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1 呼吸系统 Respiratory System 黄莺病理生理学教研室

2 绪论 Introduction

3 一呼吸与呼吸系统的基本概念 Concept of respiration & respiratory system

gases: Carbon dioxide leaving the cell, oxygen entering.

4 细胞呼吸 Cellular respiration 细胞呼吸是指有机物在细胞内经过一系列的氧化分解, 生成二氧化碳或其他产物, 释放出能量并生成 ATP 的过程 C 6 H 12 O 6 + 6H 2 O + 6O 2 enzyme 6CO H 2 O + energy (38 ATP) There must be an exchange of gases: Carbon dioxide leaving the cell, oxygen entering. Animals have organ systems involved in facilitating this exchange as well as the transport of gases to and from exchange areas.

5 生物体的不同呼吸方式 Bodies and Respiration Single-celled organisms: directly by the cell membrane Simple animals: having flattened, tubular, or thin shaped body plans Large animals: developed a variety of respiratory surfaces

6 A respiratory surface is covered with thin, moist epithelial cells that allow oxygen and carbon dioxide to exchange. Those gases can only cross cell membranes when they are dissolved in water or an aqueous solution, thus respiratory surfaces must be moist. 呼吸表面的特点 Respiratory Surfaces

7 二人类呼吸系统的基本结构和功能 Structure and functions of human respiratory system

8 人类呼吸系统 The Human Respiratory System 呼吸系统是执行机体和外界进行气体交换的器官的总称呼吸系统的机能主要是与外界的进行气体交换, 呼出二氧化碳, 吸进氧气, 进行新陈代谢呼吸系统包括呼吸道 ( 鼻腔咽喉气管支气管 ) 和肺, 是气体进出肺的通道

11 肺通气 Pulmonary ventilation 肺通气是肺与外界环境之间的气体交换过程胸廓的节律性呼吸运动则是实现肺通气的动力当膈肌和肋间外肌收缩时, 胸廓体积增大, 肺随之扩张, 这时肺内气压就低于大气压, 外界空气通过呼吸道进入肺, 完成吸气呼气过程与此相反通过呼吸运动, 肺实现了与外界环境的气体交换, 使肺泡内的气体不断地得到更新

12 肺泡与气体交换 The Alveoli and Gas Exchange 肺泡与血液流经肺泡 - 毛细血管膜 ( 简称肺泡膜 ) 进行气体交换的过程是一个物理性弥散过程单位时间内气体的弥散量取决于肺泡膜两侧的气体分压差肺泡的面积与厚度和气体的弥散常数弥散常数又与气体的分子量和溶解度相关此外, 气体总弥散量还决定于血液与肺泡接触的时间

13 呼吸色素 (respiratory pigments ) 是指能与氧气发生可逆性结合, 在呼吸作用中运载氧气的含金属 (Fe Cu 等 ), 能使血液呈现某种颜色的蛋白质血红蛋白 (hemoglobin) 分子由一分子的珠蛋白和四分子亚铁血红素组成, 每个血红素又由 4 个吡咯环组成, 在环中央有一个铁原子血红蛋白中的铁在二价状态时, 可与氧呈可逆性结合 ( 氧合血红蛋白 ), 如果铁氧化为三价状态血红蛋白则转变为高铁血红蛋白, 就失去了载氧能力

方式快速移出 RBC 外, 而 H 则与 Hb 结合, 有利于酸碱度的缓冲和 O 2 的释放通过这些途径实施对 CO 2 的运输

14 在代谢旺盛的组织细胞中,CO 2 浓度明显高于毛细血管中的 CO 2 含量, 因此,CO 2 快速从细胞弥散入血液从血浆弥散至红细胞的 CO 2 与 H 2 O 迅速反应生成 H 2 CO 3, 后者解离成 HCO 和 H, 反应具有可逆性 HCO 通过氯离子转移方式快速移出 RBC 外, 而 H 则与 Hb 结合, 有利于酸碱度的缓冲和 O 2 的释放通过这些途径实施对 CO 2 的运输在肺部毛细血管, HCO 与 H 结合生成 H 2 CO 3, 后者进一步降解为 CO 2 和 H 2 O 在此产生的 CO 2 最终通过肺呼吸排出体外

