中山大学医学院精品课程病理生理学ppt课件.ppt

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1、万用卡RespiratoryFailureThedepartmentofpathophysiologySUNHuilanO2CO2CO2ExternalrespirationcirculationInternalrespirationWhatisrespiratoryfailureRespiratoryfailureisapathologicalprocessInwhichtheexternalrespiratorydysfunctionleadstoanabnormaldecreaseofarterialpartialpressureofoxygenwithorwithoutcarb

2、ondioxideretention.HowtoJudgerespiratoryfailure（1）PaO2<8kpa（60mmHg）（2）PaCO2>6.6kpa（50mmHg）classificationofRF：Hypoxemic(GroupⅠ）RF——（1）Hypercapnic（GroupⅡ）RF——（1）＋（2）EtiologyandPathogenesisofRFVentilatorydisordersDiffusiondisordersVentilation-perfusionimbalanceAnatomicshuntEtiologyandPathogenesisof

3、RF(1)VentilatorydisorderRestrictiveVentilatorydisordersObstructiveVentilatorydisordersRestrictiveVentilatorydisordersParalysisoftherespiratoymusclesDecreasedcomplianceofchestwallDecreasedcomplianceoflungsHydrothoraxorpneumothoraxEtiologyandPathogenesisofRF(1)大脑皮层——调节呼吸肌作随意运动脑桥、延髓——不随意的自主节律呼吸调节脊髓

4、肋间神经肋间肌肋骨、胸骨隔肌胸膜及胸膜腔胸廓外伤、中毒出血、感染脊髓灰质炎、高位截瘫多发性神经炎重症肌无力、多发性肌炎大量腹水、上腹巨大肿物外伤、骨折气胸、大量胸腔积液EtiologyandPathogenesisofRF(1)CentralairwayobstructionPeripheralairwayobstructionObstructiveVentilatorydisordersO2CO2CO2O2口鼻喉头肺泡气管、支气管肺泡膜肺血管意外异物水肿炎症异物异物肿瘤哮喘肺水肿肺泡癌炎症纤维化间质水肿休克栓塞CentralairwayobstructionPeripheralair

5、wayobstructionExtrathoracicvariableobstructionexpirationinspirationIntrathoracicvariableobstructionexpirationinspirationnomalChronicbronchitisemphysema＋20＋30＋20＋350＋10＋200＋10＋20＋20＋20＋25＋20＋20＋20＋20PeripheralairwayobstructionBloodgasLowPaO2andHighPaCO2VentilatorydisordersO2CO2CO2O2口鼻喉头肺泡气管、支气管肺泡

6、膜肺血管意外异物水肿炎症异物异物肿瘤哮喘肺水肿肺泡癌炎症纤维化间质水肿休克栓塞EtiologyandPathogenesisofRF(2)Areaofalveolar-capillarymembrane↓DiffusiondisordersThicknessofalveolar-capillarymembrane↑Exchengetime↓O2CO2alveolar-capillarymembranesurfactantAlveolarepitheliumCapillaryendotheliocyteBloodgasLowPaO2andnomalPaCO2Diffusiondisord

7、ersEtiologyandPathogenesisofRF(3)LocalhypoventilationVA/Q↓FunctionalshuntLocalhypoperfusionVA/Q↑DeadspacelikeventilationVentilation-perfusionimbalanceBloodgasLowPaO2andNomalorloworhighPaCO2Ventilation-perfusionimbalanceBlood