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. MDPhD gstathop@upatras.gr
htt : www.molcellbiolu atras.net
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https://eclass.upatras.gr/courses/MED823/
Koeppen BMandStantonBA(eds.).Berne&LevyPrinciplesofPhysiology,6thEdition.Mosby,MarylandHeights,MS,2009BoronWF,Boulpaep EL(eds.).MedicalPhysiology:acellularandmolecularapproach.ElsevierSaunders,Philadelphia,PA,2005.
, . .
approach.McGrawHill,NewYork,NY,2011.PaulevZubieta (eds.).NewHumanPhysiology|2ndEdn:htt ://www.zuniv.net/ h siolo /book/index.htm
WestJB.AWebbasedcourseoflecturesinrespiratoryphysiology.Advan Physiol Edu 2011;35:249251(freely
availableathttp://meded.ucsd.edu/ifp/jwest/)
WestJB.Internetbasedcourseonpulmonarypathophysiology.Advan inPhysiol Edu 36:12,2012.(freelyavailableathttp://meded.ucsd.edu/ifp/jwest/ )
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(2) (CO2)
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1. ( )2.
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Boyle
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P = KhC
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P =P +P +P +...P
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,2ER =
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( )
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,partialpressure,P (mmHg cmH2O) ,fraction,F( )
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AB
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Thiberville L,Salan M,Lachkar S,DominiqueS,MorenoSwirc S,VeverBizet C,BourgHeckly G.Humaninvivo fluorescence
microimaging ofthealveolarducts andsacsduringbronchoscopy.Eur Respir J2009;33:97485.
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.11.
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.12.
.13.
.14.
.
20122013165
15. , .
16. (,
,
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. , , , .
17.
. , , .
.
, .
20122013
166
(FRC))
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.B
.)
.
) .
) .
20122013
167
;) .B) .
) .
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) .) .
A .B) .) .
) , . , .
20122013
168
) .
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. .
)
.) .)
, .
) , . , .
) .
20122013
169
) FVC FEV1, FEV1/FVC .
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) FEV1 FEV1/FVC , FVC. .
) TLC RV/TLC.
) .) , .) , .) .
.
20122013170
) FVC FEV1, FEV1/FVC .
) /
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) FEV1 FEV1/FVC , FVC. .
) TLC RV/TLC.
) /
.) , .) , .
.) .
20122013171
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. MDPhD
gstathop@upatras.gr
htt : www.molcellbiolu atras.net
20122013172
.
.
3.
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4.
5.
6.
7.
20122013
173
2
F
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F
VV
D /
V/Q
Q
D
20122013174
FiO2
FiO2
PB
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PB
20122013175
,,
,
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. : , ,.
. 2(12L/min)
, , .
Venturi. , Venturi.
20122013176
VENTURI
VENTURI
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VENTURI 100%2 O2,
, VAIR .FiO2 , VO2. en ur
VO2,
AIR
FiO2.
20122013177
VE =VTxRR= x
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V =500mlx12 min
=6lt/min Vmax =FEV1x30 min
~100 lt/min (x 15)
: PAO2 PACO2
20122013178
VE =V+VDf x V = f x V + f x VVE =V+VDVE =volume,expiratory; V
A
=volume,alveolar; V volume dead
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AVD =volume,dead;
E ,VA =ventilation,alveolar;
V =ventilation dead
VE ~ 500ml
VA ~ 350 ml~
VE ~ 6L
VA ~ 4L~D D
20122013
179
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20122013180
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20122013181
2
P
(F) -(P)
( mmHg)
0 21 0 20 0 13 0 12 0 06
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0,21
0
0,20
0
0,13
0 05
0,12
0 05
0,06
0 07
0
0,79
0,06
0,74
0,06
0,75
0,06
0,75
0,07
0,81 1,00 1,00 1,00 1,00 1,00
20122013182
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AaDO2 = /4 + 4 mmHg
20122013183
PAO2 = 0,21(76047)40/0.8
= 0,21x71350
= 100 mmHg
,
PAO2 = 1,0(76047)40/0.8
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PAO2 1,0(760 47) 40/0.8
= 663 mmHg
PAO2 = 0,21(57047)40/0.8 PAO2 = 0,21(42047)40/0.8
= , x
= 60 mmHg
= , x
= 28 mmHg
20122013184
1
CO2()
2
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( )
PACO2 = VCO2 X (PB-PH2O)/(VE-VD)
20122013185
PaO2 = 80-100 mmHg < PAO2
PaCO = 35-45 mmHg ~ PAO2
: PaO2 < 80 mmHg
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g : PaCO < 35 mmH
: PaCO2 > 45 mmHg
20122013186
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20122013187
.
