物治三心肺物理治疗学
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synergistically with low oxygen tensions
Aortic body (response to _____? )
not involved in ventilation produce reflex cardiovascular responses
increases HR and BP
Slowly adapting receptors (SAR) convey information about the level of inflation of the lung
rapidly adapting (phasic) receptors
rapidly adapting receptors (RAR) fire in response to transient changes in lung volume
Q: Obstructive & Central Sleep Apnea
How do we know people with sleep disorder
Overnight Sleep Lab Examination What was recorded ?
37
EKG
Exhale Airway obstructs
Cheyne-Stokes ventilation Apneustic Breathing Sleep Disordered Breathing
OSA CSA
28
Chemoresponse to hypoxia or hypercapnia
Hypoxia
Carotid
Bodies ++
Two major breathing mechanisms
_____________ _____________
3
Control of breathing
Regulation?
_____ _____
6
Q: Automatic mechanism
Spontaneous, cyclical respiration originates in the ________ to produces spontaneous, cyclical respiration.
arterial oxygen tensionsÆ carotid body Æ carotid sinus nerve Æ to the brainstem Æ increase ventilation
below 60 mm Hg Æ strong respiratory drive. High arterial carbon dioxide tensions and acidosis act
Related to loss of inspiratory inhibitory activity
Causes:
Central nervous system injury
32
Q: Obstructive & Central Sleep Apnea
How does Sleep Apnea occur?
Respiratory Physiology
Control of breathing
Automatic mechanisms Voluntary mechanisms
1
4
Respiratory Physiology
Control of breathing Mechanics of breathing Ventilation Gas exchange and
Airway opens
Airflow
Thoracic effort
Abd.ቤተ መጻሕፍቲ ባይዱeffort
Inhale
Effort gradually increases
Paradoxing
Paradoxing Ends
SAO2
Blood oxygen levels reduce to < 3% of basline value
automatic activity
9
Respiratory Controler
Two chemoresponse?
Peripheral chemoresponse Central chemoresponse
Glossopharyngeal n
Carotid body
Vagal n
Aortic body 12
35
Q:Sleep Disordered Breathing
What is Sleep Apnea? Types?
__________ __________ __________ __________
33
Sleep Apnea (Obstructive & Central)
36
lie below the surface of the ventrolateral aspects of the medulla
Response to ?
PaCO2 levels to the normal (40 mm Hg) range
18
Hypercapnic ventilatory response
Respiratory output
26
Q: Cheyne-Stokes ventilation
What is Cheyne-Stokes ventilation?
29
Disorders of Ventilatory Control
_________ _________ _________
31
Sleep Disordered Breathing
Sleep Apnea
Obstructive Apnea Central Apnea Mixed Apnea Hypopneas
34
Apneustic Breathing
Sustained periods of inspiration followed by brief periods of expiration
Obstructive Apnea No airflow for > 10 seconds
Increasing respiratory effort. / SaO2 desaturation <3% 40
Polysomnography
• EOG - Electrooculogram
Brainstem (medulla)
8
Q: Respiratory Controler
Two chemoresponse?
________________ ________________
11
Q:Voluntary or behavioral control
important during _______ arises from the _______ to modify the
transport Pulmonary circulation
2
Control of breathing
What will affect breathing?
_____ _____ _____ _____ _____ _____
5
Control of breathing
(Two Myelinated vagal fibers)
14
Central chemoreceptor mechanisms
Central chemoreceptors Location?
____________________
Response to ?
____________________
Causes:
Central nervous system injury, head trauma
High altitude Low cardiac output, reduced brain
blood flow
30
Q: Apneustic Breathing
What is Apneustic ?
Q: Respiratory Controler
These receptors (lung stretch receptors) can be divided in two types:
________________ ________________
13
Respiratory Controler
Voluntary or behavioral control
important during _______
verbal communication
arises from the _______
cerebral cortex
7
10
Automatic mechanism
originates in the _____
Central Chemo Response to
CO2 Or H+ ?
19
Peripheral chemoreceptor
Two main bodies ?
Carotid and aortic bodies
Carotid body (how to increase drive?)
21
Hypoxic and Hypercapnic Responses
24
How dose hypoxic vetilatory response drive? How dose hypercapnic vetilatory response drive?
25
Disorders of Ventilatory Control
20
Hypoxic and Hypercapnic Response Curves?
Hypoxic Response Curves?
Hypercapnic Response Curves?
23
Q: Peripheral chemoreceptor
Two main bodies ?
__________________ (sense O2) __________________(response to CV )
17
Q: Respiratory Control
Other afferent fibers?
________________ ________________
15
Central chemoreceptor mechanisms
Central chemoreceptors Location?
22
Hypercapnic ventilatory response
Central Chemo Response to ?
H+ CO2 + H2O Æ H2CO3Æ H+
+ HCO3 hydrogen ions stimulate
central chemoreceptorÆ increase respiratory neural activityÆincrease respiratory activity
27
Cheyne-Stokes ventilation
Varying tidal volume and frequency
Following an apneic period VT and f increase progressively then decrease again until another period of apnea is seen
+
+++
Br.a…… ….i++n… …--+++-+…… …-+-+--..+--......
Stem
Hypercapnia CO2 /H+
What is Normal ventilatory response
.………. …………….. ......
Respiratory nerves
Respiratory muscles
Other afferent fibers?
