呼吸系統(tǒng)教學課件：呼吸系統(tǒng)緒論

呼吸系統(tǒng)RespiratorySystem

Introduction

緒論1.Conceptofrespiration&respiratorysystemCellularrespirationCellularrespiration: ThetransferofenergyfromvariousmoleculestoproduceATP;occursinthemitochondriaofeukaryotes,thecytoplasmofprokaryotes.Intheprocess,oxygenisconsumedandcarbondioxideisgenerated.Theremustbeanexchangeofgases:

Carbondioxideleavingthecell,oxygenentering.Animalshaveorgansystemsinvolvedinfacilitatingthisexchangeaswellasthetransportofgasestoandfromexchangeareas.BodiesandRespiration Single-celledorganismsexchangegasesdirectlyacrosstheircellmembrane.However,theslowdiffusionrateofoxygenrelativetocarbondioxidelimitsthesizeofsingle-celledorganisms. Simpleanimalsthatlackspecializedexchangesurfaceshaveflattened,tubular,orthinshapedbodyplans,whicharethemostefficientforgasexchange.However,thesesimpleanimalsarerathersmallinsize.RespiratorySurfaces Largeanimalscannotmaintaingasexchangebydiffusionacrosstheiroutersurface.Theydevelopedavarietyofrespiratorysurfacesthatallincreasethesurfaceareaforexchange,thusallowingforlargerbodies. Arespiratorysurfaceiscoveredwiththin,moistepithelialcellsthatallowoxygenandcarbondioxidetoexchange.Thosegasescanonlycrosscellmembraneswhentheyaredissolvedinwateroranaqueoussolution,thusrespiratorysurfacesmustbemoist.MethodsofRespiration Sponges(海綿動物)andjellyfish(水母)lackspecializedorgansforgasexchangeandtakeingasesdirectlyfromthesurroundingwater.Flatworms(扁形蟲)andannelids(環(huán)節(jié)動物)usetheiroutersurfacesasgasexchangesurfaces.Arthropods(節(jié)肢動物),annelids,andfishusegills;terrestrialvertebrates(陸棲脊椎動物)utilizeinternallungs.spongesjellyfishGills（腮）

Gillsareveryefficientatremovingoxygenfromwater:thereisonly1/20theamountofoxygenpresentinwaterasinthesamevolumeofair.Waterflowsovergillsinonedirectionwhilebloodflowsintheoppositedirectionthroughgillcapillaries.Thiscountercurrentflowmaximizesoxygentransfer.TrachealSystems（氣管系統(tǒng)）

Manyterrestrialanimalshavetheirrespiratorysurfacesinsidethebodyandconnectedtotheoutsidebyaseriesoftubes.Tracheaearethesetubesthatcarryairdirectlytocellsforgasexchange.Spiraclesareopeningsatthebodysurfacethatleadtotracheaethatbranchintosmallertubesknownastracheoles.Bodymovementsorcontractionsspeeduptherateofdiffusionofgasesfromtracheaeintobodycells.However,tracheaewillnotfunctionwellinanimalswhosebodyislongerthan5cm.Lungs（肺）