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20122013188
2.
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20122013189
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20122013190
+
=
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20122013191
=
.
Bohr
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Bohr
()
2.
Fowler
VD
20122013192
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20122013193
=
, D mL, VT=500mL 12 (f=12/min). VA V ;
,
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, T1= m . VA1 VD1;
, f2=.
VA2
VD2;
VD, f VT;
20122013
194
VD =VD/VTxVE=VD/VTx(fxVT)
=150mL/500mLx12/minx500mL 1
=1800mL
=1,8LV =fxV=fx(VT VD)
=12/minx(500mL150mL)
VD2 =VD2/VT2xVE2=VD2/VT2x(f2xVT2)
=150mL/500mL x30/minx500
=4200mL
=4,2L=4500mL= 4 5 L x 2 5
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=4 5 L x2 5VD1 =VD1/VT1xVE1=VD1/VT1x(f1xVT1)
=150mL/1000mLx12/minx1000mLV2 =f2xV2=f2x(VT2 VD2)
=30/minx(500mL150mL)=1800 mL
=1,8 L(~)=10500mL
=10,5 L(x2,6)
1 = 1x 1= 1x T1 D1
=12/minx(1000mL150mL)
=
=10,2 L(x2,5)
20122013195
, T
( ,VD), ,V .
( VT),
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( T), ( ,VD), ( ,VA).
20122013196
. VD=150mL, VT=500mL 12 (f=12/min). V V ;
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, . VD=150mL, VT=2500mL 30 (f =30/min).
A VD;
20122013197
:
VD =VD/VTxVE=VD/VTx(fxVT)=150mL/500mL x12/minx500mL
=1800mL =1,8L
V =fxV=fx(VT VD)
=12/minx(500mL150mL)
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=4200mL =4,2L
:
(
D = D Tx E= D Tx x T=150mL/2500mL x30/minx2500mL
,
= = , ,
V =fxV=fx(VT VD)
VD .
=70500mL =70,5L(x17)
20122013
198
1.
2.
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~500mL (10% )
~
(1/10
20122013199
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20122013200
1/3
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( 200%
20122013201
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1. :
20122013202
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20122013203
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2.
20122013204
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3. PA
O2:
20122013205
Q
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Q
20122013206
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4. :
20122013207
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20122013208
. . .
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Pc:
p : ,
is: ,
PVR:,,
20122013209
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20122013210
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20122013211
SHUNT
-
-
-
100% 2
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-
- 100%
20122013212
FiO2 = 0,21
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,
20122013213
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(SHUNT)
20122013
214
/
:VQ
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Q
20122013215
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20122013216
D
C2
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2
T
20122013
217
PACO2 = PaCO2 = 35-45 mmHg
A 2 a 2 -shunt (2-3% )
AaDO = /4 + 4 mmHg
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Pa/AO = PaO PAO
Pa/AO2 > 0,8
PaO2/FiO2
~ 500
20122013
218
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20122013219
FiO2 AaDO2 a/APO2
0,21 15 0,8
, ,
0,40 26 0,8
0,50 32 0,8
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0,60 40 0,8
1,00 60 0,8
20122013220
V/Q = 1
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~~
~V
~Q~V/Q
~D
20122013
221
PAO2
V/Q = 1,0
70
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70
40 ~
,
20122013
222
V/Q = 0,5
70
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70
50
,
20122013
223
V/Q = 1
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~
20122013224
V/Q = 0,5
DL = AD/T
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80
20122013
225
(SHUNT)
=
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~
V/Q = 1
/ V/Q = 0
20122013226
(SHUNT)
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= ~
V/Q = 0,7
20122013227
V/Q
V/Q = 0,5
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,
20122013
228
V/Q = 1
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~
V/Q = 1
(SHOCK)
20122013229
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~ ~
20122013230
PaO2 AaDO2 PaCO2 PaO2
PAO2 ~ ~
~
~
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SHUNT ~ ~ SHUNT ~
~ ~
20122013231
PaO2 PaCO2
~ PAO2
(shunt)
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V/Q
20122013232
40
.:
pH =7,40
PaCO2= 44mmHg
PaO2= 70mmHg AaDO2, PaO2/FiO2 Pa/AO2?
