Fiziologia Si Fiziopatologia Respiratiei
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Transcript of Fiziologia Si Fiziopatologia Respiratiei
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Fiziologia si fiziopatologia
respiratiei
Dr. Irina Strambu
Sef de Lucrari
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RESPIRATIA
Ventilatie
Difuziune alveolo-capilara
Transport al gazelor
In sange
Difuziune tisulara
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Ventilatia
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Echilibru elastic dinamic intre plamani si cutia toracica
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Plamanii: resort tridimensional
Alveole (recul elastic:
-Elemente elastice
-Tensiune superficiala)
Bronhiole: alveolele le mentin deschise
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Volume si capacitati pulmonare
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Volume si capacitati pulmonare
• Pozitia expiratorie de repaus: pozitia de
echilibru elastic a sistemului toraco-
pulmonar
• CRF – “perna chimica” pentru a asigura
compozitia constanta a aerului alveolar
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Volume si capacitati pulmonare
Spirometria
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Spirograma normala
CV (VC) L
VEMS (FEV1) L
VEMS/CV %
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Curba flux-volum
Aparat de masura:
pneumotachograf
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Volume si capacitati pulmonare
Masurarea VR
C1, V1 C2, V2
V2 = V1 + CRF
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• Valorile normale (prezise) ale parametrilor functionali:
– Nu sunt universale
– Depind de : • varsta
• Sex
• Inaltime
• (greutate)
– Se calculeaza prin formule
– Ex: VEMS (l/s) in ecuatiile ERS 1993
• (B) 4,3 I - 0,029 V - 2,49
• (F) 3,95 I - 0,025 V - 2,6
• Limita inferioara a normalului (LLN): N - ds
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Disfunctia ventilatorie restrictiva
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Disfunctia ventilatorie obstructiva
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Disfunctia ventilatorie mixta
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Testele farmacologice 1. testul de provocare
PC20: concentratia de
metacolina care determina
o scadere cu 20% a VEMS
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Testul la metacolina
• Administrata prin nebulizare la anumite intervale, în concentraţii / doze crescânde
• Spirometrie – la începutul testului şi după fiecare doză / concentraţie de metacolină
• După încheierea protocolului de testare se administrează BADSA
Testele trebuie efectuate în centre specializate.
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Test de provocare bronsică pozitiv. Concentratia de metacolină care a determinat scăderea VEMS cu
20% = 0,5 mg/mL (bronhoconstrictie moderată).
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Testele farmacologice: 2. testul de reversibilitate
Reversibilitate:
cresterea VEMS cu
- 12% si
- 200 ml
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• Spirometria:
– Instrument de diagnostic al bolilor respiratorii
– Indispensabil pentru monitorizarea evolutiei
bolilor obstructive si a altor maladii
• Rezultatele nu au valoare de sine
statatoare, trebuie integrate in contextul
clinic si al celorlalte investigatii
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Difuziunea prin membrana
alveolo-capilara
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Structura membranei alveolo-capilare
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Factorii care influenteaza difuziunea
• Diferenta de presiune partiala a gazelor
– Oxigen: 100 mm Hg 40 mm Hg
– CO2: 40 mm Hg 45 mm Hg
• Difuzibilitatea gazelor
– CO2 = O2 x 20; CO = O2
• Suprafata membranei alveolo-capilare
• Grosimea membranei alveolo-capilare
• Prezenta transportorului Hb
• Raportul ventilatie alveolara / perfuzie capilara
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• Difuziunea este extrem de rapida:
– Oxigenare completa in 1/3 din timpul de
contact aer-sange
– Tulburari de difuziune --- desaturare la efort
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Masurarea difuziunii: TLCO
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Distributia ventilatiei si
perfuziei pulmonare
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Distributia normala a ventilatiei
-Ideal: distributie uniforma a tuturor acinilor
-Real: bazele mai bine ventilate decat varfurile (de 3 x)
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Tulburari de distributie a ventilatiei
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Distributia perfuziei pulmonare
Zonele J.B. West de distributie a perfuziei
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Particularitati ale circulatiei pulmonare
• Presiune mica (sistem “venos”)
• Flux influentat de:
– Diferenta de presiune hidrostatica intre capetele sistemului (VD, AS)
– Presiunea alveolara
• Viteza mare de circulatie
• Debit = debitul cardiac
• Distributie rapida a fluxului pe o suprafata capilara imensa
• Stimul arterioloconstrictor principal: hipoxia alveolara
• Raspuns slab la alti agenti vasomotori
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Efectul obstructiei arteriale asupra hematozei
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Efectul obstructiei bronsice asupra hematozei
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Efectul obstructiei bronsice asupra hematozei