泌功能的神经感受器感受器感受器感受器神经上皮小体神经上皮小体5/5/202418The Lungs 肺PositionPosition:located in the thoracic cavity located in the thoracic cavity by both sides of mediastinumby both sides of mediastinumGeneral featuresGeneral features Cone-shaped(Cone-shaped(圆锥圆锥圆锥圆锥),the right lung is),the right lung is shorter and broader,the left one is shorter and broader,the left one is longer and narrowerlonger and narrower Apex of lung(Apex of lung(肺尖肺尖肺尖肺尖)rises 2 rises 2 3 cm 3 cm above the medial third of clavicle into above the medial third of clavicle into neckneck BaseBaseconcave(concave(凹面凹面凹面凹面),related to),related to diaphragm(diaphragm(横隔膜横隔膜横隔膜横隔膜),also called),also called diaphragmatic surfacediaphragmatic surface Costal surface(Costal surface(肋面肋面肋面肋面)large,convex(large,convex(凸凸凸凸起的起的起的起的),related to thoracic wall),related to thoracic wall5/5/202419 Medial surface(Medial surface(纵隔面纵隔面纵隔面纵隔面)concave(concave(凹面凹面凹面凹面),related to mediastinum and vertebrae),related to mediastinum and vertebrae Hilum of lung Hilum of lung 肺门肺门肺门肺门：area on area on medial surface where structures in medial surface where structures in root enter or leave lung root enter or leave lung Root of lung Root of lung 肺根肺根肺根肺根 ContentsContents Principal bronchusPrincipal bronchus Pulmonary artery and veinPulmonary artery and vein Nerves and lymphaticsNerves and lymphatics Surrounded by connective tissue Surrounded by connective tissue 5/5/202420BordersBorders PosteriorPosteriorbluntblunt InferiorInferior sharp sharp AnteriorAnteriorsharpsharp cardiac notchcardiac notch心切迹心切迹心切迹心切迹 lingual in left lung lingual in left lung 左肺小舌左肺小舌左肺小舌左肺小舌Lobes and FissureLobes and Fissure Right lungRight lung Two fissures(Two fissures(裂裂裂裂):horizontal an):horizontal an oblique(oblique(倾斜的倾斜的倾斜的倾斜的)Three lobes:superior,middle,Three lobes:superior,middle,inferiorinferior Left lungLeft lung One fissure:obliqueOne fissure:oblique Two lobes:superior and Two lobes:superior and inferiorinferior5/5/202421呼吸系统解剖呼吸系统解剖呼吸系统解剖呼吸系统解剖-终末呼吸单位终末呼吸单位终末呼吸单位终末呼吸单位为终末细支气管以下的单位为终末细支气管以下的单位为终末细支气管以下的单位为终末细支气管以下的单位是进行气体交换的唯一场所是进行气体交换的唯一场所是进行气体交换的唯一场所是进行气体交换的唯一场所包括包括包括包括2 2个呼吸性细支气管个呼吸性细支气管个呼吸性细支气管个呼吸性细支气管每根再分级每根再分级每根再分级每根再分级3 3次，最后形成肺次，最后形成肺次，最后形成肺次，最后形成肺泡管、肺泡囊和肺泡泡管、肺泡囊和肺泡泡管、肺泡囊和肺泡泡管、肺泡囊和肺泡肺泡管由平滑肌肺泡管由平滑肌肺泡管由平滑肌肺泡管由平滑肌-弹力纤维网弹力纤维网弹力纤维网弹力纤维网络组成络组成络组成络组成终末呼吸单位终末呼吸单位终末呼吸单位终末呼吸单位5/5/202422肺肺泡泡与与肺肺血血5/5/202423呼吸系统解剖呼吸系统解剖-肺泡肺泡 平均内径平均内径平均内径平均内径200-250um200-250um 内面衬有肺泡上皮细胞内面衬有肺泡上皮细胞内面衬有肺泡上皮细胞内面衬有肺泡上皮细胞 壁内有丰富的毛细血管网及网状壁内有丰富的毛细血管网及网状壁内有丰富的毛细血管网及网状壁内有丰富的毛细血管网及网状纤维、弹力纤维和胶原纤维，网纤维、弹力纤维和胶原纤维，网纤维、弹力纤维和胶原纤维，网纤维、弹力纤维和胶原纤维，网眼内有巨噬细胞、成纤维细胞及眼内有巨噬细胞、成纤维细胞及眼内有巨噬细胞、成纤维细胞及眼内有巨噬细胞、成纤维细胞及肥大细胞肥大细胞肥大细胞肥大细胞 总数：总数：总数：总数：2-62-6亿之间亿之间亿之间亿之间 面积：面积：面积：面积：40-120m240-120m2(size of a(size of a tennis court)tennis court)有有有有1-21-2个肺泡孔与相邻肺泡相沟个肺泡孔与相邻肺泡相沟个肺泡孔与相邻肺泡相沟个肺泡孔与相邻肺泡相沟通通通通肺泡肺泡肺泡肺泡-多面型薄壁囊泡多面型薄壁囊泡多面型薄壁囊泡多面型薄壁囊泡5/5/202424呼吸系统解剖呼吸系统解剖-肺泡肺泡覆盖肺泡表面覆盖肺泡表面覆盖肺泡表面覆盖肺泡表面95%95%表面扁平，为血表面扁平，为血表面扁平，为血表面扁平，为血-气屏障的气屏障的气屏障的气屏障的主要成分。