Lungsareingrowthsofthebodywallandconnecttotheoutsidebyasseriesoftubesandsmallopenings.Lungbreathingprobablyevolvedabout400millionyearsago. Lungsarenotentirelythesolepropertyofvertebrates,someterrestrialsnails(蝸牛)haveagasexchangestructuressimilartothoseinfrogs.2.StructureandfunctionsofhumanrespiratorysystemTheHumanRespiratorySystemThissystemincludesthelungs,pathwaysconnectingthemtotheoutsideenvironment,andstructuresinthechestinvolvedwithmovingairinandoutofthelungs.VentilationVentilationisthemechanicsofbreathinginandout.Whenyouinhale,musclesinthechestwallcontract,liftingtheribsandpullingthemoutward.Thediaphragmatthistimemovesdownwardenlargingthechestcavity.Reducedairpressureinthelungscausesairtoenterthelungs.Exhalingreversesthesessteps.TheAlveoliandGasExchangeDiffusionisthemovementofmaterialsfromahighertoalowerconcentration.Thedifferencesbetweenoxygenandcarbondioxideconcentrationsaremeasuredbypartialpressures.Thegreaterthedifferenceinpartialpressurethegreatertherateofdiffusion.Respiratorypigmentsincreasetheoxygen-carryingcapacityoftheblood.Humanshavethered-coloredpigmenthemoglobinastheirrespiratorypigment.Hemoglobinincreasestheoxygen-carryingcapacityofthebloodbetween65and70times.Eachredbloodcellhasabout250millionhemoglobinmolecules,andeachmilliliterofbloodcontains1.25X1015hemoglobinmolecules.Oxygenconcentrationincellsislow(whenleavingthelungsbloodis97%saturatedwithoxygen),sooxygendiffusesfromthebloodtothecellswhenitreachesthecapillaries.Carbondioxideconcentrationinmetabolicallyactivecellsismuchgreaterthanincapillaries,socarbondioxidediffusesfromthecellsintothecapillaries.Waterinthebloodcombineswithcarbondioxidetoformbicarbonate.Thisremovesthecarbondioxidefromthebloodsodiffusionofevenmorecarbondioxidefromthecellsintothecapillariescontinuesyetstillmanagesto"package"thecarbondioxideforeventualpassageoutofthebody.Inthealveolicapillaries,bicarbonatecombineswithahydrogenion(proton)toformcarbonicacid,whichbreaksdownintocarbondioxideandwater.Thecarbondioxidethendiffusesintothealveoliandoutofthebodywiththenextexhalation.ExternalandInternalRespirationExternalrespiration

Ventilation&GasexchangeDiffusionof:O2fromalveolitobloodCO2frombloodtoalveoliInternalrespiration

Gasexchange&cellularrespirationDiffusionof:O2frombloodtotissuesCO2fromtissuestobloodJenkins,Kemmitz&Tortora(2007p.861)外呼吸與內呼吸呼吸全過程可分成外呼吸（externalrespiration，即肺呼吸）和內呼吸（tissuerespiration，即組織呼吸）兩部分。外呼吸是指機體通過呼吸道和肺，從外環(huán)境獲得O2和釋出CO2，并經心血管系統(tǒng)由血液在肺與各器官組織之間輸送O2和CO2的過程。內呼吸是指組織細胞利用O2進行生物氧化，產生能量、生成水和CO2的過程。Compositionofatmosphericairandexpiredairinatypicalsubject.

Notethatonlyafractionoftheoxygeninhaledistakenupbythelungs.ComponentAtmosphericAir(%)ExpiredAir(%)N2(plusinertgases)78.6274.9O220.8515.3CO20.033.6H2O0.56.2

100.0%100.0%Breathing&RespirationDefenseMechanisms

Airwayepithelialcellscansecreteavarietyofmoleculesthataidinlungdefense.Secretoryimmunoglobulins(IgA),collectins(includingSurfactantAandD),defensinsandotherpeptidesandproteases,reactiveoxygenspecies,andreactivenitrogenspeciesareallgeneratedbyairwayepithelialcells.Thesesecretionscanactdirectlyasantimicrobialstohelpkeeptheairwayfreeofinfection.

Airwayepithelialcellsalsosecreteavarietyofchemokinesandcytokinesthatrecruitthetraditionalimmunecells

andotherstositeofinfections.Non-RespiratoryFunctionsOftheRespiratorySystemMetabolic&EndocrineFunctionsoflungsManufacturesurfactantforlocaluse.Containafibrinolyticsystemthatlysesclotsinthepulmonaryvessels.ConvertangiotensinItoangiotensinIIbytheactionofangiotensin-convertingenzyme.Prostaglandinsareremovedfromthecirculation,buttheyarealsosynthesizedinthelungsandreleasedintothebloodwhenlungtissueisstretched.Vocalization Themovementofgasthroughthelarynx,pharynxandmouthallowshumanstospeak,orphonate.Vocalization,orsinging,inbirdsoccursviathesyrinx,anorganlocatedatthebaseofthetrachea.Thevibrationofairflowingacrossthelarynx(vocalchords),inhumans,andthesyrinx,inbirds,resultsinsound.Becauseofthis,gasmovementisextremelyvitalforcommunicationpurposes.Temperaturecontrol Pantingindogsandsomeotheranimalsprovidesameansofcontrollingbodytemperature.Thisphysiologicalresponseisusedasacoolingmechanism.Coughingandsneezing Irritationofnerveswithinthenasalpassagesorairways,caninducecoughingandsneezing.Theseresponsescauseairtobeexpelledforcefullyfromthetracheaornose,respectively.Inthismanner,irritantscaughtinthemucuswhichlinestherespiratorytractareexpelledormovedtothemouthwheretheycanbeswallowed.Others

