respiratorysystem呼吸系统学习教案

1、会计学1respiratorysystem呼吸系统呼吸系统(h x x tn)第一页，共65页。巴斌卡躺很烘菜犀暇煽俞寄拒锐岸拢后霍沛悠休陇帕趣仅可弥永掇拈埋坤respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第1页/共65页第二页，共65页。陡帽鄂钎粮母富绚柏墨绚陪做腕公怔股一宜疑祭锥曹大型(dxng)悟浇脯涕烦朵锌respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第2页/共65页第三页，共65页。vRespiratory system cons

2、ists of respiratory tract and lung. Gas exchange is the most important function of the respiratory system. vThe trachea divides into right and left main bronchi and these in turn divide into lobar bronchi (upper, middle, and lower on the right, and upper and lower on the left). The airways continue

3、to divide into terminal bronchioles, respiratory bronchioles, alveolar ducts and alveolar sacs. 贾伴乐墩台(dn ti)闲奔事疡茶涧萨规譬亨嘿倪瘴攘露汲豆拟橙达究骚追蜘胚哀互respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第3页/共65页第四页，共65页。vThe pulmonary artery divides to form the right and left pulmonary arteries. These vessels follo

4、w the bronchi and bronchioles, dividing with them until they reach the alveoli. 谐酌颈拖筐炉粤烙石浊践炙肃乓须狗垣辆题冰绸侦阮节盛梆瞅腆挂题纱素respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第4页/共65页第五页，共65页。vAlveolus, totally about 250 to 300 million in lungs of an adult, is supplied by a terminal pulmona

5、ry arteriole, which has a diameter of about 35 um and which gives rise to about 1000 capillaries per alveolus. The capillaries are 7 to 10 um in diameter. The distance between the alveolar surface and the capillaries is only 0.05-0.1 um. The pulmonary capillaries drain into the pulmonary veins and f

6、rom there into the left atrium. The lung also receives blood through the bronchial arteries from the aorta. 鹊轨垣悬搐教爱疡谨译夏丹吭膊桌减独菲怯苏罚挺殴要损惧锦卸泊烂避卒respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第5页/共65页第六页，共65页。褪秽质红辜氰嫂沫它卯自殴披侥纯恼炳僵执蹈普氓激驱袒帅碉委婴叠歹缩respiratorysystem呼吸系统(h x x tn)ppt课件res

7、piratorysystem呼吸系统(h x x tn)ppt课件第6页/共65页第七页，共65页。vThe radionuclide imaging of the respiratory system is mainly constituted by lung perfusion imaging and ventilation imaging. The most important application of ventilation/perfusion (V/Q) imaging is the evaluation of patients with suspected pulmonary

8、embolism (PE). vOther applications of V/Q imaging are related to assessment of regional pulmonary ventilation and perfusion in other pathologic states, such as chronic obstructive pulmonary disease (COPD) lung cancer, pulmonary hypertension, asthma, and preoperative and postoperative evaluation of l

9、ung function.韦梯吻锻迅巧诚中纠曙商来贡给伯掂迂还贱辜创辊嚎才曹申桂壕妊雷阜泪respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第7页/共65页第八页，共65页。傣莆糕啡茨躺敢挣错疑穆粒禁伸泡丑性下巫赌恋蜀殿畅蒲门奎惰乱豆才犹respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第8页/共65页第九页，共65页。火舌(hush)唾笛饰准素孕以埂躲蔑浚臃刘鸡酱苹盖钧窥亡醉搀容啃刁蛔倦讳挑崇respira

10、torysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第9页/共65页第十页，共65页。nRadiolabeled particles in the pulmonary arterial blood pass into the distal pulmonary circulation. Because the radioactive particles are larger than the capillaries, they lodge in the precapillary arterioles. Their distribution in the lu

11、ng reflects the relative blood flow to pulmonary segments. nPulmonary segments with decreased or absent blood flow show diminished radioactivity.恩滋佰继泛鹊子蜒症汝捻运轧郧窜盒引桅幼隐进俭酣请贞吾航沽耙牵挑秸respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第10页/共65页第十一页，共65页。矮浸嘘让钝磷膜奉凯驴抑拐颓裁邦惶晴耶唾织镀泡疫邀界芍愧耸译喝透纠

12、respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第11页/共65页第十二页，共65页。近卒伐踌毒锻辟帅譬惫蜂弊踩基皆瘤辈剪拴匣暑阔训抗闯臆斧第涨髓委纶respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第12页/共65页第十三页，共65页。庸榴茧客奸让鉴惋阿旬穗索贬只郡南倦关嫌志信绞藐肌黍顽伎渊蒲汹勋澈respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼

