運動時の換気応答と呼吸のentrainment の検討...運動時の換気応答と呼吸のentrainment の検討 工 学 院 大 学 (共同研究者) 国際武道大学 千
呼 吸 病 理 生 理
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Transcript of 呼 吸 病 理 生 理
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Respiratory pathophysiologyDepartment of Pathology Shanghai University of TCM
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External RespirationGas TransportInternal Respiration
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Pulmonary ventilation (total lung capacityTLC)(forced vital capacityFVC)(alveolar ventilation, VA)(residual volumeRV)(dead space volume, VD)(compliance) Gas exchange(diffusing capacity)[P(A-a)O2]
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(total lung capacityTLC): 5000ml3500ml(forced vital capacity, FVC)3500ml2500ml
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(residual volumeRV)1000 1500ml(functional residual capacity, FRC)2500ml
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(alveolar ventilation, VA)(dead space volume, VD)(compliance)
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(diffusing capacity)1mmHg [P(A-a)O2]
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(respiratory failure)PaO60mmHg/PaCO250mmHg(respiratory insufficiency)
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I II
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(restrictive hypoventilation)obstructive hypoventilation)
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1.
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1. alveolar surfactant
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LaplaceP=2T/r
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Neonatal respiratory distress syndrome (NRDS): lack of surfactantretraction of soft tissue on inspiration
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2. obstructive hypoventilation)airway resistanceR 1/r4
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2. :22mm COPD
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extrathoracic obstruction Inspiratory dyspnea intrathoracic obstrucdtion Expiratory dyspnia
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ExpiratoryInspiratory
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ExpiratoryInspiratory
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isobaric point, IP
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* PaO250 mmHg PAO2PACO2 PaO2PaCO2PaCO2CO2/PaCO2 PaCO2 PACO20.86Vco2/VA
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diffusion impairment ventilation-perfusion imbalanceincrease of anatomical shunt
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diffusion impairment
- 80m23540m2
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PO2KPa13.310.78.005.332.67 00 0.25 0.50 0.75Hb1 212S
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* IPaO2 PaCO2 O2CO2O2CO2
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O2CO2
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*CO2O2PaCO2
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(Ventilation/perfusion ratio, VA/Q) = 4.2 / 5 = 0.840.6~3.0
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ventilation-perfusion imbalanceVA/Q : Venous Admixture VA/Q : Alveolar Dead Space
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1. VA/Q VA/Q(venous admixtrue)(functional shunt)
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1. VA/Q 3% 30%-50% (-)
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2. VA/Q VA/Q(dead space like ventilation)30% 60%-70%
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VA/QIPaO2 PaCO2 O2CO2O2CO2
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VAVA / QPaO2 CaO2PaCO2CO2 CaCO2 NN NN
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QVA / QPaO2 CaO2PaCO2CO2 CaCO2 NN NN
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3. (anatomic shunt)-2~3%ture venous admixture
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1. CO2K+
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1.
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2. PaO2 < 60mmHg PaO2 < 30mmHg PaCO2 > 50mmHg PaCO2 > 80mmHg PaO2
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2. II(30%)(12L/min)PaO2 5060mmHg
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3.
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3. A
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3. A
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4. PaO260mmHg PaO240~50mmHg PaO220mmHg PaCO280mmHg CO2
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(pulmonary encephalopathy) ATP Na+-K+ -
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5. GFR
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PaO2PaCO2
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(acute respiratory distress syndromeARDS)(acute lung injuryALI)
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() (40%)
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ALI-TNFIL-1[5-5-HTA2TXA2LTSFDP]
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ALI
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Chronic obstructive pulmonary diseaseCOPD2mm
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COPD:
(respiratory failure)PaO60mmHg/PaCO250mmHgPaO2PaO2PaO2=1000.325mmHgPaCO2400.5mmHg (respiratory insufficiency)(respiratory failure) 1. PaOPaCO2PaCO2I IIPaOPaOPaCO22. PaO2PaCO2PaO2PaCO2 3. 4. ARDS26.0L/min4.2L/min30%
/chronic obstructive pulmonary diseaseCOPD COPD2mm-LaplacePTrP=2T/ralveolar surfactant3 -LaplacePTrP=2T/ralveolar surfactant
2 2mm 2()isobaric point, IPisobaric point, IP
3 PaO250 mmHgPAO2PACO2PaO2PaCO2PACO2VAVco2, PACO20.86Vco2/VAVco2PACO2PACO2PaCO2
180m23540m22 1m
30.750.34O20.25CO20.130.75IPaO2 PaCO2 IO2CO2100mlHb8ml CO2100mlHbO235ml O2CO2 CO2O224CO2O221CO2O2CO2O2PaCO2 O2CO2100mlHb8ml CO2100mlHbO235ml
O2CO2 CO2O224CO2O221CO2O2CO2O2PaCO2
VA4.2L/minQ5L/minVA/Q0.84VA/Q3.00.6VA/Q0.8 ventilation-perfusion imbalance 3%30%~50%VA/Q(dead space like ventilation)30%60%~70% IPaO2PaCO2 VA / QCO2CO2CO2CO2 CO2CO2CO2CO2
CO2CO2CO2(anatomic shunt)-2~3%ture venous admixture-PaO2PaCO2PaO2PaO2 1 NH3 1 NH3 2 3 4 PaO2AA PaO260mmHgPaO230mmHg PaCO2PaCO2 80mmHg PaO2 PaCO2CO2 AcapA PaO2