פיזיולוגיה ו×‍×—×œ×•× ×¨×™××יו×

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a hebrew document about respiratory physiology and disease, by medical students in ben gurion university in beersheba. if you find it useful,or find it lacking in some aspects, please leave a comment.

Text of פיזיולוגיה...

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01............... ...........................................................................................COPD 51.................................................................................... 02.......................................................................................................... 42....................................................................................................... 53............................................................................................ 93.................................................................................................... 14...........................................................................................- 44...............................................................................PULMONARY EMBOLISM 84...... ...................................................................................................... : , , , , , , .

, ' , ' . ' . ' , . : (1) ( ), (2) , (3) . () (). ( )quantification . (1) ( ,)Total lung capacity TLC -(2) ( ,)Residual volume RV . - TLC- ( RV ) (( .)Vital capacity VC 1) " , - TLC - .RV . " 3 : (1) ( Forced Expiratory Volume in 1 sec 2) ,(1 )FEV (Forced ,)vital capacity FVC-(3) %05 -VC )Forced Expiratory flow -52between 25%-75% of the VC FEF

%57). - ( .)MMFR -%57 - VC -%52 - ( .VC 2) . , " ( ) " . ( - - ,PTP ) 3.A . " 3.B ( functional residual capacity ,)FRC , , . , . - FRC " . ( 3.)C " ()FRC " ( ) " " - .FRC - ,FRC - .FRC - ,FRC -.FRC - ,TLC " . , - TLC . ( - )Compliance- TLC ( FRC , "" ). - .TLC , - TLC. ( ,)RV " " " , . - .RV , . . , - PTP . , - PT P . -.RV " - TLC .RV , . , . - ( .)effort independence of forced expiratory flow , ( )compliance . , . , , .

- ,Forced expiratory flow. VC ( )ERV ( )IC " . RV, FRC- TLC , . : ( )Helium dilution- .body phletysmography , . " . , . . , " , . , . " , " . * - : , , , 1 V 1,P .k - 2 V 2 P .k . . ( , ) . . ,X X .X '... " " , , . " . %08-%021 . . ( FEV1/FVC / ) -08.0-57.0, . %57-52 FEF , . , ( TLC-VC ). %57-52 FEF , . ( ) - ( 4). -. , 2/1 , ( , ). (- TLC )RV - .RV ( ) ( TLC) . ( ) . -

( ). . . ( ) " . . RV , .MIP , - TLC .MEP , " .

, " , () (). . , /1FEV FVC, %57-52( FEF 2, .)B - . " ( 4, .)O , , FEV1/FVC . - %57-52FEF -. , - TLC . , , . ,RV RV/TLC. , VC - RV -.TLC , TLC- .VC -, : - . , " RV ( ) . , 1 FEV FVC ( 2, .)C - (4-232, )R-P - , , , . ( 4, .)R-P -, - . ( 1). - (") , " , . , TLC , RV . , (MIP ') . " , RV , - .FRC , - ,RV . FEV1/FVC . , -( MEP '), FEV1/FVC . - ,FRC FEV1/FVC . 1 , . 2 .

, - 5 . " . ( )mean PAP - ,15mmHg - MAP - 95mmHg. . , . , , . , , . , , ( = ). : .COQRp , - PAP, , .

. , . - ( Swan-Ganz ) , PAP ( )PCW-pulmonary capillary wedge . ( )PVR " : .PVR=80)PAP-PCW(/CO - PVR -05 051 5.dynsec/cm

- PVR . . PVR -. , " " , , ,PVR. PVR, - PAP, , , - PAP .

= , . , . ( , ), ,PVR ( - pH ). , PVR , " . , - ,COPD , " - " " . , " . , ", . , " . " , , . , PVR, " .

2 CO 2 O . , , " ( ), (), () ( -). 61-21 , Tidal Volume 005 ". - %03 . , . 07 , . " , 7 , 2 -5 . , , , . , , . , : 2 CO 2CO , " PaCO2 = 0.863 VCO2/VA " (2 ,)VCO ( ,)VA " , , " . ( ) . [ ]. 2 O- 2 CO " . , , . , . , . , , , . , " . , - diffusion capacity ( ) -. - , . / ( )V/Q - -0, ( )shunt -, . " - ( ) V/Q . , 0 , , , Pvo2 40mmHg-64 2Pvco .mmHg , - V/Q, , (P02150 mmHg, Pco20 mmHg ). , - , - 1 /. , , - , . , . , V/Q . " . ( -flow )???weighted average , " . -, . ( %09) ,60mmHg -06 " . , - -06 ( ). , V/Q , , V/Q , . - V/Q ", " " .

" ( ,2Pao 2 .)Paco " , . . , . - 2 .Pao , -. (73, 4.7 )pH " , " : 2content = 1.34 [Hb] saturation + 0.0031 PO2 O 43.1 " , , 1300.0 " " . , (-3.0 " ) (-02 " ). , 2 PO . " ( ) . , ,CO- CO , . - CO , , -2 ,PO . " .Fick , 04 ", . - (2 ,)PA02 PaO - .A-a gradient , , " . " , . , - " . - . -, ( 2.)PAO : PAO2 = FIO2 )PB PH2O( PACO2/R 2 = FiO (-%12 ), = PB (-067 " ), = PH2O (74 " -73) - R " , " 8.0. " , : 2PAO2 = 150 1.25 PACO - " " . , , - -51 ". , -03 " . " " " 2 .PACO " pH/ , " -pH ( .)et al[ ] Pulse oximetry , , - . , , . Pulse oximetry . ( ) " " -, . " - . : , (" ). 06 " (- %09 ), . , , , pH .2-3DPG , ( ), . ( , , ) - - , . , -CO, 4 , 4 (, , -). , - - %09 , ", " .[ ]

- " " - .)CO )DLCO , %3.0) )CO, " -01 . - CO " " " ' . - CO , - DLCO - CO " . - . , -, - V/Q . ,DLCO . " , " ( )VA . DLCO /VA .

' . " . ( ) (1) , (2) -, (3) () -(4) - .V/Q " . " , A-a ( ) . 5 :

- " . , , -A a . . , , %12 . - " . " . - , A-a . A-a " , , - V/Q , . ( ) - . . .A-a , "" . - .V/Q , V/Q . V/Q , , . V/Q. [ . , =).

- V/Q , A-a, " " . " V/Q. - V/Q . ( " ) " . " ( )CO2 retention" -4 " ": (1) ", (2) (3) ,( )won't breathe , (" 4) ,( )can't breathe ( )V/Q . , , " . ( )Diffusing Capacity , " -, ' . " ,DLCO ' DL .CO - DLCO -, .

... . . " . ( )atelectasis , - . , " ( )hereditary hemorrhagic telangiectasia ( ). - V/Q -( COPD ) ( ). DLCO / . - : DLCO , . , - . . , " , " -.DLCO , '. , , DLCO , . - DLCO , - Goodpasture's syndrome " ,CO - CO DLCO, .

COPD COPD . COPD , , , . small airway ,disease , . COPD - .COPD ".: , ,FEV 1 ,FEV .

- %01 - COPD . - , COPD . COPD , ( .)Dutch hypothesis , , , . , COPD - , COPD . , , . - , . - , , ( SPSS, ). , . . - protease )inhibitor )PI - -1 .COPD

, , . FEV , 02. . , ( ,)B ( ,)D (.)D

(forced .)expiratory flow rate ( ,)RV " ( ,)RV/TLC , - ( V/Q mismatching ). ( COPD"), FEV/FVC . , - FEV " - FEV -01 " ,