主要成分。主要成分。主要成分。型型型型肺泡上皮间的连接为绝肺泡上皮间的连接为绝肺泡上皮间的连接为绝肺泡上皮间的连接为绝对不可渗型，防止间质中蛋对不可渗型，防止间质中蛋对不可渗型，防止间质中蛋对不可渗型，防止间质中蛋白或液体流出、防止肺泡腔白或液体流出、防止肺泡腔白或液体流出、防止肺泡腔白或液体流出、防止肺泡腔内流体流入间质内流体流入间质内流体流入间质内流体流入间质易受损伤，如易受损伤，如易受损伤，如易受损伤，如ARDSARDS已分化完整，不能再生已分化完整，不能再生已分化完整，不能再生已分化完整，不能再生型肺泡上皮细胞型肺泡上皮细胞型肺泡上皮细胞型肺泡上皮细胞5/5/202425呼吸系统解剖呼吸系统解剖-肺泡肺泡覆盖肺泡表面覆盖肺泡表面覆盖肺泡表面覆盖肺泡表面5%5%大致圆形，体积小，但大致圆形，体积小，但大致圆形，体积小，但大致圆形，体积小，但数目多，是数目多，是数目多，是数目多，是型的倍。型的倍。型的倍。型的倍。型型型型肺泡上皮为型的后肺泡上皮为型的后肺泡上皮为型的后肺泡上皮为型的后备细胞备细胞备细胞备细胞型在分化过程中，其型在分化过程中，其型在分化过程中，其型在分化过程中，其胞浆较正常者为厚，降胞浆较正常者为厚，降胞浆较正常者为厚，降胞浆较正常者为厚，降低了弥散低了弥散低了弥散低了弥散型肺泡上皮细胞型肺泡上皮细胞型肺泡上皮细胞型肺泡上皮细胞5/5/202426表面活性物质表面活性物质(surfactant)肺泡肺泡肺泡肺泡型细胞分泌的二棕榈酰卵磷脂型细胞分泌的二棕榈酰卵磷脂型细胞分泌的二棕榈酰卵磷脂型细胞分泌的二棕榈酰卵磷脂(DPPC)(DPPC)5/5/202427 Type I pneumocytes 型肺泡细胞型肺泡细胞Type II pneumocytes 型肺泡细胞型肺泡细胞形形态态 squamous epithelial cells larger cuboidal cells 数数量量少，覆盖广少，覆盖广多，覆盖少多，覆盖少结结构构细胞器不发达，吞饮小细胞器不发达，吞饮小泡，细胞间紧密连接泡，细胞间紧密连接 嗜锇性板层小体嗜锇性板层小体内含表面活性物质内含表面活性物质功功能能facilitate gas exchang secrete surfactant 增生修复增生修复I I型细胞型细胞 肺泡上皮肺泡上皮:5/5/202428The Pleura 胸膜General featuresSerous membranes Serous membranes forming closed sacsforming closed sacsTwo layersTwo layersVisceral(Visceral(内脏的内脏的内脏的内脏的)pleura)pleuraadheres to lung,adheres to lung,continuous with continuous with parietal pleura at root parietal pleura at root of lungof lungParietal(Parietal(体壁的体壁的体壁的体壁的)pleura)pleuralines the thoracic lines the thoracic cavitycavity5/5/202429 Two pleural layers Two pleural layers continue with each continue with each other at root of lung other at root of lung forming closed forming closed potential spacepotential spacepleural cavity pleural cavity 胸膜腔胸膜腔胸膜腔胸膜腔 Contains a small Contains a small amount pleural fluidamount pleural fluid Subatmospheric Subatmospheric pressure in itpressure in it5/5/202430Named parts of parietal pleura Cupula of pleura Cupula of pleura 胸膜顶胸膜顶胸膜顶胸膜顶 extends up into the neck,over the extends up into the neck,over the apex of lung,2apex of lung,23cm above the 3cm above the medial third of claviclemedial third of clavicle Costal pleura Costal pleura 肋胸膜肋胸膜肋胸膜肋胸膜 lines the inner surface of the wall lines the inner surface of the wall of the chestof the chest Mediastinal pleura Mediastinal pleura 