《器官循環(huán)課件》由會(huì)員分享，可在線閱讀，更多相關(guān)《器官循環(huán)課件（52頁珍藏版）》請(qǐng)?jiān)谘b配圖網(wǎng)上搜索。
1、單擊此處編輯母版標(biāo)題樣式,*,單擊此處編輯母版文本樣式,第二級(jí),第三級(jí),第四級(jí),第五級(jí),SECTION 5 ORGAN CIRCULATION,第五節(jié) 器官循環(huán),The blood flow of organ denpends on,器官的血流量取決于：,The difference between aortic pressure and,central venous pressure,主動(dòng)脈壓與中心靜脈壓之差,The diastolic and systolic state of blood vessel,in this organ,該器官阻力血管的舒縮狀態(tài),I.,Coronary Circ
2、ulation,冠脈循環(huán),II.,Pulmonary Circulation,肺循環(huán),III,. Cerebral Circulation,腦循環(huán),I .,Coronary Circulation,冠脈循環(huán),Anatomic consideration,解剖特點(diǎn),The boles and branches of left and right coronary,artery often penetrate myocardium in direction,perpendicular to cardiac surface.,左右冠狀動(dòng)脈主干分支垂直于心臟表面的方向,穿入心肌,。,Myocardia
3、l capillary distribution is extremely,abundance .,心肌的毛細(xì)血管網(wǎng)分布極為豐富,。,Collateral coincidence between coronary is less .,冠脈動(dòng)脈之間的側(cè)支吻合少,。,2. Physiological characteristic,of coronary circulation,冠脈循環(huán)的生理特點(diǎn),The pathway is short and,blood flow is fast,途徑短，血流快,Blood pressure is high,血壓較高,Blood flow is big and
4、it is,4%5%,of cardiac output,血流量大,心輸出量的4%,5%,Arteriovenous oxygen difference is great during silence period,平靜時(shí)動(dòng)-靜脈血含氧量差很大,Isovolumic contraction phase,rapid ejection phase,reduced ejection phase,diastolic phase (isovolumic relaxation phase),等容收縮期快速射血期,減慢射血期 舒張期（等容舒張期）,Level of arterial diastolic pr
5、essure and size of,diastolic phase are important factors of determining,coronary flow .,動(dòng)脈舒張壓高低和舒張期長(zhǎng)短是決定冠脈血流量,的重要因素。,Contraction and relaxation impact on right ventricle,is not so obvious as to left ventricle.,收縮及舒張對(duì)右心室的影響不及對(duì)左心室明顯。,(1),Regulation,of metaboilic level of myocardium to,coronary flow,心肌
6、代謝水平對(duì)冠脈血流量的調(diào)節(jié),Metaboilic level of myocardium is an important factor .,心肌本身的代謝水平是最重要因素。,The energy for myocardial contraction nearly all,comes from aerobic metabolism,.,心肌收縮的能量幾乎完全來自有氧代謝。,Occupy the secondary position,居次要地位,Coronary accepts the domination of cranial nerve,and adrenergic nerve .,冠脈接受迷
7、走神經(jīng)及交感神經(jīng)支配。,vagus nerve,: direct action is to dilate coronary,迷走神經(jīng)：直接作用是使冠脈舒張,(2),Neural regulation,神經(jīng)調(diào)節(jié),sympathetic nerve,: receptor excitation,coronary contraction,(direct),交感神經(jīng)：,受體興奮冠脈收縮（直接）, receptor excitation,coronary dilatation,(indirectdirect),受體興奮冠脈舒張（間接直接）,Adrenomedullin,腎上腺髓質(zhì)素,（,ADM),One
8、new biologically active peptide found in 1993 by,Kitamura .,1993年,Kitamura,分離出的一種新的生物活性肽。,ADM has an evident expansion effect on the main,arteries、coronary artery 、resistance vessel.,ADM,對(duì)大動(dòng)脈,、,冠狀動(dòng)脈、周圍阻力血管均有明顯,的擴(kuò)張作用。,Coronary heart disease,冠心病,Coronary heart disease results from coronary,atheroscler