15 外呼吸 (External respiration) Ventilation & Gas exchange Diffusion of: 外呼吸与内呼吸 External and Internal Respiration O 2 from alveoli to blood CO 2 from blood to alveoli 内呼吸 (Internal respiration) Gas exchange & cellular respiration Diffusion of: O 2 from blood to tissues CO 2 from tissues to blood Jenkins, Kemmitz & Tortora (2007 p. 861)

17 海平面各呼吸气体的容积百分比 Composition of atmospheric air and expired air in a typical subject. Note that only a fraction of the oxygen inhaled is taken up by the lungs. Component Atmospheric Air (%) Expired Air (%) N 2 (plus inert gases) O CO H 2 O % 100.0%

18 Breathing & Respiration

19 呼吸系统的非呼吸功能 Non-Respiratory Functions Of the Respiratory System 防御功能 (Defense Mechanisms) 非特异性防御功能 - 物理性屏障 - 化学性屏障特异性防御功能 - 分泌型 IgA(sIgA),ROS 等 - 趋化因子 (chemokines) 和细胞因子 ( cytokines) 滤过作用纤毛运动巨噬细胞

20 内分泌与代谢功能 (Metabolic & Endocrine Functions of lung) 肺泡表面活性物质抗凝和纤溶功能 ( 肺血管内皮细胞 ) 血管紧张素转化酶合成前列腺素肺泡表面活性物质, 生理学图片, 肾素 - 血管紧张素系统,

发声 (Vocalization) The movement of gas through the larynx, pharynx and mouth allows

Vocalization, or singing, in birds occurs via the syrinx, an organ located at the

The vibration of air flowing across the larynx (vocal chords), in humans, and the

21 发声 (Vocalization) The movement of gas through the larynx, pharynx and mouth allows humans to speak, or phonate. Vocalization, or singing, in birds occurs via the syrinx, an organ located at the base of the trachea. The vibration of air flowing across the larynx (vocal chords), in humans, and the syrinx, in birds, results in sound. Because of this, gas movement is extremely vital for communication purposes. 体温调节 (Temperature control) 咳嗽和喷嚏 (Coughing and sneezing)

22 其他血液酸碱平衡的调节过滤小栓子小气泡等保护心脏

23 三呼吸系统与其他器官系统的关系 Other systems or organs work with respiratory system in our bodies

24 中枢神经系统与呼吸功能的关系 The relationship of central nervous system and respiratory function 脑桥脑桥呼吸神经团 ( 呼吸调整中枢长吸中枢 ) Inspiratory center 延髓呼吸中枢 ( 呼吸节律中枢 ) 肋间内肌 Expiratory center 延髓肋间外肌脊髓膈肌

25 高位脑颈动脉体主动脉体黑 - 伯反射 ( 肺牵张反射 ) 本体感受器触觉温觉痛觉感受器

26 血液系统和呼吸功能的关系 The relationship of hematological system and respiratory function

