Sinh l h hp

Ti liu tham kho:

- Sinh l hc, tp 1, nxb QND, 2002.
- Sinh l hc tp 1, nxb Y hc, 2001.
Bi 1
Thng kh phi
Mc tiu:
1- Trnh by c cc ng tc th, mi lin
quan gia phi v lng ngc
2-Trnh by c cc th tch, dung tch v lu
lng th.
3-S bin i p lc trong khoang ph mc
v ph nang.

1- ph nang v mng h hp.
1.1- Ph nang
C # 300 triu
C 0,2mm
Tng S =
50mm
2

1.2- mng hhp
Mng nn TB ni m
Mng nn TB biu m
TB biu m ca PN
Lng
ph nang
Surfactant
Khong k
TB ni m
Hng cu




-C 6 lp

-Dy 0,2-
0,6m.





1.3- lin quan gia phi v lng ngc

C =AV
1
/ AP
1
(AV
1
: bin i th tch)
AP
1 :
bin i p sut)
1.3.1-Tnh n ca phi (C-compliance) :

-Sc cng b mt ca dch lng ph nang.
-Si chun ca thnh ph nang.
-Trng lc c ca thnh ph qun.
Ngi ln C = 200 ml / cm H
2
O.
Tr em C = 5 - 10 ml / cm H
2
O
1.3.2- khoang ph
mc v p sut m
tnh trong khoang
ph mc
* khoang ph mc
*p sut khoang ph mc
Ht vo
Th ra
p sut khoang
ph mc
- 6 - 9 mmHg - 2 - 4 mmHg
+ Cui th ht vo c: - 30 mmHg
+ Cui th th ra c: 0 n -1 mmHg

+Phi n hi co v rn phi.

+Thnh ngc vng chc l thnh
theo st thnh ngc.

* Trn dch, trn kh mng phi.

* Nguyn nhn to p lc m khoang ph
mc:
2-cc ng tc h hp
- ng tc ht vo v th ra.
- Khng kh ra vo phi c
tun theo nh lut vt l Boyll-
Mariotte:
P x V = K ( nhit khng
i)
2.1- ng tc ht vo:
L tch cc.
Th ra
Ht vo
C honh
(S = 250cm
2
)
Ht vo
C lin sn
p sut trong
ph nang
- 3 - 5 mmHg
+ Cui th ht vo c:
- 50 n - 80 mmHg
-2.2- ng tc th ra.
-L th ng
C honh
(S = 250cm
2
)
Th ra
C lin sn
+ 3 + 5 mHg
p sut trong
ph nang
Cui th th ra c:
+ 80 n +100 mmHg
- Ho, ht hi: l ng tc h hp bo
v.
- Rn: ng tc tr lc cho c bng
quang, trc trng, t cung.
- Ni, ht l hnh thc th ra ...
- Tp kh cng: th chm su (ch
yu co c honh).
2.3- Mt s ng tc h hp c bit
1500-1800
500
1200
1100
Ht vo
ht sc
Th ra
Ht sc
Th tch kh cn
3- cc th tch, dung tch h hp
3.1- Cc th tch
h hp:
-TT kh lu thng: VT
= 500ml
-TT kh d tr ht
vo: IRV = 1500 -
1800ml
- TT kh d tr th ra:
ERV = 1200ml
-TT kh cn:
RV = 1000-
1200ml
3.2- Cc dung tch h hp:
- Dung tch ht vo:
IC = TV + IRV
- Dung tch sng:
VC = IRV + TV + ERV
Ph thuc: tui...
Nam: 3,5 - 3,8 lit
N : 2,8 - 3,2 lit
BT: VC% > VC l
thuyt.
VC < 80% RL
thng kh hn ch.


