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samenvatting fysiologie ademhalingsstelsel - prof Neyrinck
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DE FYSIOLOGIE VAN DEADEMHALING
Inhoudsopgave
les 1: organisatie van het respiratoir systeem – statische longvolumes –
basisbegrippen....................................................................................................... 5
waarom respiratoire fysiologie?.................................................................................................5
begrijpen van ziekteprocessen................................................................................................ 5
Definitie van respiratoir systeem...............................................................................................5
Basisbegrippen vooraf............................................................................................................... 5
wat is de samenstelling van luchT?......................................................................................... 5
gasmengsels........................................................................................................................... 6
gassen opgelost in bloed......................................................................................................... 6
bloedgaswaarden.................................................................................................................... 6
vochtige lucht vs. droge lucht................................................................................................. 7
organisatie van he trespiratoir systeem.....................................................................................7
zuurstoftransportcascade........................................................................................................ 7
de geleidende luchtwegen...................................................................................................... 8
de alveool: functionele unit..................................................................................................... 8
dubbele bloedsvoorziening..................................................................................................... 8
het respiratoir systeem: meer dan alleen maar ademhaling......................................................8
volumes en capaciteiten......................................................................................................... 9
les 2: mechanica van de ventilatie (statisch)..........................................................10
long mechanica........................................................................................................................ 10
statische eigenschappen van de long......................................................................................10
balans tussen long en thoraxwand........................................................................................ 10
de intrapleurale ruimte......................................................................................................... 10
hoe ademen we in? (gn leerstof mr wel belangrijk)...............................................................11
hoe ademen we uit?.............................................................................................................. 11
de druk-volume (P-V) relatie van de long..............................................................................12
het begrip compliance afgeleid van de druk-volume relatie..................................................12
waarom heeft de long nu de neiging om plat te vallen? (Ex!)..................................................13
oppervlaktespanning............................................................................................................. 13
OVERZICHT........................................................................................................................... 15
les 3: mechanica van de ventilatie (dynamisch)......................................................15
dynamische eigenschappen van de long.................................................................................15
luchtstromen & weerstand....................................................................................................... 16
soorten luchtstromen............................................................................................................ 16
1
, 4 factoren die weerstand bepalen......................................................................................... 17
obstructieve longziekten luchtwegen....................................................................................17
restrictieve longziekten alveolen/blaasjes.............................................................................18
verband tussen statische en dynamische parameters in longmechanica................................18
statische parameter.............................................................................................................. 18
dynamische parameter......................................................................................................... 19
overzicht............................................................................................................................... 19
wat gebeurt er tijdens een ademcyclus...................................................................................19
Effect van transmurale druk over de luchtweg zelf..................................................................21
de transmurale druk zelf kan de luchtwegweerstand veranderen ± dynamische compressie
.............................................................................................................................................. 21
effect van transmurale druk.................................................................................................. 21
dynamische luchtwegcollaps heeft een invloed op de flowcurve van een pT........................22
les 4: O2 en co2 transport in bloed..........................................................................22
transport van O2....................................................................................................................... 22
O2 = oplosbaar in plasma...................................................................................................... 22
hoeveel O2 verbruiken wij?.................................................................................................... 23
hemoglobine: structuur......................................................................................................... 23
HemogloBine is het ultieme transportmiddel!.......................................................................23
hemoglobine is een belangrijk molecule in de kliniek!..........................................................24
hoeveel O2 is er nu gebonden aan hemoglobine?.................................................................24
de Hb-O2 dissociatie curve beschrijft de kinetiek van de binding..........................................25
het begrip “oxygen content”................................................................................................. 26
het begrip “oxygen delivery” en “oxygen consumption”......................................................26
de Hb-O2 dissociatie curve kan belangrijke veranderingen vertonen....................................27
belang van affiniteit van O2 w niet gevraagd........................................................................28
transport van Co2..................................................................................................................... 28
Co2 transport in het bloed: vele verpakkingsvormen.............................................................28
verschil tussen arterieel en veneus bloed.............................................................................29
CO2 dissociatie – curve.......................................................................................................... 29
les 5: gasuitwisseling in de long: diffusie...............................................................30
vooraf...................................................................................................................................... 30
diffusie..................................................................................................................................... 30
wat is diffusie?...................................................................................................................... 30
diffusie door een ‘eenvoudige’ barrière.................................................................................30
de alveolaire wand is uitstekend geschikt voor diffusie: dun en groot..................................30
