氧供需平衡-麻醉课件.pptVIP

氧供需平衡

BalanceofOxygenSupplyandDemand四川大学华西医院麻醉科魏蔚

氧输送oxygentransport(O2T)外呼吸血液循环组织肺通气肺换气氧在血液中的运输氧在组织中释放

氧瀑布O2Cascade氧从空气进入细胞的线粒体内要经历一系列过程，包括：肺通气、肺换气、氧在血液中的运输及氧在组织的释放四个步骤。也有学者把氧运输过程中，从空气中氧分压159mmHg至细胞内的3~4mmHg的巨大落差形象地称为氧瀑布。

空气?上呼吸道饱和蒸汽压=47mmHgPiO2=(760-47)0.2094=149mmHg

?肺泡二氧化碳-PACO2,约等于PaCO2.PAO2=PIO2–PaCO2/R.-R为呼吸商.-R＝0.8.-PAO2=149–(40/0.8)=100mmHg

Summary

ThefactorsinfluencetransportofoxygenCardiacoutputBloodoxygencontent(CaO2)Theaffinityofhemoglobinforoxygen外呼吸血液循环组织

血红蛋白与氧的结合量1g血红蛋白最多可结合1.34ml的氧气。(1.39mlwhenthehemoglobinischemicallypure)如果Hb=15g/100ml,最大结合的氧量=15*1.34=20.1ml/100ml

在组织内释放的氧量动脉血:SaO2=97%,CaO2=19.4ml/100ml混合静脉血:PvO2=40mmHg,SvO2=75%CvO2=14.4ml/100mlC(a-v)O2=19.4-14.4=5ml/100ml

摄氧率（utilizationcoefficient/oxygenextraction）Thepercentageofthebloodthatgivesupitsoxygenasitpassesthroughthetissuecapillariesiscalledtheutilizationcoefficient.-normalvalueisabout25%.-duringexercise,canincreaseto75~85%.

PhysiologicalsupplydependencyThenormalrelationshipisfora4:1ratiobetweenDO2andVO2.↑or↓inCOandDO2donotaffectoxygenconsumption.

PathologicalsupplydependencyRelationshipbetweenDO2andVO2seenincriticallyillpatients,whenincreasesinCOorincreasesinoxygendelivery,resultinparallelincreasesinVO2.

氧-血红蛋白解离曲线

EffectsonOxygen-HemoglobinDissociationCurve

PaO270090-100604026.7SaO210095Thecausesofaleft-shiftedoxy-Hbcurve

(P5027mmHg)Alkalosis–theBohreffectHypothermiaAbnormalandfetalHbCarboxyhemoglobin,MethemoglobinDecreased2,3-diphosphoglycerate

Thecausesofaright-shiftedoxy-Hbcurve

(P5027mmHg)IncreasedhydrogenionsIncreasedCO2IncreasedtemperatureIncreased2,3-diphosphoglycerate(DPG)

氧供

OxygendeliveryDO2DO2是每分钟供给机体的氧量。DO2=(0.0031×PaO2+1.34×Hb×SaO2)×CODO2=1.34×Hb×SaO2×CO如果CO=5L,Hb=15g，DO2=1.34×150×1×5=1005ml/L

氧耗

Oxygenconsumption(VO2)Oxygenconsumptionisthe