《肺功能不全——呼吸功能衰竭》由会员分享，可在线阅读，更多相关《肺功能不全——呼吸功能衰竭（95页珍藏版）》请在金锄头文库上搜索。
1、Pulmonary Insufficiency,肺功能不全,Department of Pathophysiology,肺通气,肺换气,气体在血液中的运输,组织换气,细胞内氧化代谢,外呼吸,内呼吸,图1 呼吸全过程示意图,肺,血液循环,组织细胞,3,The functions of the lung？,4,（非呼吸功能）,Non-respiratory function,5,（非呼吸功能）,Non-respiratory function,呼吸衰竭,Respiratory Failure,7,Concept and Types,Causes and Mechanisms,Functional
2、and MetabolicAlterations,Principles of Treatment,Respiratory Failure,8,Concept,Respiratory Failure,9,Diagnosis Criteria,PaO260mmHg(8.0kPa)With or withoutPaCO250mmHg (6.67kPa),Respiratory Failure,11,RFI 300时可诊断为呼衰,Diagnosis Criteria,Respiratory Failure,12,According to PaCO2,Types,Respiratory Failure,
3、13,Types,Respiratory Failure,根据发病的急缓： 急性 慢性,根据主要发病机制：通气性 换气性,根据原发病变部位：中枢性 外周性,14,Respiratory Failure,考考你：一健康登山运动员快速登上珠穆朗玛峰山顶后，出现气促、发绀。 测得PaO2低于60mmHg，而PaCO2不升高。问：该运动员发生了哪型呼衰？,15,Causes and Mechanisms,Respiratory Failure,16,Causes and Mechanisms,Respiratory Failure,17,Pulmonary ventilatory disorder,C
4、auses and Mechanisms,Respiratory Failure,18,吸气时肺泡的扩张受限引起的,Restrictive hypoventilation,Respiratory Failure,19,呼吸肌活动障碍,胸廓顺应性降低,肺顺应性降低,肺受压缩,Respiratory Failure,Restrictive hypoventilation,Causes and Mechanisms：,20,呼吸肌活动障碍,胸廓顺应性降低,Respiratory Failure,Restrictive hypoventilation,Causes and Mechanisms：,21
5、,呼吸肌活动障碍,胸廓顺应性降低,肺顺应性降低,Respiratory Failure,Restrictive hypoventilation,Causes and Mechanisms：,22,呼吸肌活动障碍,胸廓顺应性降低,肺顺应性降低,肺受压缩,胸腔大量积液 张力性气胸,Respiratory Failure,Restrictive hypoventilation,Causes and Mechanisms：,24,呼吸肌活动障碍,胸廓顺应性降低,肺顺应性降低,肺受压,Respiratory Failure,Restrictive hypoventilation,Causes and M
6、echanisms：,25,Obstructive hypoventilation,由气道狭窄或阻塞所致,气道自身病变,气道管腔被阻塞,气道周围组织病变等,Respiratory Failure,Causes and Mechanisms：,26,Obstructive hypoventilation,由气道狭窄或阻塞所致,气道自身病变,气道管腔被阻塞,气道周围组织病变等,Respiratory Failure,Causes and Mechanisms：,27,气道阻塞类型,中央性气道阻塞,外周性气道阻塞,气管分叉以上的气道阻塞,Respiratory Failure,Obstructive
7、 hypoventilation,28,Central airway obstruction,胸廓,（中央性气道阻塞）,Respiratory Failure,胸外段阻塞,阻塞减轻,气道内压大气压,胸内段阻塞,expiration,阻塞减轻,inspiration,32,气道阻塞类型,中央性气道阻塞,外周性气道阻塞,气管分叉以上的气道阻塞,Obstructive hypoventilation,Respiratory Failure,33,Peripheral airway obstruction,阻塞减轻,（外周性气道阻塞）,expiratory dyspnea,等压点上移至小气道,Resp
8、iratory Failure,34,用力呼气时，气道内压与胸内压相等的部位称等压点,正常人用力呼气,Respiratory Failure,35,+20,+20,+20,+20,+30,+35,+10,0,+20,正常人用力呼气,+20,+20,+20,+20,+35,+10,0,慢性支气管炎者用力呼气,Peripheral airway obstruction,Respiratory Failure,36,+20,+20,+20,+20,+30,+35,+10,0,+20,正常人用力呼气,等压点上移至小气道,Peripheral airway obstruction,Respiratory