IC









VC







Th tch kh cn
- Dung tch cn
chc nng:
FRC = ERV + RV
= 2,2 - 2,5lit


FRC










TLC








- Tng dung tch
phi:
TLC = VC + RV =
# 5lit
- nh ngha
- Thng kh pht: TV x f = 6-8 l/ min
(f : tn s)
- Thng kh ti a pht: 70-100 l/ min.
- Th tch th ra ti a giy (FEV
1
)
- Ch s Tiffeneau= FEV
1
/ VC
BT Tiffeneau > 75%
< 75%: RLTK tc nghn
3.3- lu lng h hp
4.1- Khong cht (d)
C 2 loi:
4- khong cht v thng kh ph
nang.
- Khong cht gii phu (V
D
):
L lng kh ng th (kh, ph qun)
#150ml.
-Khong cht sinh l:
L khong cht gii phu + khong cht
ph nang (PN khng trao i kh).
- 4.2- Thng kh ph nang (v
A
) :
- L lng kh vo tn ph nang:
- V
A
= (TV - V
D
).f (f: tn s)
- BT : V
A
= (0,5 - 0.15) x 12 = 4,2 lit
.
.



5.4-S bin i p lc trong ph nang:
-Cui th ht vo:
Bnh thng: -3 mmHg.
C gng: -50 n 80 mmHg.
-Cui th th ra:
Bnh thng: +3 mmHg.
C gng: +80 n 100 mmHg.

Ht vo
Th ra
- 3 - 5 mmHg
p sut trong
ph nang
+ Cui th ht vo c: - 50 n - 80 mmHg
+ Cui th th ra c: + 80 n +100 mmHg
+ 3 + 5 mHg
Ht vo Th ra
p lc trong ph nang
- 3 - 5 mmHg
+ 3 + 5 mmHg
p lc khoang
mng phi
- 4 - 9 mmHg - 2 - 4 mmHg
Bi 2
Hin tng l ho
ca h hp
Mc tiu:
- Trnh by c s trao i kh phi v
cc yu t nh hng.
- Trnh by c cc dng vn chuyn O
2
v
CO
2
trong mu.
-Trnh by c s vn chuyn O
2
t phi ti
m v CO
2
t m ti phi.
1- trao i kh phi
Bng thnh phn khng kh h hp kh (%)

Khng
kh
O
2
CO
2
Kh tr v
N
2
Ht vo 20,93 0,03 79,04
Th ra 15,70 3,60 74,50
Ph
nang
13,60 5,30 74,90
1.1- Thnh phn khng kh th ra, ht
vo v khng kh ph nang:
Mng nn TB ni m
Mng nn TB biu m
TB biu m ca PN
Lng
ph nang
Surfactant
Khong k
TB ni m
Hng cu
Mng h hp



-C 6 lp

-Dy 0,2-
0,6m.

pO
2
= 40
pCO
2
= 46
Ph nang
pO
2
= 104
pCO
2
= 40
pO
2
= 100
pCO
2
= 40
M phi
(Mu t/m)
TM phi
(Mu /m)
1.2- S khuch tn cc kh qua mng
h hp:
Mao mch
Tun theo nh lut vt l: Henry-Dalton.
Tc Kh. tn BT: ca O
2
= 25ml/min.mmHg,
ca CO
2
mnh hn O
2
20 ln.
Hng cu
Ph nang
O
2
O
2
O
2

CO
2

CO
2
CO
2

CO
2

CO
2

Mao ng mch
Mao tnh mch
Surfactant
1.3- Nhng yu t nh hng ti qu trnh
trao i kh-
Tun theo nh
lut Ficke:

AP . A .S
D =
d . /PTL
Tc Kh. tn: BT =
25ml O
2
/min.mmHg,
ca CO
2
hn O
2

20 ln.
1.4- nh hng ca h hp vi tun hon.
- Tun hon phi c p sut thp ...
- Th ht vo, p sut lng ngc m hn,
lm mu v phi d dng hn, tim phi
lm vic nh nhng hn.
M nh
TM nh
Mao mch
Nhiu Oxy
Mao mch co tht Ph nang b xp

1.5 - Mi lin quan gia thng kh v
tun hon:


T l thng kh-thng mu: V
A
/Q = 0,8

. .
Thiu Oxy
2- qu trnh vn chuyn kh ca
Mu.


Mu vn chuyn O
2
t phi ti m;
vn chuyn CO
2
t m v phi

2.1- Mu vn chuyn oxy.
2.1.1- Cc dng vn chuyn.
- Dng ho tan: 0,3ml O
2
/100ml mu.
- Dng kt hp: O
2
+ Hb HbO
2

- (20ml O
2
%)
2.1.2- th phn ly HbO
2
(Biu Barcroft)

- -Th nghim
Barcroft
%

b

o

h
o

o
x
y
h
e
m
o
g
l
o
b
i
n

pO
2
mmHg
Hb c 4 hem,
mi hem + 1 O
2
.

