呼吸系统教学课件：04 ventilation.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Ventilation of the Respiratory System,The Importance of its Lack of Uniformity in Disease,Reference,P,62,76,P,220,-,224,P 471 475,Outline,Pulmonary,Volume and,Capacity,Dead Space,3,I Pulmonary Volume and Capacity,Pulmonary,Volume,（肺容积）,P,ulmonary,Capacity,（肺容积）,F,orced Vital Capacity,Spirometric,Abnormalities in Disease,5,Pulmonary Volumes,Tidal volume(,潮气量）,Volume of air inspired or expired during a normal inspiration or expiration(400,500 ml),Inspiratory reserve volume,（补吸气量）,Amount of air inspired forcefully after inspiration of normal tidal volume(1500,2000 ml),Expiratory reserve volume,（补呼气量）,Amount of air forcefully expired after expiration of normal tidal volume(900,1200 ml),Residual volume,（残气量，,RV,）,Volume of air remaining in respiratory passages and lungs after the most forceful expiration(1500 ml in male and 1000 ml in female),6,7,Pulmonary Capacities,A Capacity is composed of two or more volumes,I,nspiratory capacity,（深吸气量）,Tidal volume plus inspiratory reserve volume,Functional residual capacity,（功能残气量,FRC,）,Expiratory reserve volume plus the residual volume,Vital capacity,（肺活量,VC,）,Sum of inspiratory reserve volume,tidal volume,and expiratory reserve volume,T,otal lung capacity,（肺总量,TLC,）,Sum of inspiratory and expiratory reserve volumes plus the tidal volume and residual volume,8,9,RV/TLC,Normally less than 0.25,Increase by the obstructive pulmonary disease(RV),Increase during the restrictive lung disease(TLC),10,FVC-forced vital capacity(cont),Defines maximum volume of exchangeable air in lung(vital capacity),forced expiratory breathing maneuver,requires muscular effort and some patient training,Initial(healthy)FVC values approx 4 liters,slowly diminishes with normal aging,11,Significantly reduced FVC suggests damage to lung tissue,restrictive lung disease(fibrosis,，纤维化,),constructive lung disease,loss of functional alveolar tissue,FVC volume reduction trend over time(years)is key indicator,Intra-subject variability factors,age,sex,height,ethnicity,FVC-forced vital capacity(cont),12,FEV,1,-forced expiratory volume,(1 second),Defines maximum air flow rate out of lung in initial 1 second interval,forced expiratory breathing maneuver,requires muscular effort and some patient training,FEV,1,/FVC ratio,normal FEV,1,about 3 liters,FEV,1,needs to be normalized to individuals vital capacity(FVC),typical normal FEV,1,/FVC ratio=3 liters/4 liters=0.75,13,Standard screening measure for,obstructive,lung disease,FEV,1,/FVC reduction trend over time(years)is key indicator,calculate%predicted FEV,1,/FVC(age and height normalized),Reduced FEV,1,/FVC suggests obstructive damage to lung airways,episodic,reversible by bronchodilator drugs,probably,asthma,(,哮喘,),continual,irreversible by bronchodilator drugs,probably,COPD,（,chronic obstructive pulmonary disease,，慢性阻塞性肺病）,FEV1-forced expiratory volume(1 second),14,Volume(litres),Time(sec),Forced Vital Capacity-,FVC,Total Lung Capacity,Residual Volume,Spirometry,Forced Expiratory Volume in 1 sec-,FEV,1,1 sec,15,Restrictive and Obstructive Lung,Disease,Restrictive Lung Disease,fibrosis,pulmonary oedema,O,bstructive Lung Disease,asthma,bronchitis,eg,fibrosis/pulmonary oedema,Assessment,of,RESTRICTIVE,Lung Diseases,These are diseases that reduce the effective surface area available for gas exchange,Normal Lung Volume,Lung Volume in Restrictive Disease,17,REDUCED,Volume(litres),Time(sec),Vital Capacity,Total Lung Capacity,Residual Volume,Spirometry,RESTRICTIVE,lung disease,18,eg,asthma/bronchitis,Assessment of,OBSTRUCTIVE,Lung Diseases,These are diseases that reduce the diameter of the airways and increase airway resistance-,remember,Resistance increases with 1/radius,4,Normal Airway Calibre,Airway Calibre in Obstructive Disease,19,Forced Vital Capacity-,FVC,Forced Expiratory Volume in 1 sec-,FEV,1,FEV,1,80%of FVC,is Normal,or in words-you should be able to forcibly expire more than 80%of your vital capacity in 1 sec.,20,Forced Vital Capacity-,FVC,Volume(litres),Time(sec),Total Lung Capacity,Residual Volume,Spirometry,Forced Expiratory Volume in 1 sec-,FEV,1,1 sec,FEV,1,80%of FVC,OBSTRUCTIVE,lung disease,21,22,Spirometric,Abnormalities in Disease,Variable,Restrictive Disease,Obstructive Disease,FVC,FEV1,FEV1/FVC,0,FRC,+,RV,+,TLC,+,II Dead,Space,Area where gas exchange cannot occur,Includes most of airway volume,Anatomical dead space(=150 ml),Airways,Physiological dead space,=anatomical+non functional alveoli,24,Basic Structure of the Lung,V,D,A tube=Airway,(Trachea Bronchi Bronchioles),NO GAS EXCHANGE,DEAD SPACE,A thin walled Sac=Alveolus,Blood Vessels,GAS EXCHANGE,OCCURS HERE,V,A,Formula:Total Ventilation=Dead Space+Alveolar Space V,T,=V,D,+V,A,25,Physiological =Anatomical Dead Space,Dead Space +,Similar Concept:Physiological Dead Space,Diseased lungs:,Healthy Lungs,:,Blocked,Vessel,Additional Dead Space,Anatomical Dead Space=Airways(constant),V,A,V,D,26,Minute and Alveolar Ventilation,Minute ventilation,:Total amount of air moved into and out of respiratory system per minute,Respiratory rate or frequency,:Number of breaths taken per minute,Anatomic dead space,:Part of respiratory system where gas exchange does not take place,Alveolar ventilation,:How much air per minute enters the parts of the respiratory system in which gas exchange takes place,27,Expired CO,2,and,O,2,Concentration,Homework,Case 1.,Asthma:Obstructive Lung Disease.pdf,C,ase 2.,Chronic Obstructive Pulmonary Disease.pdf,C,ase 3.,Essential Respiratory Calculations.pdf,C,ase 4:,Interstitial Fibrosis Restrictive Lung Disease.pdf,