AlterthepHofbloodbyfacilitatingalterationsinthepartialpressureofcarbondioxide.Filteroutsmallbloodclotsformedinveins.Filteroutgasmicro-bubblesoccurringinthevenousbloodstreamsuchasthosecreatedafterscubadivingduringdecompression.Mayserveasalayerofsoft,shock-absorbentprotectionfortheheart,whichthelungsflankandnearlyenclose.3.Othersystemsororgansworkwithrespiratorysysteminourbodies腦橋延髓脊髓延髓呼吸中樞（呼吸節(jié)律中樞）腦橋呼吸神經團（呼吸調整中樞、長吸中樞）InspiratorycenterExpiratorycenter膈肌肋間外肌肋間內肌中樞神經系統(tǒng)與呼吸功能的關系

本體感受器主動脈體頸動脈體黑－伯反射（肺牽張反射）高位腦觸覺、溫覺痛覺感受器血液系統(tǒng)與呼吸功能的關系

循環(huán)系統(tǒng)與呼吸功能的關系

4.RespiratorydiseasesCommonrespiratorydiseases

Commonrespiratorydiseasestreatedbyrespiratorycarephysiciansandotherspecialistsinclude:Asthma-constrictionofhypersensitiveairways;ChronicObstructivePulmonaryDisease(COPD)-lungdiseasecausingshortnessofbreath;ChronicBronchitis-inflammationandpermanentscarringofthebronchialtubesEmphysema-damagetoairsacswallscausinglossofelasticity;Pleurisy-inflammationofthepleuralmembranelininglungsandthechestcavity;LungCancer-malignanttumorsthatdevelopinlungtissueAcuteBronchitis-inflammationofthebronchialtubes;Influenza-seriousinfectioncausebytheinfluenzavirus;Pneumonia-infectionofthelungscausedbyavirusorbacteria;Sinusitis-inflammationofthesinuscavities;CommonCold-infectioncausedbyavirus;ChronicObstructivePulmonaryDisease(COPD),ChronicBronchitisandEmphysema LungdiseasereferredtoasCOPDgenerallyincludeschronicbronchitisandemphysema.Whilebronchitisinvolvesinflammationandscarringofthemainairways,thebronchialtubes,andemphysemaispermanentdamagetothewallsoftheairsacsandlossoflungelasticity,bothcauseobstructionofthenormalairflow.IndividualswithCOPDexhibitsymptomssuchasshortnessofbreath,chroniccoughandchronicmucusproduction.COPDistheleadingcauseofbreathingdisabilityintheU.S.TheAmericanLungAssociationstatisticsstate: COPDclaimsthelivesof107,146Americansannually; COPDisthefourthleadingcauseofdeath; COPDcostsAmericans$30.4billion--$14.7billioninhealthcarecosts,$15.7indirectcosts; 80-90percentofCOPDcasesarecausedbysmoking.

AdditionalcausesofCOPDinclude:Second-handsmoke;Airandoccupationalpollution;Heredity;Pre-dispositiontoandhistoryofrespiratoryinfections;Chronicorunder-treatedasthma;CysticFibrosis(inherited). COPDSymptoms:Shortnessofbreath,difficultybreathing;Increasedmucusorsputum;Frequentclearingofthethroat;Cough;Wheezing;Yellow,greenorbloodysputum;Ankleorlegswelling;Sleepdifficulties;Overallfatigue;Forgetfulness,confusionorslurredspeech.5.Progressesindiagnosis&therapiesofrespiratorydiseasesNoveldiagnostictechniquesX光是穿透性很強的射線，一種高能量光波粒子。射線要被阻擋，關鍵由射線強度、頻率、阻擋物質與射線作用程度、阻擋物質厚度、阻擋物質大小共同決定。目前大醫(yī)院CR與DR就是利用X射線的吸收，二維成像。X線電子計算機斷層掃描