纵隔胸膜纵隔胸膜纵隔胸膜纵隔胸膜Lines mediastinum Pulmonary ligament 肺韧带肺韧带肺韧带肺韧带 Diaphragmatic pleura Diaphragmatic pleura 膈胸膜膈胸膜膈胸膜膈胸膜 Lines diaphragmLines diaphragm5/5/202431 Costodiaphragmatic Costodiaphragmatic recesserecesse肋膈隐窝肋膈隐窝肋膈隐窝肋膈隐窝are are the slit-like intervals the slit-like intervals between costal and between costal and diaphragmatic pleurae diaphragmatic pleurae on each side,the on each side,the lowest point of pleural lowest point of pleural cavitycavityCostomediastinal Costomediastinal recess recess 肋纵隔隐窝肋纵隔隐窝肋纵隔隐窝肋纵隔隐窝on the left side on the left side between the between the mediastinal pleural mediastinal pleural and costal pleuraand costal pleuraPleura recesses 胸胸膜隐窝膜隐窝potential potential spaces of pleural spaces of pleural cavity which lungs cavity which lungs are not occupied in are not occupied in quiet respirationquiet respiration5/5/202432The Respiratory System与机械通气有关的呼吸生理知识与机械通气有关的呼吸生理知识1.1.呼吸系统解剖呼吸系统解剖呼吸系统解剖呼吸系统解剖3.3.肺容积划分及通气功能：肺容积划分及通气功能：肺容积划分及通气功能：肺容积划分及通气功能：4.4.肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换5.5.呼吸动力学基础呼吸动力学基础呼吸动力学基础呼吸动力学基础6.6.呼吸的调节呼吸的调节呼吸的调节呼吸的调节2.肺的防御功能：肺的防御功能：5/5/202433肺的防御功能肺的防御功能传导作用：自鼻到终末细支气管传导作用：自鼻到终末细支气管传导作用：自鼻到终末细支气管传导作用：自鼻到终末细支气管加温、加湿功能：喉以上为上呼吸道可调加温、加湿功能：喉以上为上呼吸道可调加温、加湿功能：喉以上为上呼吸道可调加温、加湿功能：喉以上为上呼吸道可调节节节节当到达肺泡时，都接近体温，相对湿度当到达肺泡时，都接近体温，相对湿度当到达肺泡时，都接近体温，相对湿度当到达肺泡时，都接近体温，相对湿度100%100%静息时呼出气消耗静息时呼出气消耗静息时呼出气消耗静息时呼出气消耗250ml250ml水分水分水分水分/天天天天吸入干澡、寒冷的气体可致呼吸道脱水、吸入干澡、寒冷的气体可致呼吸道脱水、吸入干澡、寒冷的气体可致呼吸道脱水、吸入干澡、寒冷的气体可致呼吸道脱水、纤毛功能减退。纤毛功能减退。纤毛功能减退。纤毛功能减退。经口咽呼吸与经鼻咽呼吸：调节差异不大经口咽呼吸与经鼻咽呼吸：调节差异不大经口咽呼吸与经鼻咽呼吸：调节差异不大经口咽呼吸与经鼻咽呼吸：调节差异不大经不经上呼吸道呼吸：差别大，须加温、经不经上呼吸道呼吸：差别大，须加温、经不经上呼吸道呼吸：差别大，须加温、经不经上呼吸道呼吸：差别大，须加温、加湿。加湿。加湿。加湿。吸入气体调节功能吸入气体调节功能5/5/202434肺的防御功能肺的防御功能成人每天吸入成人每天吸入成人每天吸入成人每天吸入10000-1200L10000-1200L空气空气空气空气每每每每L L空气含数百分悬浮颗粒空气含数百分悬浮颗粒空气含数百分悬浮颗粒空气含数百分悬浮颗粒滤过作用：滤过作用：滤过作用：滤过作用：10um10um2-10um2-10um：多在气道、支气管、细支：多在气道、支气管、细支：多在气道、支气管、细支：多在气道、支气管、细支管壁上管壁上管壁上管壁上：可达终末呼吸单位：可达终末呼吸单位：可达终末呼吸单位：可达终末呼吸单位0.3um 0.3um 像水蒸气，可呼出像水蒸气，可呼出像水蒸气，可呼出像水蒸气，可呼出呼吸性细支气管以下不含纤毛呼吸性细支气管以下不含纤毛呼吸性细支气管以下不含纤毛呼吸性细支气管以下不含纤毛过滤及清洁机制过滤及清洁机制5/5/202435肺的防御功能肺的防御功能咳嗽是一高度协调的复杂动作咳嗽是一高度协调的复杂动作咳嗽是一高度协调的复杂动作咳嗽是一高度协调的复杂动作咳嗽时截面积减少到原来的咳嗽时截面积减少到原来的咳嗽时截面积减少到原来的咳嗽时截面积减少到原来的16%16%气体可以气体可以气体可以气体可以85%85%的速度冲击的速度冲击的速度冲击的速度冲击咳嗽对气道分泌物多者尤其重要。咳嗽对气道分泌物多者尤其重要。咳嗽对气道分泌物多者尤其重要。咳嗽对气道分泌物多者尤其重要。咳嗽咳嗽5/5/202436The Respiratory System与机械通气有关的呼吸生理知识与机械通气有关的呼吸生理知识1.1.呼吸系统解剖呼吸系统解剖呼吸系统解剖呼吸系统解剖2.2.肺的防御功能：肺的防御功能：肺的防御功能：肺的防御功能：4.4.肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换肺泡气与血液的气体交换5.5.呼吸动力学基础呼吸动力学基础呼吸动力学基础呼吸动力学基础6.6.呼吸的调节呼吸的调节呼吸的调节呼吸的调节3.