名校生理學(xué)血液循環(huán)課件

1、CHAPTER 4 CIRCULATI血液循環(huán),Prof. Wang Ting huai Department of Physiology,SECTION 3 VASCULAR PHYSIOLOGY 血管生理,動脈,毛細(xì)血管,靜脈,彈性儲器血管：主動脈和大動脈 分配血管：中等動脈 阻力血管：小動脈和微動脈,交換血管,容量血管,. Functional properties of different blood vessels 不同血管的功能特征 1. Artery: 動脈 A. Aorta and large artery (windkessel vessel ) 主動脈和大動脈，又稱彈性貯器

2、血管,pressure reservoir 壓力儲存器 maintain the continual blood fluid in the artery system. 維持動脈系統(tǒng)內(nèi)連續(xù)的血流 Low resistance vessel 低阻力血管 transport blood to every apparatus of the globle body 運(yùn)送血液到全身各個器官,B. Middle artery: carry blood to arterioles (distribution vessel)中動脈 ：運(yùn)送血流至小動脈,又稱分配血管。,C. Small artery and a

3、rteriole resistance vessels 小動脈和微動脈阻力血管Small artery and arteriole are the main position of organism to regulate the organ blood flow and the redistribution of blood among apparatus. The diameter of resistance vessels are regulated by neurohormonal factors. 小動脈和微動脈是機(jī)體調(diào)節(jié)器官血流量和器官之間血液重新分配的主要部位，其血管的口徑受神經(jīng)

4、體液因素的調(diào)節(jié) 。,2. Capillary vessels: exchange vessels 毛細(xì)血管：交換血管 Blood flow from arteriole to venules by passing capillary to carry out the exchange of substances between blood and interstitial fluid. 血流通過毛細(xì)血管從小動脈到小靜脈，完成 血液和組織液的物質(zhì)交換。,Precapillary sphincter 毛細(xì)血管前括約肌 Function: Control of inflow of capillari

5、es 作用：控制毛細(xì)血管的流入量。 A-V shunt (anastomosis) 動靜脈短路（吻合） Function：Blood flows directly from arteriole to veinule through A-V shunt . 作用：血液通過動靜脈吻合由微動脈直接到達(dá)微靜脈。,3. Venous Vessels ( capacitance vessel) 靜脈血管（容量血管） Large vein，vena cava，venule，veinule 大靜脈，腔靜脈，小靜脈，微靜脈 Blood reservoir 血液儲存庫（6070） Big compliance 順

6、應(yīng)性大 Low mean venous pressure 平均靜脈壓低(2mmHg） Venous valve 靜脈瓣,. Hemodynamics 血流動力學(xué) Blood flow, resistance to blood flow and pressure 血流量，血流阻力和血壓 1. Blood flow: Blood volume passing a given section in the cardiovascular system per unit time (ml/s). 血流量：單位時(shí)間流過血管某一橫截面的 血量（ml/s）。,P1-P2 A. Q = R Q ：blood f

7、low（血流量） P1-P2：the dp of the two vessels ends (血管兩端壓力差) R: resistance of blood flow (血流阻力) B. Poiseulles law for laminar flow p pr4 F = = 阻力 8L L :血管長度 ：血液黏度 r veinule：血管半徑,The mode of blood flowing in the blood vessels can be classified into Laminar flow and turbulent flow. 血液在血管內(nèi)的流動方式可以分為層流和湍流。,Em

8、pirical equation（經(jīng)驗(yàn)公式） Reynolds number-Reynold數(shù): NR =DV/ (rho): density of fluid 液體密度 D: diameter of the tube 管徑 V: velocity of flow 流速 NR2000 laminar flow turbulent flow 層流 湍流,Laminar flow Turbulent flow 層流 湍流 The same flow direction The different flow direction 流動方向一致 流動方向不一致 no vibration Vibratio