28 循环系统与呼吸功能的关系 The relationship of circulatory system and respiratory function

29 四呼吸系统疾病及其临床地位 Respiratory diseases

33 呼吸系统常见疾病 Common respiratory diseases 呼吸系统疾病是一种常见病多发病, 主要病变在气管支气管肺部及胸腔, 病变轻者表现为咳嗽胸痛呼吸受影响, 重者呼吸困难缺氧, 甚至呼吸衰竭而致死哮喘 (asthma) 是由多种细胞特别是肥大细胞嗜酸性粒细胞和 T 淋巴细胞参与的慢性气道炎症慢性阻塞性肺疾病 (COPD) 特征性病变为气流受限, 是小气道病变和肺实质破坏共同作用的结果慢性支气管炎 (chronic bronchitis) 指气管支气管粘膜及其周围组织的非特异性炎症肺气肿 (emphysema) 指终末细支气管远端的气道弹性减退, 过度膨胀充气和肺容积增大或同时伴有气道壁破坏的病理状态胸膜炎 (pleurisy) 胸膜炎通常由病毒或细菌刺激胸膜所致的胸膜炎症肺癌 (lung cancer) 肺癌是发病率和死亡率增长最快, 对人群健康和生命威胁最大的恶性肿瘤之一流感 (influenza) 流感病毒引起的急性呼吸道感染, 传染性强传播速度快肺炎 (pneumonia) 是由病原微生物或其他因素所致的肺实质性病变鼻窦炎 (sinusitis) 一个或多个鼻窦发生炎症感冒 (common cold) 上呼吸道感染

34 慢性阻塞性肺疾病 Chronic Obstructive Pulmonary Disease (COPD) Lung disease referred to as COPD generally includes chronic bronchitis and emphysema. While bronchitis involves inflammation and scarring of the main airways, the bronchial tubes, and emphysema is permanent damage to the walls of the air sacs and loss of lung elasticity, both cause obstruction of the normal air flow. Individuals with COPD exhibit symptoms such as shortness of breath, chronic cough and chronic mucus production. COPD is the leading cause of breathing disability in the U.S. The American Lung Association statistics state: COPD claims the lives of 107,146 Americans annually; COPD is the fourth leading cause of death; COPD costs Americans $30.4 billion--$14.7 billion in healthcare costs, $15.7 indirect costs; percent of COPD cases are caused by smoking. 引起 COPD 的其他原因 : 二手烟 (second-hand smoke) 空气与职业污染遗传性呼吸道感染病史慢性或未治疗的哮喘囊性纤维化 ( 遗传 ) COPD 症状 : 气促呼吸困难痰量或粘液量增多经常性清嗓子 (clearing of the throat) 咳嗽喘息黄色绿色或血色的痰液踝或蹆水肿睡眠困难疲劳健忘混乱或口齿不清

35 五呼吸系统疾病诊治的新进展 Progresses in diagnosis & therapies

36 新的诊断技术 Novel diagnostic techniques X 光是穿透性很强的射线, 一种高能量光波粒子射线要被阻挡, 关键由射线强度频率阻挡物质与射线作用程度阻挡物质厚度阻挡物质大小共同决定目前大医院 CR 与 DR 就是利用 X 射线的吸收, 二维成像 X 线电子计算机断层扫描 (computed tomography,ct) 是利用 X 线断层扫描, 电光子探测器接收, 并把信号转化为数字输入电子计算机, 再由计算机转化为图像,CT 是一种无痛苦无损伤无危险快速方便, 适合于任何年龄且准确性高的辅助检查工具磁共振成像 (nuclear magnetic resonance imaging,mri) 是根据有磁距的原子核在磁场作用下, 能产生能级间的跃迁的原理而采用的一项新检查技术, 成像过程与图像重建和 CT 相近, 只是 MRI 既不靠外界的辅射吸收与反射, 也不靠放射性物质在体内的 γ 辅射, 而是利用外磁场和物体的相互作用来成像, 高能磁场对人体无害能发现 CT 显示完全正常的等密度病灶, 对神经血管肌肉等软组织成分显示明显优于 CT 正电子发射型计算机断层显像 ( Positron Emission Computed Tomography,PET) 是新发展起来的核医学检查方法扫描前先给病人注射一种标记某种正电子的放射性制剂 ( 通常为 18 F-FDG), 从它们所参与的代谢过程来测定脑组织的代谢改变由于大脑所需能量的 80% 来自葡萄糖, 大脑某一部位的功能越活跃, 那个部位的脑细胞和葡萄糖代谢就越旺盛 PET 可根据葡萄糖代谢率的高低, 来检测脑异常代谢的确切部位