肺容积划分及通气功能：肺容积划分及通气功能：5/5/202437Pulmonary Function TestingThe Basics of InterpretationThe Basics of InterpretationProvide quantifiable,reproducible measurement of lung function5/5/202438ObjectivesIdentify the components of PFTsIdentify the components of PFTsDescribe the indicationsDescribe the indicationsDevelop a stepwise approach to interpretation Develop a stepwise approach to interpretation Recognize common patternsRecognize common patterns5/5/202439Pulmonary Function TestingPulmonary Function TestingWhich of the following is used to follow disease Which of the following is used to follow disease severity in COPD patients?severity in COPD patients?a.a.Total lung capacity(TLC)Total lung capacity(TLC)b.b.Degree of responsiveness to bronchodilatorsDegree of responsiveness to bronchodilatorsc.c.Forced vital capacity(FVC)Forced vital capacity(FVC)d.d.Forced expiratory volume in 1 secondForced expiratory volume in 1 seconde.e.e.Diffusing capacity(DLCO)e.Diffusing capacity(DLCO)5/5/202440DescriptionSpirometrySpirometryFlow Volume LoopFlow Volume LoopBronchodilator responseBronchodilator responseLung volumesLung volumesDiffusion capacity(DLCO)Diffusion capacity(DLCO)Bronchoprovocation testingBronchoprovocation testingMaximum respiratory pressuresMaximum respiratory pressuresSimple and complex cardiopulmonary Simple and complex cardiopulmonary exercise testingexercise testing5/5/202441Indications Diagnosis Evaluation of signs and symptomsEvaluation of signs and symptoms-exertional dyspnea,chronic cough exertional dyspnea,chronic cough Screening at-risk populationsScreening at-risk populationsEvaluation of occupational symptomsEvaluation of occupational symptomsMonitoring pulmonary drug toxicityMonitoring pulmonary drug toxicityAbnormal studyAbnormal study-CXR,EKG,ABG,hemoglobinCXR,EKG,ABG,hemoglobinPreoperative assessmentPreoperative assessment5/5/202442Indications Prognostic Assess severity Assess severity Follow response to therapy Follow response to therapy Determine further treatment goals Determine further treatment goals Referral for surgery Referral for surgery Disability Disability5/5/202443肺通气功能的指标肺通气功能的指标基本基本基本基本:肺容积肺容积肺容积肺容积肺容量肺容量肺容量肺容量5/5/202444肺容积肺容积(pulmonary volume)(pulmonary volume)肺容量肺容量(pulmonary capacity)(pulmonary capacity)1 1 潮气量潮气量潮气量潮气量(TV)1 (TV)1 深吸气量深吸气量深吸气量深吸气量(IC)(IC)2 2 补吸气量补吸气量补吸气量补吸气量(IRV)2 (IRV)2 肺活量肺活量肺活量肺活量(VC),(VC),用力肺活量用力肺活量用力肺活量用力肺活量(FVC)(FVC)3 3 补呼气量补呼气量补呼气量补呼气量(ERV)3 (ERV)3 用力呼气量用力呼气量用力呼气量用力呼气量(FEV,(FEV,时间肺活量时间肺活量时间肺活量时间肺活量)4 4 余气量余气量余气量余气量 (RV)4 (RV)4 功能余气量功能余气量功能余气量功能余气量(FRC)(FRC)5 5 肺总量肺总量肺总量肺总量 (TLC)(TLC)5/5/202445SpirometrySimple,office-basedMeasures