呼吸科呼吸系统课件1概要1.pptVIP

The medium-sized bronchi (?2 mm) actually constitute the side of highest resistance along the bronchial tree. Although the small radii of bronchioles (2 mm) might predict that they would have the largest resistance, they do not because of their parallel arrangement. Early changes in resistance in the small airways may be “silent” and go undetected because of their small overall contribution to resistance. * * Neurohumoral Control of the Airways Michoud et al * * The Smooth Muscle Tone of Airways is Controlled by Nerves Sympathetic adrenergic fibers Bronchial dilation inhibition of gland secretion. Parasympathetic cholinergic postganglionic fibers Bronchial constriction increased mucus secretion Non-adrenergic non-cholinergic neuronal fibers Bronchcoconstrictory effects (tachykinins, substance P or neurokinin etc.) Bronchodilatatory pathway (nitric oxide and vasoactive intestinal peptide) * * ?2-adrenergic Receptors and cholinergic Muscarinic Receptors Stimulation of sympathetic adrenergic fibers causes dilation of bronchial and bronchiolar airways via ?2 adrenergic receptor activation and inhibition of gland secretion. ?2-adrenergic agonists are used for treatment of asthma. Stimulation of parasympathetic cholinergic postganglionic fibers causes bronchial constriction as well as increased mucus secretion via muscarinic receptor (M2/M3 ) activation. M receptor antagonists are used for treatment of asthma. * * Lung Volume inversely Relates to Airway Resistance * * Summary on Ventilatory Resistances Elastic resistance (70% of total ventilatory resistance) It is a static resistance. It results from elastic recoil (30%) and surface tension (70%). Non-elastic resistance (30% of total) It is a dynamic resistance. It consists of inertial resistance, viscous resistance and airway resistance The airway resistance accounts 80% of non-elastic resistance * * Respiratory resistance elastic resistance (70%) thoracic elastic resistance lung elastic resistance elastic