9、 Failure,37,常见于慢性阻塞性肺病,Peripheral airway obstruction,阻塞减轻,（外周性气道阻塞）,expiratory dyspnea,等压点上移至小气道,Respiratory Failure,38,Pulmonary ventilatory disorder,Respiratory Failure,Causes and Mechanisms,39,PaO2 PaCO2,Pulmonary ventilatory disorder,Respiratory Failure,Blood gas alterations：,肺通气,肺换气,气体在血液中的运输,组
10、织换气,细胞内氧化代谢,外呼吸,内呼吸,图1 呼吸全过程示意图,肺,血液循环,组织细胞,41,PaO2 PaCO2,PaCO2的增值与PaO2降值成一定比例关系，其比值相当于呼吸商。,前提：单纯性通气不足,Respiratory Failure,Pulmonary ventilatory disorder,Blood gas alterations：,42,Pulmonary ventilatory disorder,Pulmonary gas exchange disorder,Causes and Mechanisms,Respiratory Failure,43,Pulmonary ga
11、s exchange disorder,Causes and Mechanisms,Respiratory Failure,44,Diffusion impairment,指肺泡膜面积减少或 异常增厚和弥散时间缩短引起的气体交换障碍。,Concept:,Respiratory Failure,(弥散障碍),45,肺泡膜厚度增加,肺泡膜面积减少,肺泡膜结构示意图,肺泡,毛细血管腔,红细 胞,O2,CO2,弥散时间缩短,Respiratory Failure,Diffusion impairment,(弥散障碍),Causes and Mechanisms:,46,肺泡膜病变静息时一般不出现血气异
12、常,Respiratory Failure,Diffusion impairment,(弥散障碍),Blood gas alterations：,10080604020,PO2 PCO2 (mmHg),PaO2,0 0.25 0.50 0.75,血液通过肺泡毛细血管时的血气变化,PaCO2,(s),40,46,PvCO2,PvO2,实线为正常人，虚线为肺泡膜病变患者,48,肺泡膜病变静息时一般不出现血气异常,肺泡膜病变在体力负荷增加时可引起PaO2, 但PaCO2不增高,Diffusion impairment,Respiratory Failure,(弥散障碍),Blood gas alte
13、rations：,10080604020,PO2 PCO2 (mmHg),PaO2,0 0.25 0.50 0.75,血液通过肺泡毛细血管时的血气变化,PaCO2,(s),40,46,PvCO2,PvO2,实线为正常人，虚线为肺泡膜病变患者,50,Causes and Mechanisms,Pulmonary gas exchange disorder,Respiratory Failure,51,最常见和最重要的机制,Ventilation-perfusion imbalance,(肺泡通气与血流比例失调 ),Respiratory Failure,52,部分肺泡通气不足,部分肺泡血流不足,
14、Ventilation-perfusion imbalance,Respiratory Failure,Type:,53,部分肺泡通气不足,Functional shunt (功能性分流),Respiratory Failure,Causes and Mechanisms:,54,又称静脉血掺杂(Venous admixture),Normal Functional shunt,肺泡,肺V,肺A,气道,部分肺泡通气不足,正常：仅占肺血流量3%，慢阻肺时：可达30%50%,Respiratory Failure,55,PaO2,PaCO2,部分肺泡通气不足Functional shunt (功能
15、性分流),（混合后的动脉血）,Respiratory Failure,Blood gas alterations:,部分肺泡通气不足,功能性分流,健肺,全肺,病肺,=0.8,0.8,0.8,代偿性通气增加,0.80.8,PCO2和PO2,血液氧和二氧化碳解离曲线,CO2和 O2 含 量,(ml/dl),氧解离曲线,CO2解离曲线,部分肺泡通气不足,功能性分流,健肺,全肺,病肺,=0.8,0.8,0.8,代偿性通气增加,59,PCO2和PO2,血液氧和二氧化碳解离曲线,CO2和 O2 含 量,(ml/dl),氧解离曲线,CO2解离曲线,部分肺泡通气不足,功能性分流,健肺,全肺,病肺,=0.8,0.8,0.8, , ,代偿性通气增加,0.80.8,61,N （oror）,PaO2,PaCO2,Respiratory Failure,部分肺泡通气不足Functional shunt (功能性分流),Blood gas alterations:,62,部分肺泡血流不足,dead space like ventilation(死腔样通气),
