呼吸功能不全课件1.pptVIP

呼吸衰竭 Respiratory Failure;呼吸全过程 Respiration;;Symbols;呼吸衰竭(Respiratory Failure);呼衰的类型Classification of Respiratory failure;一、呼衰的原因和发病机制 Respiratory Failure: The Causes and the Mechanisms; （一）肺通气功能障碍: Disorders in Pulmonary Ventilation;1. 限制性通气不足（Restrictive Hypoventilation）：肺泡扩张受限; 气道阻力(正常人平静呼吸)： 80%: 直径 2mm 气管 20%: 直径 2mm 气管 病因：气管痉挛` 肿胀` 纤维化` 渗出物` 异物` 肿瘤` 气道内外压力改变;阻塞位于胸外，表现为吸气性呼吸困难 (Inspiratory Dyspnea);阻塞位于胸内，表现为呼气性呼吸困难 (Exspiratory Dyspnea);用力呼气时等压点(isobaric point)移向小气道;问题 ： 呼吸衰竭? 限制性通气不足的定义及其发生原因? 胸内、胸外气道阻塞在呼吸中的差异?;（二）弥散障碍 Diffusion Impairment;毛细血管内皮细胞;1. 弥散面积减少 (Decrease in the Surface Area of the Membrane);2. 弥散膜厚度增加(Increase in the Thickness of the Membrane);3. 弥散时间缩短 (Shortening in the Diffusion Time);Solubility Coefficient (vol/vol, 760 mmHg): O2: 0.024 CO2: 0.57;正常静息状态下： 每分钟肺泡 通气量（VA)：~ 4L 每分钟肺血 流量（Q): ~ 5L VA/Q: 0.8;VA;血液氧和二氧化碳解离曲线 Oxygen and Carbon DioxideDissociation Curves;O2 transported as: O2: 1.5% Hb.O2: 98.5% ;2. 解剖分流增加(Increase in Anatomic Shunt);Q;血液氧和二氧化碳解离曲线 Oxygen and Carbon DioxideDissociation Curves;问题 ： 弥散障碍的发生机制? 功能性分流,静脉血掺杂? 解剖分流, 真性分流? 死腔样通气?;肺泡-毛细血管膜 (alveolar capillary membrane) 损伤引起的急性呼吸衰竭。 病因：感染（肺炎，败血症等），休克，严重创伤，吸入毒物或胃酸等。;;ARDS发生机制(Pathogenesis); A previously healthy 23-year-old male sustained numerous traumatic crush, burn, and smoke inhalation injuries during a landing accident in an airplane. His initial B.P. was 80/50 mmHg, and he was immediately infused with saline at the maximal rate. In the ER he was intubated and had no signs of pneumothorax. His orthopedic injuries and burns were treated. The ventilator was placed on the assist-control mode with the initial settings of inspired O2 concentration at 40%, respiration rate at 12/min, and tidal volume at 900 ml. Arterial blood gas measurements were: pH = 7.47, PCO2 of 33 mmHg, and PO2 of 62 mmHg.; 24 hrs. after admission, the patient becomes agitated and his respiration rate in