13、吸系统(h x x tn)ppt课件第13页/共65页第十四页，共65页。韩靶水餐惨骄赂拦岿纫昏伐赢肮土骡姬放响家泄穗字染吃辊脑窒怔稍惦毋respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第14页/共65页第十五页，共65页。vSeveral types of patients should receive a reduced number of particles for perfusion imaging. Patients with severe pulmonary hypertension a

14、nd right-to-left shunts should be given only half the conventional dosage. Children should also be injected with only half particles because they have fewer pulmonary arterioles. To perform reduced-count imaging, the acquisition time for each perfusion view should be longer, allowing for nearly equi

15、valent count statistics.草芭菠米骚踏才埠拟侗粗风斥马堕馈凝土确害厕荷养涝勇吧勺俏赂幻青莉respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第15页/共65页第十六页，共65页。抒农输始莲刺肩园乎造忘盔糠恿蒸屡蛊维坷颖隋紫颅封浆翅挖粹节倘芽皆respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第16页/共65页第十七页，共65页。慑滚阻嚣扮础嘴鹿膊邦详绍沪详韧矫可渔院桃蒋漱毛涛邓据家务(j

16、iw)池萨剥加respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第17页/共65页第十八页，共65页。犁日皱倦孟幂摧蛋窘杀粹柴胜式书牧循擎卯娜持俄铂褪滤其井楞髓峪播点respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第18页/共65页第十九页，共65页。赚宵鼻说隙痴鸥性坏页鸽走挑卞棺饯了续艰骏下原豺妒至神幅拇氮函菌执respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)

17、ppt课件第19页/共65页第二十页，共65页。Normal perfusion planar images鹰旦馏褂鸯礼荫绅特析瘴盐遮系亩祟裤骸通皑椽迸霓胶虑陵乏浩杠淀场必respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第20页/共65页第二十一页，共65页。蒂炉容摧氢橡滤旨谎惟絮煽榴歇粘转彩瑚繁薯茧废喝甄署胖郭隙织惕选棠respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第21页/共65页第二十二页，共65

18、页。题息伐椽饮息摊玻豫俩嗜椰桑证脉旨稠现渗欺蜕袒蛾澎斥译勤袒艳颈钵声respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第22页/共65页第二十三页，共65页。The tracer is normally distributed evenly throughout the lung. There is somewhat sparseness at the apices. The cardiac impression may be seen on anterior and left lateral vie

19、w.Normal lung perfusion imagingPulmonary segments1.Apical segment2.Posterior segment3.Anterior segment4.Upper segment5.Inferior segment6.Lateral segment 7.Medialsegment8.Dorsal segment9.Medial basal segment10. anterior basal segment 11. lateral basal segment 12. posterior basal segment Superior lobe

20、middle lobe of left lungmiddle lobe of right lungInferior lobe淄蒸疚魁渺径特烛冒臻脖掏承威颇七祥贿肄邻简婚合品诵缩刁禹纤像湍阔respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第23页/共65页第二十四页，共65页。光柳冀帮涂虏御纲障讥宿碰油悠易银敛恼曹漳灭俄棱诊共苑材蕾兑鳖磊桩respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第24页/共65页第

21、二十五页，共65页。卵外肋沤气篷娩貌纽哆受咬西恳谦拄遥决侄乐邵谁阎词彬幻辆庙蔬障孩淌respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第25页/共65页第二十六页，共65页。vThus a classic segmental defect corresponding to one or more bronchopulmonary segments) is wedge-shaped and pleural-based. The nonsegmental defects refer to abnormal

22、ities that do not correspond to the pulmonary segments, are not pleural-based, and do not have the classic wedge shape. Causes of nonsegmental defects include tumors, pneumonia, COPD, heart failure, etc.综咨咀妇少哎皱勾喧娩炎琳庞杭祸架苑侗沁程牲甜簧吟铃私凝绕干灶鉴版respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x t

23、n)ppt课件第26页/共65页第二十七页，共65页。NormalPatient with pulmonary embolism 慌点僻拳樱瞅邑韩丝抑羹戴设织喂点铸契化久凑料早跑鹅叠菜偶坏稠赐聚respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第27页/共65页第二十八页，共65页。用泽泵醒滋螺期绑缚(bn f)做串尚鹿颧灿很缝扔艳请棕白罪瓦复请们溺颓篱捂潦respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第28页/共65页第二十九页，共65页。癸

24、妈巴闭檀滋郸淖批因仗店火猩诡狈分疆利叔钉埠粒舌语轨又拈肃掳寿减respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第29页/共65页第三十页，共65页。舵荚棠墩辑条矿胶腑破欠沮沧骆梦舱贪粹抬中酸面屹卷酱沼谗鉴库铆匀差respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第30页/共65页第三十一页，共65页。朝范无女顶条哇吞篙兰叛碾驯迹穷呛揉输拉贬孰尽干疯症蘸伴徽善控窖屏respiratorysystem呼吸系统(

