1中山大学医学院精品课程生理病理5Respiratory Failure.ppt

Respiratory Failure Functional shunt and  Anatomic shunt Anatomic shunt No blood –gas exchange Applying O2 can’t increase PaO2 Functional shunt blood –gas exchange decrease Applying O2 can increase PaO2 Pathogenesis of ARDS Stimulus Complement activation Pulmonary edema Lysosomal proteinase Active oxygen Pulmonary vasoconstiction Arachidonic acid metabolites Epithelial and endothelial Cell damage C5a Sequestration of neutrophils in lungs Increased pulmonary permeability Pulmonary hypertension Pathophysiology of ARDS causative factor alveolar-capillary membrane damage inflammation Pulmonary edema Pulmonary vasoconstriction Microvascular thrombus Diffusion disorders Pulmonary shunt Dead space ventilation Atelectasis Bronchia constriction Hypoxemia * 万用卡 The department of pathophysiology SUN Huilan O2 CO2 CO2 External respiration circulation Internal respiration What is respiratory failure Respiratory failure is a pathological process In which the external respiratory dysfunction leads to an abnormal decrease of arterial partial pressure of oxygen with or without carbon dioxide retention. How to Judge respiratory failure （1）PaO2 8kpa（60mmHg） （2）PaCO2 6.6 kpa（50mmHg） classification of RF： Hypoxemic(Group Ⅰ）RF——（1） Hypercapnic（ Group Ⅱ）RF——（1）＋（2） Etiology and Pathogenesis of RF Ventilatory disorders Diffusion disorders Ventilation-perfusion imbalance Anatomic shunt Etiology and Pathogenesis of RF (1) Ventilatory disorder Restrictive Ventilatory disorders Obstructive Ventilatory disorders Restrictive Ventilatory disorders Paralysis of the respiratoy muscles Decreased compliance of chest wall Decreased compliance of lungs Hydrothorax or pneumothorax Etiology and Pathogenesis of RF (1) 大脑皮层——调节呼吸肌作随意运动 脑桥、延髓——不随意的自主节律呼吸调节 脊 髓 肋间神经 肋间肌 肋骨、胸骨 隔肌 胸膜及胸膜腔 胸 廓 外伤、中毒 出血、感染 脊髓灰质炎、高位截瘫 多发性神经炎 重症肌无力、多发性肌炎 大量腹水、上腹巨大肿物 外伤、骨折 气胸、大量胸腔积液 Etiology and Pathogenesis of RF (1) Central airway obstruction Pe