37 X-ray imaging

(Sean Fain, University of Wisconsin-Madison) Time sequence of Helium-3 MRI of

38 An MRI using the new helium-3 technique on the left, and a conventional MRI on the right. (Sean Fain, University of Wisconsin-Madison) Time sequence of Helium-3 MRI of lungs during inhalation and exhalation. M Salerno TA Altes JR Brookemann EE de Lange JP Mugler III Magnetic Resonance in Medicine 46: (2001)

39 Caption: Lung cancer. Coloured axial positron electron tomography (PET) scan of lung cancer (white, lower left) in the right lung. Lung cancers are most often caused by cigarette smoking, exposure to asbestos, or other forms of pollution. Treatment includes radiotherapy, chemotherapy and the surgical removal of all or part of the affected lung.

40 PET-CT scan of the lungs with a tumour necrosis

41 机械通气 Mechanical ventilation RICU Intensive Care Unit,ICU 呼吸机

42 气管镜 Bronchoscope 气管镜的应用 ⑴ 取出支气管异物 ⑵ 清除异常分泌物, 包括痰液脓栓血块等 ⑶ 明确了咯血患者出血部位可行局部止血 ⑷ 对肺癌患者作局部放疗或局部注射化疗药物 ⑸ 对气道良恶性肿瘤进行激光微波冷冻高频电刀治疗

43 其他肿瘤干细胞与肺癌 (tumor stem cell and lung cancer) 蛋白组学与呼吸系统疾病 (Proteomics and respiratory diseases) 肺干细胞 (Lung stem cells) 干细胞治疗肺动脉高压 (Stem Cell Therapy for Pulmonary Hypertension) 介入性肺病学 (Interventional pulmonology) 肺移植 (Lung transplantation) 肺癌的疫苗 (Vaccine for lung cancer) 靶向治疗 (Targeted therapy)

44 Artificial Lung Katie Sutherland is shown in this undated family handout photo. In a world's first, Canadian doctors kept Katy alive using an external artificial lung until donor lungs were available for transplant. The 16-year-old girl is now back at school and playing soccer again.

46 体外膜肺氧合 (extracorporeal membrane oxygenation, ECMO) 是体外循环技术范围的扩大和延伸,ECMO 可对需要外来辅助的呼吸和 ( 或 ) 循环功能不全的重危患者进行有效的呼吸循环支持

47 呼吸系统课程 Curriculum of respiratory system 绪论呼吸系统的发生和结构 / 实验肺通气和换气功能气体的运输和呼吸调节呼吸系统疾病的症状和体征呼吸系统疾病病理学 ( 肺炎 COPD, 矽肺肺癌 ) / 实验呼吸系统疾病的病理生理学 ( 缺氧呼吸衰竭 ) 肺部的体格检查呼吸系统常见疾病肺功能检查药理学 ( 常用药物 ) 影像学诊断临床见习问题导向学习 (problem-based learning, PBL)

48 教学大纲 : pmenuid=114581&action=view&type=&name=&menutype=1 考核方式期末卷面考 ( 占总评比例 75% ) 见习 ( 占总评 5%),PBL( 占总评 10%) 读书报告或小论文 ( 占总评比例 10%)

49 Thanks

50 Outlines 1. Basic ideas of respiration and respiratory system 2. Basic structures and functions of respiratory system 3. Non-respiratory functions of respiratory system 4. The relationship of respiratory system and other systems 5. Common diseases in respiratory system 6. Progresses in diagnosis and therapies

Chronic Obstructive Pulmonary Disease (COPD) - Simplified Chinese

Chronic Obstructive Pulmonary Disease (COPD) COPD is a common lung disease. There are 2 main types of COPD: Emphysema involves the alveoli or small air sacs being irritated. Over time the air sacs get