中山医科大学病理生理学ppt课件肺部疾病

万用卡 Respiratory Failure The department of pathophysiology SUN Huilan O2 CO2 CO2 External respiration circulation Internal respiration What is respiratory failure Respiratory failure is a pathological process In which the external respiratory dysfunction leads to an abnormal decrease of arterial partial pressure of oxygen with or without carbon dioxide retention. How to Judge respiratory failure （1）PaO2 6.6 kpa（50mmHg） classification of RF： Hypoxemic(Group ）RF（1） Hypercapnic（ Group ）RF（1）（2） Etiology and Pathogenesis of RF Ventilatory disorders Diffusion disorders Ventilation-perfusion imbalance Anatomic shunt Etiology and Pathogenesis of RF (1) Ventilatory disorder Restrictive Ventilatory disorders Obstructive Ventilatory disorders Restrictive Ventilatory disorders Paralysis of the respiratoy muscles Decreased compliance of chest wall Decreased compliance of lungs Hydrothorax or pneumothorax Etiology and Pathogenesis of RF (1) 大脑皮层调节呼吸肌作随意运动 脑桥、延髓不随意的自主节律呼吸调节 脊 髓 肋间神经 肋间肌 肋骨、胸骨 隔肌 胸膜及胸膜腔 胸 廓 外伤、中毒 出血、感染 脊髓灰质炎、高位截瘫 多发性神经炎 重症肌无力、多发性肌炎 大量腹水、上腹巨大肿物 外伤、骨折 气胸、大量胸腔积液 Etiology and Pathogenesis of RF (1) Central airway obstruction Peripheral airway obstruction Obstructive Ventilatory disorders O2 CO2 CO2 O2 口 鼻 喉头 肺泡 气管、支气管 肺泡膜 肺血管 意外 异物 水肿 炎症 异物 异物 肿瘤 哮喘 肺水肿 肺泡癌 炎症 纤维化 间质 水肿 休克 栓塞 Central airway obstruction Peripheral airway obstruction Extrathoracic variable obstruction expirationinspiration Intrathoracic variable obstruction expirationinspiration nomal Chronic bronchitis emphysema 20 30 20 35 0 10 20 0 10 20 20 20 25 20 20 20 20 Peripheral airway obstruction Blood gas Low PaO2 and High PaCO2 Ventilatory disorders O2 CO2 CO2 O2 口 鼻 喉头 肺泡 气管、支气管 肺泡膜 肺血管 意外 异物 水肿 炎症 异物 异物 肿瘤 哮喘 肺水肿 肺泡癌 炎症 纤维化 间质 水肿 休克 栓塞 Etiology and Pathogenesis of RF (2) Area of alveolar- capillary membrane Diffusion disorders Thickness of alveolar- capillary membrane Exchenge time O2 CO2 alveolar-capillary membrane surfactant Alveolar epitheliumCapillary endotheliocyte Blood gas Low PaO2 and nomal PaCO2 Diffusion disorders Etiology and Pathogenesis of RF (3) Local hypoventilation VA/Q Functional shunt Local hypoperfusion VA/Q Dead space like ventilation Ventilation- perfusion imbalance Blood gas Low PaO2 and Nomal or low or high PaCO2 Ventilation-perfusion imbalance Blood gas Ventilation-perfusion imbalance Functional shunt Damaged lung Nomal lung Whole lung V/Q0.8=0.8 0.80.80.80.8 PaO2 CaO2 PaCO2 N CaCO2 N Etiology and Pathogenesis of RF (4) Anatomic shunt abnormal anatomical shunt Be not ventilated at all Pulmonary arterio- venous fistulas Pulmonary edema Atelectasis Functional shunt and Anatomic shunt Anatomic shunt No blood gas exchange Applying O2 cant increase PaO2 Functional shunt blood gas exchange decrease Applying O2 can increase PaO2 Blood gas Low PaO2 Anatomic shunt ARDS adult/acute respiratory distress syndrome What is ARDS? ARDS is a common form of acute respiratory failure in adult that is characterized by dyspnea,hypoxia. Recognition of ARDS. History:Systemic or pulnonary insult Chest radiograph:Diffuse pulnonary infiltrates Respiratorydistress:Labored breathing,tachypnea Severe hypoxemia:refractory to treatment with supplement of oxygen Sequential development of ARDS Trauma,Shock,Infection and other causative factor Pulmonary hypoperfusion and hypoxemia Damage to epithelium Hypoxemia Damage to endothelium Platelet aggregation Increased vascular permeability Release of vasoactive substances Mechamical obstruction Stagnation of blood Leakage of fluid and plasma into lungs Noncardiogenic pulmonary edema or hemorrhageDecreased surfactant Alveolar fillingAtelectasis Pathogenesis of ARDS Stimulus Complement activation Pulmonary edema Lysosomal proteinase Active oxygen Pulmonary vasoconstiction Arachidonic acid metabolites Epithelial and endothelial Cell damage C5a Sequestration of neutrophils in lungs Increased pulmonary permeability Pulmonary hypertension Pathophysiology of ARDS causative factor alveolar-capillary membrane damage inflammation Pulmonary edema Pulmonary vasoconstriction Microvascular thrombus Diffusion disorders Pulmonary shunt Dead space ventilation Atelectasis Bronchia constriction Hypoxemia COPD Chronic obstructive pulmonary disease What is COPD? COPD is a kind of chronic obstructive ventilatory disorders caused by chronic bronchitis and emphysema Pathophysiology of RF in COPD COPD Peripheral airway obstructed and convulsion surfactant respiratory muscles failure diffusion membrane underventilated or Poor perfusion Obstructive ventilatory disorders Restrictive ventilatory disorders Diffusion disorders Ventilation- Perfusion mismatching Respiratory Failure Functional and Metabolic Alterations in Respiratory Failure (1) 1.Metabolic acidosis K 、Cl 2.respiratory acidosis K 、Clor normal 3.respiratory alkalosis K 、Cl Acid-base disturbance Functional and Metabolic Alterations in Respiratory Failure (2) PaO2 30mmHg PaCO2 80mmHg Ventilation increase Ventilation depression 60mmHg 50mmHg 20mmHg 90mmHg medulla carotid Respiratory system 1 medulla medulla Functional and Metabolic Alterations in Respiratory Failure (2) Central depression PaCO2 Cheyne-stokes respiration Central excitement PaCO2 Respiratory system 2 Functional and Metabolic Alterations in Respiratory Failure (3) Pulmonary hypertension Hypoxia、Hypercapnia 【H】 Pulmonary embolism、 Pumonary ateriolitis Pulmonary ateriolosclerosis right ventricle Afterload polycythemia Blood viscidity Hypoxia acidosis Dyspnea Heart extrusion Cardiovascular system chronical Heart failure R Functional and Metabolic Alterations in Respiratory Failure (4) acidosis Hypoxia Cerebrovascular Vasodilation Damage endothelium ATP NaK