9、n 無振動 有振動 no sound Sound 無聲音 有聲音 Wasteful energy less Wasteful energy more 耗能少 耗能多,Poiseulles law for laminar flow conforms to laminar flow but turbulent flow.Under turbulent flow, the blood flow is not in direct proportion to the bp of the two ends of vessels, however to its square root. 泊肅葉定律適于層流情

10、況。在湍流情況下，泊肅葉定律不再適用，血流量不是與血管兩端的壓力差成正比，而是與壓力差的平方根成正比。,2. Resistance to blood flow: 血流阻力 P1-P2 8L F = R = R r4 Resistance comes from external friction (L, r) ,internal friction (). Total peripheral resistance is mainly determined by arterioles(6070%). 阻力來自外摩擦（L，r）和內(nèi)摩擦(）, 60-70%的總外周阻力主要來自微動脈。,The blood

11、flow of organ is determined by mean arterial blood pressure and blood resistance. The diameter of arterioles is the determining factor to regulate the redistribution of blood flow of organs.一個器官血流量的多少主要受平均動脈壓和血管半徑的影響。小動脈和微動脈口徑的變化是調(diào)節(jié)器官血流量和器官之間血液重新分配的最主要因素。,Blood pressure 血壓 Two requirements for blood

12、 pressure formation: 血壓形成的兩個條件： A. Blood filling in cardiovascular system 心血管系統(tǒng)血液充盈 Mean circulatory filling pressure blood volume = 7mmHg vascular volume 血液容量 循環(huán)系統(tǒng)平均充盈壓 = 7mmHg 血管容量,B. Cardiac ejection 心臟射血 kinetic energy： push the blood to flow Cardiac Contraction Energesis potential energy: vesse

13、l wall expand Cardiac relaxation：large artery elasticity recovery Percentage potential energy kinetic energy : Push blood to continuously flow forward,動能：推動血液流動 心臟收縮 釋放能量 勢能：血管壁擴(kuò)張 心臟舒張：大動脈彈性回縮 部分勢能 動能：推動血液繼續(xù)向前流動,. Arterial Blood Pressure 動脈血壓,1. Normal value 正常值,Normal value mmHg kPa Systolic Pressu

14、re 收縮壓 100120 13.316 Diastolic Pressure 舒張壓 6080 810 Pulse Pressure 脈壓 3040 4.05.3 MAP 平均動脈壓 100 13.3 MAP = DP + 1/3 (pulse P),A. D n fluctuating rules of blood pressure 血壓的晝夜波動,Double peaks and double valley (day rhythm) 雙峰雙谷（日節(jié)律）,Lowest at 2 to 3 oclock in the morning 凌晨2 3時(shí)最低 One Peak during 6 to

15、 10 in the morning 上午6 10時(shí)高 Another peak during 4 to 8 in the afternoon 下午4 8時(shí)高 Lowing down after 8 oclock in the evening 晚上8時(shí)緩慢下降,B. Diagnosis criteria of hypertension 高血壓的診斷標(biāo)準(zhǔn),Catalogues SP DP Normal 120 90 prophase 120139 8089 1st phase 140159 9099 2nd phase 160 100 The JNC 7 Report JAMA.2003;289

16、:(DOI 10.1001/jama.289.19.2560.,高血壓分類 收縮壓 舒張壓 (mmHg) （mmHg) 正常 120 和 90 高血壓前期 120 139 或 80 89 1 期高血壓 140 159 或 90 99 2 期高血壓 160 或 100,C. Pressure of different vessels of systemic circulation體循環(huán)不同血管的血壓,平均壓（mmHg）主動脈 100動脈（3mm） 95微動脈起始端 85 微動脈末端 55毛細(xì)血管起始端 30,Fall of blood pressure is in direct proporti

17、on to the resistance of blood flow,and the BP decreases significantly in the arteriole ,where the blood flow resistence is the biggest.血壓降落與血流阻力成正比，在血流阻力最大的微動脈段，血壓降落最為顯著。,D. Arterial pressure curves recorded from different sites of systemic circulation(dog) 體循環(huán)不同部位血壓波波形,Arch lower abdomen iliac knee