9、otic ,which leads to ischemic and,anoxyaemia of cardiac muscle.It is also called,ischemic heart disease.,因冠狀動(dòng)脈粥樣硬化使血管腔阻塞導(dǎo)致心肌缺血,缺氧而引起的心臟病。亦稱缺血性心臟病。,Pathogenesy,發(fā)病機(jī)制,The atherosclerotic plaque can cause a local thrombus .,The thrombus usually occurs where the plaque has broken through the endothelium
10、,thus coming in direct contact with the flowing blood .The blood platelets begin to adhere to the plaque, fibrin begins to be deposited, and red blood cells become entrapped to form a blood clot that grows until it occludes the vessel .,動(dòng)脈粥樣硬化斑塊可以引發(fā)局部血栓。血栓通常發(fā)生于斑塊已經(jīng)侵入內(nèi)皮處，血流的直接沖擊使血液中的血小板粘附到斑塊之上，血漿纖維蛋白
11、發(fā)生降解，紅細(xì)胞疊連形成血栓。血栓可不斷增大直至堵塞血管，從而誘發(fā)心肌缺血缺氧的一系列病理性改變。,The occurrence of coronary disease is closely relates,to the degree of sclerostenosis and branches.,本病的發(fā)生與冠狀動(dòng)脈粥樣硬化狹窄的程度和支數(shù),有密切關(guān)系。,Occurs most at:,the upper and middle part of anterior descending branch、the middle 1/3 part of right coronary artery.,好發(fā)
12、部位：前降支上、中1/3，右冠狀動(dòng)脈中1/3。,1.,Physiological characteristic of pulmonary circulation,肺循環(huán)的生理特點(diǎn),(1) Short circulatory pathway and small peripheral,resistance.,循環(huán)途徑短，外周阻力小。,(2) Blood pressure is low and it is only,1/61/5,of systemic circulation,.,血壓較低，僅為體循環(huán)的1/6,1/5。,肺循環(huán)毛細(xì)血管平均壓：7,mmHg,Interstitial fluid in
13、lung is negative pressure .The,alveolar membrane and capillary wall tightly sticks,to each other. It is favorable to gas exchange between,alveoli of lung and blood.,肺部組織液為負(fù)壓，肺泡膜和毛細(xì)血管壁緊密相貼，,利于肺泡和血液之間的氣體交換。,Left heart failure Edema of lung,左心衰竭 肺水腫,The fluid exchange,ofcapillaries,of pulmonary circula
14、tion,肺循環(huán)毛細(xì)血管處的液體交換,Intrapleural negative pressure：reabsorb filtration,fluid to keep pulmonary alveoli dry ,thus prompts,the process of gas change.,胸膜腔負(fù)壓：重吸收濾過液，保持肺泡干燥，利于,氣體交換。,平靜呼氣末：5,mmHg,3,mmHg,left,heart failure、mitral stenosis：pneumonedema,左心衰、二尖瓣狹窄：肺水腫,2. Regulation of Pulmonary flow,肺循環(huán)血流量的調(diào)節(jié),
15、(1) Neural regulation,神經(jīng)調(diào)節(jié),In general , systemic circulation contracts and lung blood volume increases when sympathetic nerve,excites. Stimulating vagus nerve can cause vasodilatation and pulmonary vascular resistance increases.,整體情況下，交感神經(jīng)興奮時(shí)體循環(huán)收縮肺血容量,增加。刺激迷走神經(jīng)則引起輕度舒血管作用，肺血,管阻力稍有降低。,(2) Oxygen parti
16、al pressure,of alveolar air,肺泡氣的氧分壓,Both acute or chronic hypoxia can cause vasoconstriction and vasoconstriction increase .,急性或慢性的低氧都能使肺血管收縮，血流阻力增大。,Significance: hypoxic,perialveolar arteriole contracts, more blood flows through sufficient ventilation alveolar and carries on effective gas exchange