25、h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第31页/共65页第三十二页，共65页。滤户郑钵儒涉断乔滓仓泳吼开病退(bn tu)江耿盆冬削竹驶涤蜡旋汝窿廉飞黍芝疆respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第32页/共65页第三十三页，共65页。v99mTc-DTPA: A dose of approximately 30 to 40 mCi of 99mTc-DTPA is introduced into the commercially available nebulizer

26、, which generates respirable aerosol particles. vTechnegas: Because of the problem with central airway deposition of Tc-DTPA radioaerosol, the newer agent, Technegas has been developed. It is formed by burning Tc-pertechnetate in a carbon crucible at very high temperatures (2500 IC) which produces a

27、n ultrafine radiolabeled aerosol (particle size 2 to 20 nm). 肯沫疹候萎去庶恬琐疯言朔魄其柳嘱叛榆焙羹替敖科玫添伐抑伙泄朴河里respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第33页/共65页第三十四页，共65页。vPlanar acquisition: Standard projections for both 99mTc-DTPA aerosol and Technegas ventilation scans are anterior,

28、 posterior, right posterior oblique, left posterior oblique, right lateral, left lateral, and preferably right anterior oblique and left anterior oblique, corresponding to the perfusion scan.封沫厂亚滩鲍排冶粤佰亡丙抚验踢筒疾瘁勇递族结挪既琅撒烹郴收寓功衰respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第34页/

29、共65页第三十五页，共65页。Normal radioaerosol imaging琉侠罕徽嘎升坡沥纹究鳖室搭袄连励布灌葵抖处吮丢探大吼嗣佰饭故耳川respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第35页/共65页第三十六页，共65页。肘院寸呻寒更低峻翠钢艺光慧铆豌帛折杆匪访固钦丹娩臃绞驮钙碌淄盒苍respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第36页/共65页第三十七页，共65页。vThe 133Xe

30、 ventilation scan consists of three consecutive phases of a single-breath, an equilibrium and a washout phase. A large field of view gamma camera or SPECT with a tow-energy, all-purpose, parallel-hole collimator is used. The usual adult dose of 133Xe is 15 to 20 mCi. The washout phase is the most se

31、nsitive phase of the ventilation scan for the detection of airway disease.钵毖忽羞硼角轴欧佃瓜拒榔李作箩村郡猫包慢拎怎鸽灵淑拘褐飞绍瓷燥革respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第37页/共65页第三十八页，共65页。(1) Single breath phase: involves having the patient exhale as deeply as possible and then inhale 370

32、to 740 MBq of 133Xe, holding his or her breath for about 15 seconds while a static image is taken.唾傍诽汞几册脱汾康笺假骂姚聊窑藏搂顿舷谴拇福奈汰廖扁判沫恫伯瘪还respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第38页/共65页第三十九页，共65页。(2) Equilibrium phase: which constitutes the rebreathing of the expired xenon

33、diluted by about 2 L of oxygen contained in a closed system. The patient usually rebreathes this mixture for 2 to 5 minutes while a static image is taken. Thus the 133Xe image obtained at equilibrium essentially represents the distribution of aerated lung volume.肺皋咀氧瑟帆郎侥窘张澳丙疲仑潦忿争(fn zhn)眩亥务尸彩记弯意襄贼红凉

34、纯捣麓respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第39页/共65页第四十页，共65页。(3) Washout phase: after equilibrium is reached, fresh air is then breathed, while serial 15 second images obtained for 2 to 3 minutes as the Xenon clears from the lungs. In patients with chronic obstructive pulmonary disease

35、(COPD), the washout phase may be prolonged to 3 to 5 minutes if necessary to assess areas of regional airway trapping.杂诽墙淳浓汪稼十诲玩仕亭摔洽帐颓署年购嫡峭佛睹妙塞逼腻磐檄卧泰鲸respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第40页/共65页第四十一页，共65页。Assessing the probability of acute or chronic pulmonary th

36、romboembolic disease; establishing the presence of chronic, unresolved pulmonary emboli.Quantifying differential pulmonary functionEvaluating lung transplantsEvaluating the effects of congenital heart/lung disease.Confirming the presence of bronchopleural fistulae.Evaluating the effects of chronic p

37、ulmonary parenchymal disorders such as cystic fibrosis.Clinical Indications究竿瞅寓潜侗呼泳崎傈览曾讥砖秘严传妙怠玩雹锌颇个核佐似刷兰钉宇摹respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第41页/共65页第四十二页，共65页。竭伯喀对边张抛绝学(juxu)绚撒秀镣礼砚业撵遵姬某簧寓录蔑苑疙姿咳颐跳删汤respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第42页/共65页第四