Unmyelinated vagal fiber Others: nonchemical afferent
(proprioceptors)
16
Respiratory Controler
slowly adapting (tonic) receptors
Aortic body (response to _____? )
not involved in ventilation produce reflex cardiovascular responses
increases HR and BP
Slowly adapting receptors (SAR) convey information about the level of inflation of the lung
rapidly adapting (phasic) receptors
rapidly adapting receptors (RAR) fire in response to transient changes in lung volume
Q: Obstructive & Central Sleep Apnea
How do we know people with sleep disorder
Overnight Sleep Lab Examination What was recorded ?
37
EKG
Exhale Airway obstructs
Cheyne-Stokes ventilation Apneustic Breathing Sleep Disordered Breathing
OSA CSA
28
Chemoresponse to hypoxia or hypercapnia
Hypoxia
Carotid
Bodies ++
Two major breathing mechanisms
_____________ _____________
3
Control of breathing
Regulation?
_____ _____
6
Q: Automatic mechanism
Spontaneous, cyclical respiration originates in the ________ to produces spontaneous, cyclical respiration.
arterial oxygen tensionsÆ carotid body Æ carotid sinus nerve Æ to the brainstem Æ increase ventilation
below 60 mm Hg Æ strong respiratory drive. High arterial carbon dioxide tensions and acidosis act
Related to loss of inspiratory inhibitory activity
Causes:
Central nervous system injury
32
Q: Obstructive & Central Sleep Apnea
How does Sleep Apnea occur?
Respiratory Physiology
Control of breathing
Automatic mechanisms Voluntary mechanisms
1
4
Respiratory Physiology
Control of breathing Mechanics of breathing Ventilation Gas exchange and
Airway opens
Airflow
Thoracic effort
Abd.ቤተ መጻሕፍቲ ባይዱeffort
Inhale
Effort gradually increases
Paradoxing
Paradoxing Ends
SAO2
Blood oxygen levels reduce to < 3% of basline value
automatic activity
9
Respiratory Controler
Two chemoresponse?
Peripheral chemoresponse Central chemoresponse
Glossopharyngeal n
Carotid body
Vagal n
Aortic body 12
35
Q:Sleep Disordered Breathing
What is Sleep Apnea? Types?
__________ __________ __________ __________
33
Sleep Apnea (Obstructive & Central)
36
lie below the surface of the ventrolateral aspects of the medulla
Response to ?
PaCO2 levels to the normal (40 mm Hg) range
18
Hypercapnic ventilatory response
Respiratory output
26
Q: Cheyne-Stokes ventilation
What is Cheyne-Stokes ventilation?
29
Disorders of Ventilatory Control
_________ _________ _________
31
Sleep Disordered Breathing
Sleep Apnea
Obstructive Apnea Central Apnea Mixed Apnea Hypopneas
34
Apneustic Breathing
Sustained periods of inspiration followed by brief periods of expiration
Obstructive Apnea No airflow for > 10 seconds
Increasing respiratory effort. / SaO2 desaturation <3% 40
Polysomnography
• EOG - Electrooculogram
Brainstem (medulla)
8
Q: Respiratory Controler
Two chemoresponse?
________________ ________________
11
Q:Voluntary or behavioral control
important during _______ arises from the _______ to modify the
transport Pulmonary circulation
2
Control of breathing
What will affect breathing?
_____ _____ _____ _____ _____ _____
5
Control of breathing
(Two Myelinated vagal fibers)
14
Central chemoreceptor mechanisms
Central chemoreceptors Location?
____________________
Response to ?
____________________
Causes:
Central nervous system injury, head trauma
High altitude Low cardiac output, reduced brain
blood flow
30
Q: Apneustic Breathing
What is Apneustic ?
Q: Respiratory Controler
These receptors (lung stretch receptors) can be divided in two types:
________________ ________________
13
Respiratory Controler
Voluntary or behavioral control
important during _______
verbal communication
arises from the _______
cerebral cortex
7
10
Automatic mechanism
originates in the _____
Central Chemo Response to
CO2 Or H+ ?
19
Peripheral chemoreceptor
Two main bodies ?
Carotid and aortic bodies
Carotid body (how to increase drive?)
21
Hypoxic and Hypercapnic Responses
24
How dose hypoxic vetilatory response drive? How dose hypercapnic vetilatory response drive?
25
Disorders of Ventilatory Control
20
Hypoxic and Hypercapnic Response Curves?
Hypoxic Response Curves?
Hypercapnic Response Curves?
23
Q: Peripheral chemoreceptor
Two main bodies ?
__________________ (sense O2) __________________(response to CV )
17
Q: Respiratory Control
Other afferent fibers?
________________ ________________
15
Central chemoreceptor mechanisms
Central chemoreceptors Location?
22
Hypercapnic ventilatory response
Central Chemo Response to ?
H+ CO2 + H2O Æ H2CO3Æ H+
+ HCO3 hydrogen ions stimulate
central chemoreceptorÆ increase respiratory neural activityÆincrease respiratory activity
27
Cheyne-Stokes ventilation
Varying tidal volume and frequency
Following an apneic period VT and f increase progressively then decrease again until another period of apnea is seen
+
+++
Br.a…… ….i++n… …--+++-+…… …-+-+--..+--......
Stem
Hypercapnia CO2 /H+
What is Normal ventilatory response
.………. …………….. ......
Respiratory nerves
Respiratory muscles
Other afferent fibers?
Unmyelinated vagal fiber Others: nonchemical afferent
(proprioceptors)
16
Respiratory Controler
slowly adapting (tonic) receptors