(computedtomography，CT)是利用X線斷層掃描，電光子探測器接收，并把信號轉化為數字輸入電子計算機，再由計算機轉化為圖像，CT是一種無痛苦、無損傷、無危險、快速、方便，適合于任何年齡且準確性高的輔助檢查工具。磁共振成像(nuclearmagneticresonanceimaging，MRI)是根據有磁距的原子核在磁場作用下，能產生能級間的躍遷的原理而采用的一項新檢查技術，成像過程與圖像重建和CT相近，只是MRI既不靠外界的輔射、吸收與反射，也不靠放射性物質在體內的γ輔射，而是利用外磁場和物體的相互作用來成像，高能磁場對人體無害。能發(fā)現CT顯示完全正常的等密度病灶，對神經、血管、肌肉等軟組織成分顯示明顯優(yōu)于CT。正電子發(fā)射型計算機斷層顯像（PositronEmissionComputedTomography，PET）是新發(fā)展起來的核醫(yī)學檢查方法。掃描前先給病人注射一種標記某種正電子的放射性制劑（通常為18F-FDG），從它們所參與的代謝過程來測定腦組織的代謝改變。由于大腦所需能量的80%來自葡萄糖，大腦某一部位的功能越活躍，那個部位的腦細胞和葡萄糖代謝就越旺盛。PET可根據葡萄糖代謝率的高低，來檢測腦異常代謝的確切部位。X-rayimagingCaption:

Lungcancer.Colouredaxialpositronelectrontomography(PET)scanoflungcancer(white,lowerleft)intherightlung.Lungcancersaremostoftencausedbycigarettesmoking,exposuretoasbestos,orotherformsofpollution.Treatmentincludesradiotherapy,chemotherapyandthesurgicalremovalofallorpartoftheaffectedlung.AnMRIusingthenewhelium-3techniqueontheleft,andaconventionalMRIontheright.(SeanFain,UniversityofWisconsin-Madison)TimesequenceofHelium-3MRIoflungsduringinhalationandexhalation.

MSalernoTAAltesJRBrookemannEEdeLangeJPMuglerIIIMagneticResonanceinMedicine46:667-677(2001)PET-CTscanofthelungswithatumournecrosisMechanicalventilation、RICU呼吸機IntensiveCareUnit，ICUBronchoscope氣管鏡技術OthersTumorstemcells&lungcancerProteomicsandrespiratorydiseasesLungstemcellsStemCellTherapyforPulmonaryHypertensionInterventionalpulmonologyLungtransplantationVaccineforlungcancerExtracorporealMembraneOxygenation(ECMO)IntroductionECMOisaformofpartialcardiopulmonarybypassusedforlong-termsupportofrespiratoryand/orcardiacfunction.Thistechnologyarosefromcardiopulmonarybypassusedforcardiacsurgery.Initialsystemsusedbubbleoxygenatorswhichwerepoorlysuitedforprolongedusebecauseoftheirtendencytohemolyzeblood.Membraneoxygenatorsmadelong-termuseofECMOpossible.ThefirstreportofsuccessfulECMOsupportofanadultwaspublishedbyHillin1972.ECMOisusedininfantswhoareextremelyillduetobreathingorheartproblems.TheECMOmachinecirculatesbloodthroughanartificiallungbackintothebloodstream.Thisprovidesadequateoxygentothebabywhileallowingtimeforthelungsandheartto"rest"orheal.ArtificialLungKatieSutherlandisshowninthisundatedfamilyhandoutphoto.Inaworld'sfirst,CanadiandoctorskeptKatyaliveusinganexternalartificiallunguntildonorlungswereavailablefortransplant.The16-year-oldgirlisnowbackatschoolandplayingsocceragain.Interventionalpulmonology(IP)IPisanevolvingfieldthathasrapidlymaturedinrecentyears.ThefieldofIPhasalwaysheldastrongfocusonthediagnosisandtreatmentofcommonairwayandpleuraldiseases.WelldocumentedisIP’sabilitytomanagemalignantandnon-malignantcomplexairwaydiseasethroughrigidandflexiblebronchoscopicintervention.Inaddition,advanceddiag