呼吸科呼吸系统1 课件.ppt

Where Does the Airway Constitute the Site of Largest Airway Resistance? The medium-sized airways (?2 mm)? Or The small airways (<2 mm)? 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) Sequential Events Occur during Expiration Relaxation of Diaphragm Thoracic Cavity Shrinks Negative Pleural Pressure Decreases Transpulmonary Pressure Becomes Small Alveolar Pressure Rises above the Atmospheric Pressure Lung Volume Tends to Decrease Air Flows out the Lungs until Alveolar Pressure Equals Atmospheric Pressure P1XV1 = P2XV2 Boyle’s Law The Significance of a Negative Pleural Pressure Keeps the lungs to be inflated as it is demonstrated in pneumothorax (气胸). Promotes the returns of venous blood and lymphatic fluid (淋巴液). Pneumothorax (气胸) A condition in which air has entered and expanded the normally closed pleural space, driving pleural pressure up toward atmospheric pressure, and resulting in partial or complete collapse of the lung.? Consequences of Pneumothorax Hypoxia（缺氧） due to shunt (blood passes through those collapsed alveoli). Decrease in venous blood return due to compression of vena cava, resulting in lower cardia