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 gazelorIn 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 pulmonareSpirometria
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Volume si capacitati pulmonareMasurarea VR
C1, V1 C2, V2V2 = V1 + CRF
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Spirograma normala
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• Valorile normale (prezise) ale parametrilor functionali: – Nu sunt universale– Depind de :
• varsta• Sex• Inaltime• (greutate)
– Se calculeaza prin formule– Se pot gasi in tabele
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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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Curba flux-volum
Aparat de masura:pneumotachograf
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Curba flux-volum:disfunctia ventilatorie obstructiva
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Testele farmacologice1. testul de provocare
PC20: concentratia de metacolina care determina o scadere cu 20% a VEMS
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Testele farmacologice:2. testul de reversibilitate
Reversibilitate:cresterea VEMS cu
- 15% sau- 500 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