?
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0 8.
20122013233
PAO2 =FiO2(PBPH2O)PaCO2/R
=0,3(76047)44/0,8
=161mmHg
PaO2/FiO2=70/0,3=233
AaDO2=PAO2 PaO2 Pa/AO2=PaO2/PAO2=16170mmHg
=81mmHg
= mm g mm g
=0,43
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g
a (40/4+4mmHg=14mmHg). FiO2=0,30.
PaO2/FiO2 .ToPa/AO2 (0,75).
( shunt).
20122013234
1.
.2. (Pgas) (Fgas)
.3. .
O2,N2,
4. O2 .
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. AaDO2, O2.
6. CO2
CO2.
20122013
235
7. CO2
(VA) , CO2.
. 40 mmHg.
9.
10. (VD) (VT).
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. , .
12. .
20122013
236
13.
.14. 7
.15.
16. (PPA)
PLA T
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PLA T .17.
..
.
20122013
237
19. (V/Q)
, .20. , V/Q 1 .
. .
22. , .
23. 8 : , PAO2,
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, , ,
shunt, V/Q, .
20122013238
12 , 450
ml 150ml , ,:)2,9, 1,5 2,1.
B)5,4,1,8 3,6.
)6,8,1,8 5,0. 8 2 6 2 2 0 .)12,0,3,4 8,6.
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= = = = = , , , , 1,0, (PAO2) )50mmHg.
.)110mmHg.
) VCO2. 100mmHg
.
20122013239
.B) .) .
.
) .
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) >) =
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)
) .)
.) .
20122013241
.B).) .
.) .
) .B) .
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)
) .) . .)
20122013242
=
, .B) FiO2.) .
.) .
) .B) .
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) .) (shunt). CO2 .) O2 ().
20122013243
. MDPhD
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244/379
gstathop@upatras.gr
htt : www.molcellbiolu atras.net
20122013244
.
.
3.
4.
5.
6.
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7.
20122013
245
: :
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20122013246
,2ER =
2=VO2/DO2=0,25
RQ R =VCO2/VO2
~0,8
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=DO2
=VO2=
=VCO2= C2
= 2
20122013247
C2
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T
Fick
D
= A x/x(1 2)
20122013248
:1.
2.
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20122013249
1. enry
= Henry x
P=KhC C=P/Kh
Henry's ( 298,15K)
,
O2 769.23
C2/
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H2 1282.05CO2 29.41
O2 = 770/30 = 26
2 .
He 2702.7
Ne 2222.22
Ar 714.28
CO 1052.63
20122013250
2.
Graham
, 1 / 2 = 2/ 1C2/O2 = O2/ CO2 = 32/44 = 0,86
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20122013251
DCO2/DO2 = 26 x
0,86 ~ 22
-
25
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!!!
L
Vgas = DL x (P1-P2)
20122013252
;
1. 2.
DL = A x D / T
Vgas = DL x (P1-P2)
1 2
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20122013253
()/ (V) n x
=0
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N=1=20 =2 x
V=n4/3r =n4/3(x/2) =n4/3x /8=4nx /83=x /6
A=n4r2
=14(x/2)2
=4x2
/4=x2
20122013254
=3
N=8 =23 =2
r=x/4
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x
V=n4/3r =84/3(x/4) = 32/3x /64=x /6=V
A=n4r2
=84(x/4)2
=32x2
/16=2x2
=2A
20122013
255
=6
N=64=26 =2 r=x/8
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x
V=n4/3r =644/3(x/8) = 256/3x /512=x /6=V=V
A=n4r2
=644(x/8)2
=256x2
/64=4x2
=2A=4A
20122013
256
20112012
600 1.0x
2
)
400
(
200
.