18、 ankle主動脈弓 下腹部 髂部 膝部 踝部,ascending branch onsets later 升支起始延遲 waveshape sharper 波形變窄 amplitude higher 幅度增高 reentry wave appears 出現(xiàn)折返波,2. Determinants of arterial blood pressure 動脈血壓的決定因素 A. arterial blood volume 動脈血容量 It is determined by ejection volume and peripheral resistance. 由心臟射血量和外周阻力決定。,B. ar

19、terial compliance 動脈順應(yīng)性 順應(yīng)性=V/p In normal condition ,the elasticity of arterial can buffer the fluctuations of BP,and change the blood ejected into arterial to continuous blood flow . 正常時(shí)，動脈的彈性對血壓起“緩沖”作用，維持 一定的收縮壓和舒張壓，使心室間斷的射入動脈 的血流變成動脈的連續(xù)性血流。,If we assume that arterial compliance remains constant a

20、rterial blood pressure will depend on arterial blood volume and vascular volume.假定動脈順應(yīng)性保持恒定，則動脈血壓取決于動脈血量和血管容量。,Blood volume BP vascular volume,Arterial blood volume is determined by the rate of inflow and outflow of arterial system. 動脈血容量取決于動脈系統(tǒng)流入量與流出量 。 Rate of inflow：cardiac output 流入量：心輸出量 Rate o

21、f outflow: resistance and BP 流出量: 血流阻力和動脈血壓,3. Factors affecting arterial pressure影響動脈血壓的因素 A. stoke volume 每搏輸出量 B. heart rate 心率 C. peripheral resistance 外周阻力 D. Compliance of aorta and large artery 主動脈和大動脈的順應(yīng)性 E. circulatory blood flow 循環(huán)血量,影響動脈血壓的因素,影響因素,變化,收縮壓,舒張壓,脈壓,備 注,心率(40180次/分),All the ab

22、ove-mentioned factors of influencing BP is deduced when assuming other influencing factor keeping stable.Actually , the fluctuations of BP under certain physiological condition is always the summation of many factors functions mutually. 上述影響動脈血壓的各種因素，都是在假定其他影響因素不變的前提下，分析某一因素變化時(shí)對動脈血壓可能發(fā)生的影響。實(shí)際上，某種生理情

23、況下動脈血壓的變化，往往是各種因素相互作用的總和結(jié)果。,IV.Venous pressure and venous return 靜脈血壓和靜脈回流 1. Central venous pressure 中心靜脈壓 （412 cm H2O） Affect factors：影響因素 A. Heart pump action 心臟泵功能 B. Venous return velocity 靜脈回流速度,CVP：an index of cardiovascular function 反映心血管功能的一項(xiàng)指標(biāo) CVP ：輸液量不足 CVP ：輸液過快或心臟射血功能不全,2. Peripheral ve

24、nous pressure 外周靜脈壓 Effect of gravity on venous pressure 重力對靜脈壓的影響 Orthostatic hypotension 直立性低血壓,3. Venous return and affecting factors 靜脈回流及影響因素 A. Mean circulatory filling pressure 循環(huán)系統(tǒng)平均充盈壓 B. Cardiac contractility 心肌收縮力 C. Sympathetic nerve 交感神經(jīng) D. Muscle pump 肌肉泵 E. Thoracic pump 呼吸泵,影響靜脈回心血量因

25、素,V. Microcirculation 微循環(huán),Microcirculation is the blood circulation between arteriole and veinule.The microcirculation is the place where the blood and interstitial fluid to carry out the exchange of substances. 微循環(huán)是指微動脈和微靜脈之間的血液循環(huán)。 微循環(huán)是血液和組織之間進(jìn)行物質(zhì)交換的場所。,Architecture of microcirculation 微循環(huán)的結(jié)構(gòu),A. Fu