17、.,意義：氧分壓低的肺泡周圍微動(dòng)脈收縮，較多的血液流經(jīng)通氣充足的肺泡進(jìn)行有效的氣體交換。,(3) Impact on pneumoangiogram of vasoactivesubstance,血管活性物質(zhì)對(duì)肺血管的影響,Contract arteriole : adnephrin ,noradrenaline , Angiotensin II, thromboxane A2, prostaglandin F2,收縮微動(dòng)脈：腎上腺素、去甲腎上腺素、,血管緊張素,II,、血栓素,A,2,，前列腺素,F,2,Relax arteriole : histamine , 5-HT,舒張微動(dòng)脈：組胺、
18、,5,羥色胺,III Cerebral Circulation,腦循環(huán),blood supply of cerebral circulation,腦循環(huán)血液供應(yīng),Frontal 2/3 part of cerebral hemisphere:,internal carotid,大腦半球前2/3腦區(qū)：頸內(nèi)動(dòng)脈,Post 1/3 part of cerebral hemisphere, cerebellum,and brain stem: cone artery,大腦半球的后1/3腦區(qū)，小腦，腦干：椎動(dòng)脈,腦靜脈,頸內(nèi)靜脈,腔靜脈,vena encephali,internal jugular v
19、ein,vena cava,Function：Providing brain with oxygen, energy while,discarding its metabolic products to maintain,homeostasis,.,功能：為腦組織供氧、供能、排出代謝產(chǎn)物以維持,內(nèi)環(huán)境穩(wěn)定。,1. Characteristic of cerebral circulation,腦循環(huán)的特點(diǎn),(1) Plentiful cerebral blood flow and oxygen consumption,腦血流量大，耗氧量多,The weight of brain is about
20、 20 percent of body weight and its blood flow is 15 percent of cardiac output，oxygen consumption is about 20 percent of whole body oxygen consumption.,腦的重量約占體重的20，血流量占心輸出量的15,。,耗氧量約占全身耗氧量的20。,2.,Little change of cerebral blood flow,腦血流量變化小,Brain tissue cant compress in bony cranial cavity.,骨性顱腔，腦組織不
21、可壓縮。,3.,Great influence of regional chemical circumstance,on systaltic activity of cerebral vessels,局部化學(xué)環(huán)境對(duì)腦血管舒縮活動(dòng)影響大,Oxygen and carbon dioxide partial pressure have obvious influence on cerebral blood flow .,血液中,CO,2,和,O,2,分壓對(duì)腦血流量影響明顯。,4.,Little function of neural factor to cerebral,vascular activi
22、ty,神經(jīng)因素對(duì)腦血管活動(dòng)的調(diào)節(jié)作用小,5.,Blood brain barrier existing in cerebral circulation,腦循環(huán)中存在血腦屏障,2.,Regulation of cerebral blood flow,腦血流量的調(diào)節(jié),（1）Autoregulation of cerebral vascular,腦血管的自身調(diào)節(jié),Cerebral blood flow mainly depends on pressure,difference between cerebral artery and cerebral,vein and resistance of bl
23、ood flow of cerebral vessels .,The BP of arteria carotis is the main factor of,influencing cerebral blood flow.,腦的血流量主要取決于腦的動(dòng)脈和靜脈的壓力差和,腦血管的血流阻力。,影響腦血流量的主要因素是頸動(dòng)脈壓。,When MAP changes within 60 140mmHg, the,cerebral vessels can keep the cerebral blood flow,at a constant level through autoregulation.,當(dāng),M
24、AP,在60,140,mmHg,之內(nèi)變動(dòng)時(shí)，腦血管可通過,自身調(diào)節(jié)機(jī)制使腦血流量保持恒定。,2.,Impact of Oxygen and carbon dioxide partial pressure on cerebral blood flow,CO,2,和,O,2,分壓對(duì)腦血流量的影響,P,CO2,H,2,CO,3,H,+,cerebral vascular diastoles,cerebral blood flow, ,H,+,homeostasis recovers,乳酸，丙酮酸，酸性代謝產(chǎn)物,P,CO2,H,2,CO,3, ,H,+,腦血管舒張,腦血流量增多 ,H,+, 恢復(fù)內(nèi)環(huán)境