(x3
/6)
0 0.0
= 3 ~
()
, ,
( 0) 2 0 125 2
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(=0), =x2=0,125m2
8 (=3), =2x2=0,25 m2
64 (=6), =4x =0,5 m 135000000 (=27), =512x2=64 m2
= = 2= 2 ,: =2829,500000000,=85m2
20122013257
)2 CO2
2 (
CO
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COO2 ,
D
20122013
258
DL;DLO2
DLCO
DLHe
:
1 2 P1 P23 4
O2 2 3
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O2 2 3CO2 1 3
He 4
N2 3
CO
20122013259
CO
0,3%CO He
10
( ) ,
DLCO = VCO/(PACOPaCO)
= VCO/PACO
DLCO/VA (
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DLCO/VA( )
DLCO = 20-30 mL/min/mmHgDLCO/VA = 5-8 mL/mmHg/L
20122013260
CO
0,3%CO RV TLC 10. VCO =1,5mL/min,VA=4 L/min
PACO=0,1mmHg. CO; ;
DLCO =VCO/PACO
=1,5mL/min/0,1mmH
= 15 mL/min/mmHg
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=15mL/min/mmHg DLCO/VA =15mL/min/mmHg/4 L/min
=3,75mL/mmHg/L
DLCO , , .
20122013261
1. (>97%)2. (
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20122013262
()2
g :x65
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20122013263
1. Gower1(22)2. Gower2(22)
. 4. F(22)
1
1. A(22) (>95%)
2 A2 (22) 1 5 3 5%
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2. A2(22) 1.53.5%3. F(22).
.
20122013
264
HGB 1.
2.
(CO2)
(NO)
3.
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20122013265
nm (910nm)
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20122013266
SaO2=9698%
PvO2=40mmHg
SvO2=75%
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2 PiO2 2
20122013267
,
2(
)
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)
20122013268
O BOHR
2
2,3
pH
CO2 ( Bohr) , 2
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2 +
RBC
20122013269
Hgb
Hgb
P.
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Falciparum
20122013270
%Hgb CO(/ NO), 200(200000)
H b
Hgb
PCO=1mmHg
HbCO =13%
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20122013271
2 1 Hgb 4
2
, Hgb 2:
Hgb 2
2(1,34mL O2/gr Hgb)
2:CO2=1,34x Hg xSO2CaO2=1,34mL/gx15g/dL x98%
~200mL O2/L
CvO2=1,34mL/gx15g/dL x75%~150mL O2/L
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/ CaO2:1. ( SaO2)2. ( Hgb)
. ,2 Hgb
20122013272
2 (2DELIVERY,DO2) ,
D2 =CaO2xCO
=1 34x H b xSaO2xHRxSV
=1,34mL/gx15g/dLx98%x70/minx70mL
~200mL/Lx5L/min
~1000mL/min
V2 =(CaO2CvO2)xCO= , x g x a v x x
=1,34mL/gx15g/dLx(98%75%)x70/minx70mL
~50mL Lx5L min
~250mL/min
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2
2,O2extractionration,O2ER=SaO2SvO21000%
UthSrensenOvergaardPedersen
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Coopertest
20122013274
VO2 = = (SHOCK)
= , x g x a v x x VO2, 1. Hgb
2. SaO2
:
O2ER = SaO2 - SvO2 > 25%
(CO,MetHgb)
.
4 HR
1: ()2: ()
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4. HR ( )3:
5. SV
4,5: ()
20122013275
( )
C H O + x + /4 - z/2 O ---> x CO + /2 H O
RQ R = VCO2/VO2
= + -
: 0,7 < R < 1,0
~ ,
/H/C
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= .
(z ~ 0): R = 0,7
20122013276
CO2
CO2
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20122013277
2
Haldane
( 2 CO2)
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20122013278
1. CO2,HCO3()2.
( )
. ()
4.
5.
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5.
20122013279
Henderson+
asse ac
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20122013280
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20122013281
= H
=pH
CO2
CO2
HCO3
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HCO3
20122013282
HCO3
CO2
HCO3
HCO3 CO2
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CO2
HCO3
: CO2
():
20122013283
1. CO2
2. CO2
4. ( HCO3)
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20122013284
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20122013285
pH=7,30PaCO2=50
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()
20122013286
pH=7,33PaCO2=50
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()
20122013287
pH=7,20PaCO2=50
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20122013288
1. ()
.
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