26、ndamental composition 基本構(gòu)成 Arteriole metarteriole precapillary sphincter true capillary venule 微動脈后微動脈毛細(xì)血管前括約肌 真毛細(xì)血管微靜脈,B. Preferential channel or thoroughfare 通血毛細(xì)血管（直捷通路） Arteriole metarteriole Preferential channel venule 微動脈后微動脈通血毛細(xì)血管微靜脈 The blood flows into veins quickly through microcirculation

27、 ,and its can be easily found in skeletal muscle. 血液通過微循環(huán)迅速進(jìn)入靜脈，骨骼肌中多見。,C. A-V anastomosis or A-v shunt 動靜脈吻合或動靜脈短路 Arteriole venule 微動脈微靜脈 Participate in thermoregulation 參與體溫調(diào)節(jié) infection or toxic shock open more, and the oxygen deficiency aggravate. 感染或中毒性休克時(shí)大量開放，加重組織缺氧。,Hemodynamic of microcircul

28、ation微循環(huán)的血流動力學(xué) A. big cross section area 橫截面積大 slow velocity of blood flow 血流速度緩慢The substances can be thoroughly exchanged between blood and interstitial fluid.有利于血液與組織液在毛細(xì)血管進(jìn)行物質(zhì)交換。,B. capillary pressure depends on precapillary resistance / postcapillary resistance. 毛細(xì)血管壓力取決于毛細(xì)血管前阻力與毛細(xì) 血管后阻力的比值。 Th

29、e blood volume of microcirculation is in direct proportion to the dp of arteriole and veinule,and in inverse proportion to the whole resistance of microcirculation. 微循環(huán)的血流量與微動脈和微靜脈之間的血壓差成正比，與微循環(huán)中血流總阻力成反比。,C. alternate opening and closing of capillaries. 毛細(xì)血管交替性收縮和舒張 vasomotion activity 血管舒縮活動 (510次/

30、min) Vasomotion activity is maily concerned with the metabolic activity of regional tissues .The blood flow of microcirculation conforms to the level of metabolic activity. 血管舒縮活動主要與局部組織的代謝活動有關(guān)。 微循環(huán)的血流量和組織的代謝活動水平相適應(yīng)。,3. Exchange of substances between blood and interstitial fluid 血液和組織液之間的物質(zhì)交換 A. Dif

31、fusion: the most important way. 擴(kuò)散：最重要的方式,Lipid soluble substances: O2, CO2 脂溶性物質(zhì)： O2, CO2 non-lipid soluble substances 非脂溶性物質(zhì) Rate of diffusion =(DA/a)(Co-Ci) D: diffusion coefficient D:擴(kuò)散系數(shù),B. Filtration and reabsorption 濾過和重吸收 Filtration and reabsorption play an important role in the generation o

32、f interstitial fluid. 在組織液的生成中起重要作用。 C. Pinocytosis 吞飲 The big molecules can carry out the exchange of substances through Pinocytosis. 大的分子可以通過這種方式進(jìn)行物質(zhì)交換。,Formation of interstitial fluid 組織液的形成About 60% of the weight of the health adult is water, in which:正常人體重中大約60是水，其中細(xì)胞內(nèi)液（5/8） 1/5: 血漿 細(xì)胞外液 （3/8）

33、4/5: 組織液和腔室內(nèi)液體,A端 Pf=（30+15）-（25+10）= +10mmHg V端 Pf=（12+15）-（25+10）= - 8 mmHg,Formation of interstitial fluid組織液的生成,EP= ( Pc +if ) (p + Pif ) 有效濾過壓=（毛細(xì)血管血壓+組織液膠滲壓）- （血漿膠體滲透壓+組織液靜水壓）,Pc ：毛細(xì)血管血壓 if ：組織液膠體滲透壓 p ：血漿膠體滲透壓 Pif ：組織液靜水壓,The filtration and reabsorption of fluid through the capillary wall is determined by the difference of the strength of filtration and reabsorption. 液體通過毛細(xì)血