Wat bepaalt DL in de alveool?................................................................................................30
wat betekent Dit (DL) voor de diffusie van zuurstof over de alveool?....................................31
diffusie van O2 is nog complexer...........................................................................................31
enorm complex: wet van Fick is onbruikbaar principe van fick...........................................32
diffusie-limitatie van gastransport/ uptake over een alveolaire wand......................................33
wat gebeurd er als ik CO inadem?.........................................................................................33
hoe meer co opnemen in het bloed dat door de long passeert?............................................33
perfusie-limitatie van gastransport/uptake over een alveolaire wand......................................34
wat gebeurd er als ik N2O inadem?.......................................................................................34
hoe meer N2O opnemen in het bloed....................................................................................35
2
, extremen bestaan!!!............................................................................................................. 35
hoe zit het nu voor O2 en co2: perfusie of diffusie limitatie?.....................................................36
O2 uptake is perfusie-gelimiteerd..........................................................................................36
Co2 diffusie is perfusie gelimiteerd........................................................................................37
pathologische omstandigheden die diffusie verminderen (DLCO)...............................................38
les 6: perfusie van de long.....................................................................................38
pulmonaal circulatie................................................................................................................. 38
organisatie............................................................................................................................ 38
pulmonaal circulatie: gekenmerkt door lage perfusiedrukken...............................................38
pulmonaal circulatie vs. systeemcirculatie............................................................................39
kenmerken pulmonaalciculatie............................................................................................. 39
de pulmonaal vasculaire weerstand = onderhevig aan externe factoren !!..........................40
hoe meten we de pulmonale circulatie in de klinische praktijk?............................................42
regionale verschillen in de perfusie van de long......................................................................42
zijn er regionale verschillen in de perfusie van de long?.......................................................42
verklaring van regionale verschillen in de distributie............................................................43
zone 1 : capillairen hoog in de thorax...................................................................................43
zone 2................................................................................................................................... 43
zone 3................................................................................................................................... 44
zone 4................................................................................................................................... 44
hoe zones van west voor te stellen?.....................................................................................44
regionale verschillen in de ventilatie bij de long?....................................................................45
De basis van de long is beter geventileerd...........................................................................45
De verklaring voor betere ventilatie aan basis van de long..................................................45
les 7: ventilatie/perfusie verhoudingen..................................................................45
de alveolaire ventilatie vergelijking......................................................................................... 45
vooraf: definities................................................................................................................... 45
meten van de alveolaire ventilatie........................................................................................46
al het CO2 komt van de alveolaire ventilatie.........................................................................46
alveolaire ventilatie vergelijking: gebruik van PCO2..............................................................46
de alveolaire gas vergelijking.................................................................................................. 46
alveolaire gas vergelijking en alveolaire ventilatie vergelijking combinatie.............................47
ventilatie-perfusie verhouding................................................................................................. 47
goed maar niet perfect op elkaar afgestemd........................................................................47
ventilatie-perfusie verhouding bepaald
door effecten van zwaartekracht .............................48
ventilatie-perfusie verhouding bepaalt alveolaire gas samenstelling....................................48
2 extreme situaties............................................................................................................... 49
zuurstoftranspoortcascade !!!!................................................................................................ 50
les 8: controle van de ventilatie.............................................................................50
componenten van het ademcircuit om controle uit te voeren..................................................51
begrippen mbt controle van de ventilatie.............................................................................51
de centrale controller............................................................................................................ 51
effectoren: ademhalingsspieren............................................................................................51
“central pattern generator”..................................................................................................51
3
, de neuronen dIE centraal de ademhaling controleren.............................................................52
neuronen in de “medulla”..................................................................................................... 52
volledige organisatie (in DRG en VRG met insp en exp bijdrage) REspiratoir ritme .............52
neuronen in de pons............................................................................................................. 52
chemische controle van de ventilatie (sensoren).....................................................................53
wat?...................................................................................................................................... 53
perifere receptoren............................................................................................................... 53
centrale receptoren............................................................................................................... 53
integratie van de receptoren................................................................................................... 54
De respons op hypercapnie wordt beïnvloed door hypoxie...................................................54
de respons op Hypoxie wordt beïnvloed door hypercapnie...................................................54
bijzondere adempatronen........................................................................................................ 54
apnea.................................................................................................................................... 54
sigh (zucht)........................................................................................................................... 55
cheyne-stokes ademhaling................................................................................................... 55
gasping................................................................................................................................. 55
dyspnea................................................................................................................................ 55
hersendood.............................................................................................................................. 55
4
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