1 Hb + 4 O
2


- ngha:
. pO
2
100mmHg
80mmHg...
. pO
2
20 - 40mmHg...
- Nhng yu t nh hng ti s phn
ly HbO
2


%

b

o

h
o

o
x
y
h
e
m
o
g
l
o
b
i
n

pO
2
mmHg
- pCO
2
cao | phn
ly HbO
2
(Hiu ng
Borh).
- pH mu +, t
o
|...
- | 2,3 diphosphoglycerat
(2,3DPG)...

2.1.3- Mu vn chuyn oxy t phi ti
t chc.
2.1.3- Mu vn chuyn oxy t phi ti
t chc.
- Mu M: pO
2
# 100mmHg , HbO
2
~ 97% -
98%, cha 19ml O
2
/ 10ml mu.
- M: pO
2
= 20 - 40mmHg phn ly HbO
2
- Mu TM cn 14ml O
2
/ 100ml.
- Hiu xut s dng oxy ca m, bnh th-
ng 5ml/19ml = 26%.
2.2- Mu vn chuyn CO
2
.
2.2.1- Cc dng vn chuyn CO
2

-Dng ho tan: # 2,5ml/100ml mu.
-Dng cacbamin (kt hp vi Hb):
(Hb + CO
2
HbCO
2
)
khong 4,5ml CO
2
/100ml mu
* Dng kt hp mui kim: 51ml CO
2
/100ml mu.
- Vi H
2
O trong H.cu: CO
2
+ H
2
O H
2
CO
3
H
+
v HCO
3
-

AC
- Vi mui kim:
B
2
HPO
4
+ H
2
CO
3
BH
2
PO4 + BHCO
3

(B l Na
+
hoc K
+
)
- Vi protein:
PB + H
2
CO
3
PH + BHCO
3

Tng 3 dng v/c: # 58ml CO
2
/100ml mu
2.2.2- yu t nh hng ti vn chuyn CO
2
.
* Chnh lch phn p CO
2
m - mu,
mu - ph nang.
* Hin tng di chuyn ion Cl
-

(Hin tng Hamburger)
- ngha sinh l: m tng v/c CO
2
phi tng thi CO
2

* th phn ly HbCO
2
v hiu ng
Haldane
- pO
2

cao, O
2
+
Hb v
y CO
2

khi
HbCO
2

- Mu nh-
ng O
2
s
ly thm
CO
2














T
h

c
h

%

C
O
2




















Phn p CO
2
mmHg

* H hp iu ho pH mu .

-Trong mu CO
2
tn ti 2 dng: H
2
CO
3
v BHCO
3
+ Khi acid mnh vo mu:
AH + BHCO
3
BA + H
2
CO
3
H
2
O + CO
2
(CO
2
tng)
+khi base mnh vo mu:
BOH + H
2
CO
3
H
2
O + BHCO
3
(CO
2
gim)


* Chng toan huyt bng tng thng kh phi.
* Chng kim huyt bng gim thng kh
phi.

- CO
2
: m # 48mmHg mu T/m 46mmHg
F.nang 40mmHg.

2.2.3- Mu vn chuyn CO
2
t m v phi.

Phn p kh (mmHg) FN v mu M, TM

Kh Mu TM Ph nang Mu M
O
2
40 104 100
CO
2
46 40 40
1.3- Nhng yu t nh hng ti qu trnh
trao i kh-
Tun theo nh
lut Ficke:

AP . A .S
D =
d . /PTL
Tc Kh. tn: BT =
25ml O
2
/min.mmHg,
ca CO
2
hn O
2

20 ln.
1.2- mng hhp
Mng nn TB ni m
Mng nn TB biu m
TB biu m ca PN
Lng
ph nang
Surfactant
Khong k
TB ni m
Hng cu




-C 6 lp

-Dy 0,2-
0,6m.

* Dng kt hp mui kim:
51ml CO
2
/100ml mu.
- Vi H
2
O trong hng cu:
CO
2
+ H
2
O H
2
CO
3
H
+
v OH
-

AC
Bi 3

iu ho h hp



1- Trung tm h hp.
1.1-Th nghim ct no tu trn ng vt
ca Legalois (1810) v Flourens (1842).