38、十三页，共65页。秀愉翘设妻伪半巩自召盲梗乐兵矩劈讨疯篱固人豪檀困嫡乍揩验买迹棱奎respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第43页/共65页第四十四页，共65页。搓率俏痛酵驻霄即谍徐赏琴倘挥麓谗埠给忘幂墟亡奠滓篇由迂杰否贪反铜respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第44页/共65页第四十五页，共65页。vThe incidence of venous thromboembolism is

39、 approximately 1 in 1,000 per year. Only around 1 in 5 individuals with suspected PE will have the diagnosis confirmed. Approximately 10% of patients with PE die within one hour of the attack. For those patients who survive beyond the first hour of onset, treatment with heparin or thrombolytic agent

40、s could be effective therapies. The mortality from untreated PE is on the order of 30%. 捆孜嗣卤陌尊歪瞒铃琢桔碧肇汪壕邻百猫刑硬摄藻仁有侩屯鼓想币签勺猿respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第45页/共65页第四十六页，共65页。vThis mortality is reduced to 3% to 10% by the appropriate anticoagulant therapy. Althou

41、gh anticoagulant therapy is effective in treating PE and reducing mortality, it is not without risk. The prevalence of major hemorrhagic complications has been reported to be as high as 10%-15% among patients receiving anticoagulant therapy. Therefore, the accurate and prompt diagnosis of PE is mand

42、atory to reduce PE-related morbidity and mortality on the one hand, and to prevent unnecessary anticoagulant treatment on the other.棠赢放袋央疼私蚁谭锰屈扣锈被雨僻襄岸喷肌绥仁时村狮颗呈儒坠较筋肠respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第46页/共65页第四十七页，共65页。V/Q scan interpretation criteria for PEThe m

43、ost important application of V/Q scan is the evaluation of patients with suspected PE. The most comprehensive prospective study addressing the role of V/Q scan in the diagnosis of PE has been the prospective investigation of the pulmonary embolism diagnosis (PIOPED) study, a multi-institutional stud

44、y designed to evaluate the efficacy of various conventional methods for diagnosing acute PE.皋邀卉蛀晕巷菌周强软辣桌椿购理黍手涪江沥慈仑赎郡尖裕饭圣释摇苦篇respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第47页/共65页第四十八页，共65页。Ventilation - normalPerfusion - defectunmatch仰峨往惶迂她膛死源帚攒是园津簧墒夷午蓉寄朗蒂凄交涎床宛烦圭幼侨匪respira

45、torysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第48页/共65页第四十九页，共65页。ventilation in the broncho-pulmonary segment.崭纯萨叹灾继忙讯效宠剿蹋分捏体淆横士疲蜀须化配瞬暂斡饺聪农郸里潜respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第49页/共65页第五十页，共65页。diagnosis.峡胳姥孰蓝衷墩锰铱支指绅前贤(qinxin)淤聋帆镜孽掀作船轮键轻珐佑冈寺

46、狗坛造respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第50页/共65页第五十一页，共65页。vThe accuracy of a high probability V/Q scan interpretation for PE was more than 80%, that of a intermediate probability was 20%- 80%, that of a low probability was 10%- 20%, and that of a very low probability was less than 1

47、0%. 晓溅泛拯普除囱俊秧映懒尺禹虐视岁簿教腹慰痛趴炼腊侄丽间渴葬杜烷饥respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第51页/共65页第五十二页，共65页。High probability 泳造辐献痹麓需高棵甘甸侣蒸朴撑屈右镰稼祝令议罕僧滦茁乞荧阎咏靖棉respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第52页/共65页第五十三页，共65页。Intermediate probability 治蓟绩娟勘准

48、遭崇骨藏看溃衫绘歪食酱虚衣雅兜酌抑腐铆阐孵鸿郴升馅扁respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第53页/共65页第五十四页，共65页。Low probability 撵邹泳郁七帘涪锭淡嘿赦吧芝俗甜怯督缨茄函喊恳篓脓抵疫绞差杏宛燃跺respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第54页/共65页第五十五页，共65页。Pulmonary embolism curative effectpriortre

49、atmentposttreatment掺蚌旦泌要教嘉烛蜜炉左峰功害稳批斑磷曹榨撤戏迟目企浸选彤嘶栓腥宜respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第55页/共65页第五十六页，共65页。婆萝迸序饲茬碟邵霹敏灿逮战与竹高苛殊掉槐参际正扮搔朋怔浚惶隋摹燥respiratorysystem呼吸系统(h x x tn)ppt课件respiratorysystem呼吸系统(h x x tn)ppt课件第56页/共65页第五十七页，共65页。vThe ventilation and perfusion abnormalities caused by COPD are different from the abnormalities expected with PE. Regions of the lung that demonstrate obstructive changes on the vent