25、穩(wěn)態(tài),hypoxia,Po,2,cerebral vessel relaxing,brain blood flow O,2,supply,缺氧氧分壓 腦血管舒張 腦血流量, 氧供應(yīng),Function: avoiding decrease of neuron activity and,any damage to brain in local regulation,of brain blood flow.,作用： 在腦血流量的局部調(diào)節(jié)中防止神經(jīng)元活性,下降和防止腦功能損害的保護(hù)性反應(yīng)。,(3),The effect of cerebral Metabolism to brain,blood flo
26、w,腦的代謝對(duì)腦血流的影響,Mechanism:,cerebral vessels relax due to metabolic product of,H,+,、K,+,、adenosine, PO,2,.,機(jī)制：通過代謝產(chǎn)物如,H,+,、K,+,、,腺苷、,PO,2,降低,引發(fā)腦血管舒張。,4.,Neural regulation,神經(jīng)調(diào)節(jié),Neural factors do little to regulate vasomotion. when doing violent sports, the sympathetic excitation leads to increase in BP,
27、 and large artery and medium-sized artery constrict to prevent high pressure in little vessels, which may cause apoplexy.,神經(jīng)因素在腦血管活動(dòng)調(diào)節(jié)中所起的作用很小。激烈運(yùn)動(dòng)時(shí)，交感神經(jīng)興奮血壓顯著升高，腦大動(dòng)脈和中動(dòng)脈收縮，防止高壓傳遞至腦部小血管致使腦出血。,3.,Blood-cerebrospinal fluid barrier and,blood-brainbarrier,血-腦脊液屏障和血-腦屏障,（1）Blood-cerebrospinal fluid barri
28、er,血-腦脊液屏障,(2) Blood-brain barrier,血腦屏障,（1）Blood-cerebrospinal fluid barrier,血-腦脊液屏障,A special barrier existing between blood and CSF,is called blood cerebrospinal fluid barrier.,在血液和腦脊液之間存在一種特殊屏障，稱為血,腦脊液屏障。,Structure basis,結(jié)構(gòu)基礎(chǔ),Close intact among endothelium cells ;special carrier,system in capilla
29、ry wall and choroid plexus cells.,毛細(xì)血管內(nèi)皮之間存在緊密連接；,毛細(xì)血管壁和脈絡(luò)叢細(xì)胞中轉(zhuǎn)運(yùn)各種物質(zhì)的特殊,載體系統(tǒng)。,Easy to permeate:,H,2,O,O,2,CO,2,most lip soluble substance,易通透：,H,2,O,O,2,CO,2,大多數(shù)脂溶性物質(zhì),Difficult to permeate:,Na,，K,+,，Cl,protein, non- lipsoluble organic,matter with giant molecular,較難通透：,Na,，K,+,，Cl,，蛋白質(zhì)，非脂溶性,大分子有機(jī)物質(zhì),(
30、2) Blood-brain barrier,血腦屏障,Such barrier exists between blood and brain,tissue to limit the exchanging activities.,血液和腦組織之間也存在類似的屏障,限制物質(zhì),在血液和腦組織之間的自由交換。,Structure basis,結(jié)構(gòu)基礎(chǔ),capillary endothelium, basement layer , star colloid,cells and perivascular feet.,毛細(xì)血管內(nèi)皮、基膜和星狀膠質(zhì)細(xì)胞的血管周足等,結(jié)構(gòu)。,Easy to permeate:
31、,Lip soluble substances,O,2,CO,2,，some narcotic ,alcohol,Water soluble substances- glucose, amino acid,易通透：,脂溶性物質(zhì),O,2,CO,2,，,某些麻醉藥，乙醇,水溶性物質(zhì)葡萄糖，氨基酸,Uneasy to permeate: mannitol ,cane sugar,不易通透：甘露醇，蔗糖,Physiological function,生理功能,Maintaining a stable chemical environment around brain and avoiding noxious substances invading ,as well as preventing hormone to interfere normal neuronal activities,保持腦組織周圍穩(wěn)定的化學(xué)環(huán)境和防止血液中有害物質(zhì)侵入腦內(nèi)。阻止某些激素進(jìn)入腦內(nèi)干擾神經(jīng)元的正?；顒?dòng)。,Thank you,
器官循環(huán)課件
