病生学--缺氧幻灯片.pptVIP

北京大学医学部病理生理学教研室 赵亚莉 ;Clinical Example In 1875 three French scientists ascended in a balloon. A height of over 26,000 feet (Bar. 280 mmHg) was reached. They lost consciousness at about 25,000 feet. When Tissandier regained consciousness the balloon was falling rapidly, but his two companions were dead. Oxygen containers were carried in this ascent but Tissandier records that his arms became powerless and so he was unable to raise the mouthpiece to his lips. Why?; ;氧气的获得和利用:;运送氧或利用氧发生障碍时，机体发生功能、代谢、形态结构改变的病理过程.;血氧指标;一、血氧分压 (Partial Pressure of Oxygen, PO2);影响因素：;定义：体内100ml血液的实际带氧量。 溶解氧（0.3ml/dl)+结合氧 A: 19ml/dl V:14ml/dl;动静脉血氧差;血氧含量-溶解的氧量 血氧容量;; ;Air;（一）Definetion： PaO2↓,动脉血供应组织的 O2不足;1. 吸入气中PO2过低 (atmospheric hypoxia);海拔高度 大气压 大气PO2 肺泡内PO2 (m) (mmHg) (mmHg) (mmHg) 海平面 760 159 105 1000 680 140 90 2000 600 125 70 3000 530 110 62 5000 405 85 45 366 74 40 8000 270 56 30 ;（三）血氧变化 特点:;HbO2;发绀 (cyanosis) 毛细血管中脱氧血红蛋白≥5 g/dl，使皮肤、粘膜呈青紫色.;（一） Definetion ：Hb数量↓或性质改变导致的供氧不足.;（二）Causes：;?碳氧血红蛋白血症 (Carboxy hemoglobinemia) HbCO: 亲和力高; 抑制糖酵解; 樱桃红色 ;?高铁血红蛋白血症 （methemoglobinemia);（三）血氧变化 特点:;(一）Definetion： 血液循环发生障碍，组织供血量↓ 引起的缺氧.;（二）Causes:;（三）血氧变化 特点:;19ml/dl;（一）Definetion：组织细胞利用氧障碍所引起的缺氧.;（二）Causes：;2. 线粒体损伤: 放射线、细菌毒素;（三）血氧变化 特点:;混合性缺氧;第三节 缺氧对机体的影响 Effects of Hypoxia; 一、对细胞代谢的影响 ;(一)Compensatory Reaction ;;(二)Injured Manifestations;Na+、Ca2+内流，K+外流; ;(一) Compensatory Reaction ;(二)Injured Manifestations;PaO230mmHg→抑制呼吸中枢→中枢性呼吸衰竭; ;(一) Compensatory Reaction ;2. 血流重新分布 ;4. 组织毛细血管