肺内分流zuihou学习资料.pptx

肺内分流zuihou学习资料;;Hypoxia occurs more easily than hypercarbia.;出着容易进着难;气体分压 PO2+ PCO2= a constant;The burly alveolus (high V/Q). The weakling alveolus (low V/Q). ;A fundamental question:;;;健壮的肺能排出更多的二氧化碳而吸进和运载储备更多的氧;Average alveolar PACO2 = 40 mm Hg. Hence, PaCO2 = 40 mm Hg;第12页/共145页;第13页/共145页;二氧化碳的事好解决;PaO2 is always slightly lower than PAO2？;问题;第17页/共145页;第18页/共145页;1. Gas exchange, 2. A key to lung disorders, 3. Uneven distribution of tidal volume and perfusion, 4. Blood gases, 5. The PO2 - PCO2 diagram, 6. The V?A / Q??- curve, 7. Blood-R-curves, 8. Dead space, 9. Anatomic venous-to-arterial shunt, 10. Ficks law of diffusion, 11. Single -breath diffusing capacity, 12. Compensation of V?A /Q ? - mismatch, 13. Pulmonary bloodflow, 14. Regional ventilation. ……..;Pulmonary Shunting;肺循环、体循环、冠脉循环 ;肺内分流量（Qsp,Qs/Qt）概念;1. The word “shunt” refers to blood that has not exchanged gases that mixes with blood that has exchanged gases. 2. Sources of shunt: Thebesian circulation that perfuses the left ventricle then dumps into the left ventricle. Bronchial circulation that perfuses lung tissue and empties into the pulmonary vein. In normal people this accounts for about 2-4% of total blood flow. Perfusing collapsed alveoli or having a hole in the wall of the atria or ventricles will produce a right to left shunt.;Pulmonary Shunting;True Shunt;解剖分流;Normal shunt– bronchial circulation and Thebesian veins;Shunt etiologies;;Shunt-Like Effect ;地球上必然的;区别？;ventilation—perfusion balance or imbalance;肺泡与血液之间的气体交换，不仅取决于足够的肺泡通气和有效的气体弥散，还取决于肺泡通 气量与肺血流量的比例配合，即通气血流比值。 正常人平静呼吸时平均肺泡通气量（VA）为4L/min，平均肺血流量（Q）为5L/min，通气血流 （VA/Q）比值为0.8。由于受重力影响气体和血流的分布在肺内各部分并不均匀，直立体位时， 肺通气量和肺血流量自上而下都是递增的，但以血流量的增幅更为明显，因而VA/Q比值肺上部 可高达3.0，而肺底部仅为0.6，但通过自身调节机制，使总的VA/Q保持在最合适的生理比值0.8 ;VA/Q比例失调的基本形式;;（2）部分肺泡血流不足—VA/Q比值升高 肺动脉分支栓塞、炎症，肺动脉收缩，肺毛细血管床大量破坏可使 流经该部分肺泡的血液灌流量减少，而该部分肺泡的通气相对良好，使 VA/Q比值明显升高。这使该部分肺泡内的气体未能与血液进行有效的气 体交换，则使死腔气量增加。 死腔气量包括解剖死腔（指不参与