flow,volumesVolume vs.TimeCan determine:-Forced expiratory volume in one second(FEVForced expiratory volume in one second(FEV1 1)-Forced vital capacity(FVC)-Forced vital capacity(FVC)-FEV-FEV1 1/FVC/FVC-Forced expiratory flow 25%-75%(FEF-Forced expiratory flow 25%-75%(FEF25-7525-75)5/5/202446Lung Volumes5/5/202447Spirometry5/5/202448Normal Spirometry5/5/202449Lung VolumesIRVTVERV4 Volumes4 Volumes4 Capacities4 CapacitiesSum of 2 or Sum of 2 or more lung more lung volumesvolumesRVICFRCVCTLCRV5/5/202450Tidal Volume(TV)IRVTVERVRVICFRCVCTLCRVVolume of air Volume of air inspired and inspired and expired during expired during normal quiet normal quiet breathingbreathing5/5/202451Inspiratory Reserve Volume(IRV)Inspiratory Reserve Volume(IRV)IRVTVERVThe maximum The maximum amount of air amount of air that can be that can be inhaled after a inhaled after a normal tidal normal tidal volume volume inspirationinspirationRVICFRCVCTLCRV5/5/202452Expiratory Reserve Volume(ERV)Expiratory Reserve Volume(ERV)IRVTVERVMaximum Maximum amount of air amount of air that can be that can be exhaled from exhaled from the resting the resting expiratory expiratory levellevelRVICFRCVCTLCRV5/5/202453Residual Volume(RV)IRVTVERVVolume of air Volume of air remaining in remaining in the lungs at the lungs at the end of the end of maximum maximum expirationexpirationRVICFRCVCTLCRV5/5/202454Vital Capacity(VC)IRVTVERV Volume of air that Volume of air that can be exhaled can be exhaled from the lungs after from the lungs after a maximum a maximum inspirationinspiration FVC:when VC FVC:when VC exhaled forcefullyexhaled forcefully SVC:when VC is SVC:when VC is exhaled slowlyexhaled slowly VC=IRV+TV+VC=IRV+TV+ERVERVRVICFRCVCTLCRV5/5/202455Inspiratory Capacity(IC)IRVTVERVMaximum Maximum amount of air amount of air that can be that can be inhaled from inhaled from the end of a the end of a tidal volumetidal volumeIC=IRV+TVIC=IRV+TVRVICFRCVCTLCRV5/5/202456Functional Residual Capacity(FRC)Functional Residual Capacity(FRC)IRVTVERV Volume of air Volume of air remaining in the remaining in the lungs at the end of a lungs at the end of a TV expiration TV expiration The elastic force of The elastic force of the chest wall is the chest wall is exactly balanced by exactly balanced by the elastic force of the elastic force of the lungsthe lungs FRC=ERV+RVFRC=ERV+RVRVICFRCVCTLCRV5/5/202457Total Lung Capacity(TLC)IRVTVERVVolume of air in Volume of air in the lungs after a the lungs after a maximum maximum inspirationinspirationTLC=IRV+TV+TLC=IRV+TV+ERV+