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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