第七章 呼吸系统1.pptVIP

呼吸系统疾病(1) 概 述 呼吸系统包括鼻、咽、喉、气管、支气管和肺，通常以喉环状软骨为界分为上下两个部分 细支气管：内径约1mm，上皮为单层纤毛柱状，环形平滑肌更为明显，粘膜常形成皱襞，杯状细胞、软骨及腺体逐渐减少或消失 细支气管的末端称为终末细支气管，在其以下的管壁上有肺泡开口，称为呼吸性细支气管 肺小叶：3~5个终末细支气管连同它的各级分支和分支末端的肺泡组成 肺腺泡：由呼吸性细支气管及其远端所属的各级肺组织直至肺泡组成，是肺的基本功能单位 Intrapulmonary bronchi are relatively large conduits for air whose lumina (L) are lined by a typical respiratory epithelium (E). The smooth muscle (Sm) is found beneath the mucous membrane and it encircles the entire lumen. Plates of hyaline cartilage (HC) act as the skeletal support, maintaining the patency of the bronchus. The entire structure is surrounded by lung tissue (LT). Bronchioles maintain their patent lumen (L) without the requirement of a cartilaginous support, since they are attached to surrounding lung tissue by elastic fibers radiating from their circumference. The lumina of bronchioles are lined by simple columnar to simple cuboidal epithelium (E), interspersed with Clara cells (CC), depending on the diameter of the bronchiole. The lamina propria (LP) is thin and is surrounded by smooth muscle (Sm), which encircles the lumen. Bronchioles have no glands in their walls and are surrounded by lung tissue (LT). This cast of lung terminole tissue 1 This cast of lung terminole tissue 2 Normal pulmonary lobule 气管由内向外依次为粘膜、粘膜下层和外膜 浆液性细胞：核为圆形，位于细胞偏基底部，基底部胞质呈强嗜碱性，顶部胞质含许多嗜酸性的分泌颗粒 粘液性细胞：核扁圆形，居细胞基底部；大部分胞核几乎不着色，呈泡沫或空泡状 肺泡表面覆盖有两种肺泡上皮细胞： 90%为Ⅰ型肺泡上皮细胞呈扁盘状，胞浆稀薄，厚 约0.2 μm，于光镜下难以辨认，又称膜状肺泡上皮细胞，其与基底膜、CAP内皮细胞构成气血屏障 Ⅱ型肺泡上皮细胞呈圆形或立方形，数量少，位于Ⅰ型肺泡上皮细胞之间，能分泌肺表面活性物质 Normal alveoli 常见的呼吸系统疾病可归纳为： 阻塞性疾病如慢支、肺气肿、支气管扩张、支气管哮喘 限制性疾病如呼吸窘迫综合征、肺尘埃沉着症和弥漫性肺间质纤维化等 感染性疾病如鼻炎、鼻窦炎、咽喉炎、支气管炎、肺炎、肺结核和流行性感冒等 常见肿瘤如鼻咽癌、喉癌、肺癌 慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）是一组由各种原因引起的以肺实质和小气管受损后，导致慢性不可逆性气道阻塞、呼气阻力增加以及肺功能不全为共同特征的肺疾病的统称，主要有不可逆性气道阻塞的慢支、肺气肿，也包括有慢性支气管阻塞的 支气管哮喘、支气管扩张症等疾病。 慢性支气管炎 chronic bronchitis 指气管、支气管粘膜及其周围组织的慢性非特异性炎症 临床诊断标准 反复发作的咳嗽、咳痰或伴有喘息 每年至少持续3个月 连续两年以上 可并发支气管扩张症、肺气肿和肺心病