H hp khng thay i
H hp chm
H hp chm
H hp ngng
Cu
no
Hnh no
D
H hp yu
C
3
- C
5

1.2- Trung tm h hp hnh cu no.
- hnh no:
trung tm
ht vo (In)
v trung
tm th ra
(Ex).

- cu no: c trung tm iu chnh th: P v
A .
Pneumotaxic
Apneustic
Inspiratory
Expiratory
Neuron vn ng
cc c h hp
Cu no
C
3
- C
5

C honh
D
1
- D
5

C lin sn
Hnh no
1.3- Trung tm h hp tu sng:
C
D
C honh
Trung tm In
Trung tm A
Dy honh
Dy lin sn
- Nhng neuron chi phi c honh.
- Nhng neuron chi phi c lin sn.
1.4- Tnh t ng ca trung tm h hp
hnh cu no:
- Th nghim ca Ranson, Magoun v Gesell
(1936) dng vi in cc ghi c in th hot
ng ca neuron h hp.

1
2
3

1.5 - S lin h ca cc neuron h hp
hnh cu no vi cc neuron tu sng


- Neuron ht vo vi nhn dy TK honh.
- Neuron th ra vi nhn dy TK lin sn v
TK chi phi c bng.

- C hai nhm neuron: ht vo v th ra
hai bn ng gia hnh no.
2- l thuyt v nhp th c bn.

- Ngun pht xung ng l trung tm ht vo.
- Trung tm ht vo hng phn li do trung
tm nhn cm ho hc (TT A.) gi xung ti.
- TT A. hng phn do H
+
v CO
2
kch thch:
CA
CO
2
+ H
2
O H
2
CO
3
H
+
+ HCO
3
A B
Kp
3- iu ho h hp.

iu ho h hp l iu ho nhp th c
bn, c 2 c ch:
3.1- C ch th dch iu ho h hp.
3.1.1-Th nghim tun hon cho ca Frederic
(1880).

3.1.2- Vai tr ca CO
2
.






Tng CO
2
mu Tng CO
2
mu
* Din bin:
* C ch:+ CO
2
+ H
2
O H
2
CO
3
H
+
+ HCO
3
-
H
+
Tkhu A v T khu ht vo
+ | CO
2
Xoang M cnh T.khu HV
CA
* ng dng:
+ Cp cu ngt
th kh carbogen
+ Ting khc cho
i...


Gim O
2
mu
3.1.3- Vai tr ca oxy:




- Din bin: khi pO
2
# 50-60mmHg Tng th
- C ch: O
2
Th th ho hc...

3.1.4- Vai tr ca nng ion H
+
:







- Khi nng H
+
tng (pH gim):
H
+
tng trong t chc no TK. Apneustic...
H
+
tng trong mu TCT ho hc...





Tng H
+
/m no
Tng H
+
/

mu
* So snh tc dng ca 3 yu t ho hc.

CO
2
tng tng th 8 ln
H
+
tng tng th 4 ln
O
2
gim tng th 65% ln


3.2- C ch thn kinh iu ho h hp.


3.2.1- Vai tr ca dy X
- Th nghim Hering - Breuer.
- Th nghim ct dy X.


3.2.2- Vai tr dy thn kinh cm gic nng:

Vai tr dy thn kinh cm gic s V
3.2.3- Vai tr th cm th (TCT) phi.
- Th cm th c hc phi.
- Th cm th c - ho ng th.
3.2.4- nh hng ca TCT p lc ng mch.
TCT p lc xoang M cnh, quai M ch.
3.2.5- nh hng ca mt s trung tm thn kinh
khc.
-Trung tm nut c ch trung tm h hp.
-Vng hypothalamus :
(c TK cm xc, TK iu nhit, TK TKTV).

3.2.6- nh hng ca v no.
- H hp ch ng.
- Phn x c iu kin v h hp.
phn x c iu kin v h hp
4- h hp trong iu kin c bit.
Bnh th ln, bnh ni cao.
pO
2
mu (mmHg)











%

H
b
O
2













cao (Km)
Mch mu mc treo rut
Tu sng
98%
80%
50%
6
5
4
3
2
1
0