Chapter7BloodCirculation血液循环-课件.ppt

1、Chapter 7 Blood Circulation （血液循环）血液循环）Section 1 SummaryBlood circulation(血液循环血液循环):Def:Blood continuously circulatory flows in cardiovascular system(是指血液在心血管系统内周而复始地循环流动)Heart(心脏心脏):Muscle-pump,dynamic organ.(肌肉泵,动力器官)Artery(动脉动脉):The vessel which can guide blood to leave heart and flow into tissue

2、s.(引导血液离开心脏流向各组织器官的管道).exchange.(进行物质交换的场所)Vein(静脉静脉):The vessel which can guide blood to return heart.(引导血液回心的管道)Capillary(毛细血管毛细血管):The place of substanceSection 2 The Structures and Functions of Myocardium(心肌的结构与机能特性心肌的结构与机能特性)1.Autorhythmicity(自动节律性自动节律性)Def:The ability of an excitable cell to r

3、hythmically initiate its own action potentials (组织细胞能自动发生节律性兴奋的特性组织细胞能自动发生节律性兴奋的特性)衡量指标衡量指标:The frequency of automatic excitation (自动兴奋的频率自动兴奋的频率)2.Functional Synplasm（机能机能合胞体合胞体）Structure basis:Intercalated disc(闰盘)心肌的机能合体性 The phenomenon of all or none in the myocardial （心肌收缩的“全或无”现象）3.Specific Co

4、nduction System(特殊传导系统特殊传导系统)The types of myocardium cell(心肌细胞的类型心肌细胞的类型):(1)Normal myocardium(普通的心肌细胞普通的心肌细胞):工作细胞工作细胞(非自律细胞非自律细胞),包括心房肌、心室肌包括心房肌、心室肌,具兴奋性具兴奋性,传导性传导性,收缩性收缩性,无自律性无自律性 working cardiac cell(non-autorhythmic cell)：include atrial muscle and ventricular muscle,have excitability,conductivi

5、ty,and contractibility,non-autorhythmicity.(2)Specific myocardium(特殊分化的心肌细胞特殊分化的心肌细胞):自律细胞和非自律细胞自律细胞和非自律细胞,包括包括P细胞、浦肯野氏细胞、浦肯野氏细胞与结区细胞细胞与结区细胞,自律细胞有兴奋性自律细胞有兴奋性,自律性和传自律性和传导性导性,基本无收缩性基本无收缩性,具有产生和传导节律性兴奋具有产生和传导节律性兴奋的能力的能力 Rhythmic cell and non-autorhythmic cell,include P cell and Purkinje cell,have excit

6、ability,autorhythmicity and conductivity,no contractibility,also have capacity to produce and conduct rhythmic excitation Sino-artrial node(S-A node,窦房结窦房结)Artrio-ventricular node(A-V node,房室结房室结)atrioventricular bundle 0.05m/s and bilateral bundles (房室束及左右束支房室束及左右束支)2-5m/s Purkinje fiber(浦肯野氏纤维浦肯野氏

7、纤维)2-5m/s Fig.7-14 atrioventricular delay(房室延搁)and its significance:Pacemaker(正常起搏点正常起搏点)：S-A node,right atrium intine wall(窦窦房结房结,右心右心房内壁房内壁)Latent pacemaker(潜在起搏点潜在起搏点):A kind of autorhythmic tissue which dont express autorhythmicity in normal circumstances.(正常情况下不表现本身自律性的自律组织正常情况下不表现本身自律性的自律组织)Ec

8、topic pacemaker(异位起搏点异位起搏点):The latent pacemaker which can control cardiac excitation and palmus in abnormal circumstances.(异常情况下控制心脏兴奋和跳动的潜在起搏点异常情况下控制心脏兴奋和跳动的潜在起搏点)Artificial pacemaker(人工起博器人工起博器)4.The AP of myocardial cell-bioeletricity phenomenon of myocardial cell (心肌细胞的心肌细胞的AP-心肌细胞的生物电现象心肌细胞的生物

9、电现象)(1)Different from the skeletal muscle.(不同于骨骼肌不同于骨骼肌)(2)Different types of myocardial cell have different transmembrane potential extent,persistent time,wave forms and mechanism.(不同的心肌细胞，其跨膜电位的幅度、不同的心肌细胞，其跨膜电位的幅度、持续持续 时间、波形、产生机制亦不相同时间、波形、产生机制亦不相同)Mechanism of AP:0期期:去极去极,钠内流钠内流(快通道快通道)1期期:快速复极初期快

10、速复极初期,钾通过瞬时性外向钾外流通钾通过瞬时性外向钾外流通道外流道外流,膜内电位降至膜内电位降至0mv左右左右2期期:缓慢复极期又叫平台期缓慢复极期又叫平台期,钙和少量钠通过慢钙和少量钠通过慢通道的通道的 内流与少量钾外流相持内流与少量钾外流相持3期期:快速复极末期快速复极末期,膜对钾的通透性膜对钾的通透性 升高升高,钾外流钾外流 膜电位由膜电位由0mv 降至降至-90mv4期期:静息期静息期 细胞膜的离子转运机能细胞膜的离子转运机能 加强加强Mechanism:5.The refractory period of the heart (心脏的不应期心脏的不应期)(1)Absolute re

11、fractory period&effective refractory period,ARP&ERP(绝对不应期绝对不应期与有效不应期与有效不应期):0 -55mv,-60mv,cant generate AP.AP (2)Relative refractory period,RRP(相对相对不应期不应期):-60 -80mv,threshold intensity(阈强度),can cause AP.(3)Superanormal period,SNP(超常期超常期):-80 -90mv,threshold intensity,can causeFig.7-16Significance o

12、f Long Time Effective Eefractory Period (有效不应期长的意义有效不应期长的意义):Premature systole or extrasystole&compensatory pause (期前收缩与代偿间歇期前收缩与代偿间歇)Fig.7-17 6.Electrocardiogram,ECG(心电图心电图)Basic waveform(基本波形基本波形):P,QRS,TSignificance:P:QRS:T:P-R period Fig.7-18 7-20Section 3 The Dynamics Change of Cardiac Cycle (心

13、动周期的力学变化心动周期的力学变化)1.Def.Cardiac cycle(心动周期心动周期):The whole cycle of systole and diastole (心脏由收缩到舒张的整个过程心脏由收缩到舒张的整个过程)2.The blood ejection process of heart(心脏的射血心脏的射血过程过程)(1)Period of atrial systole(心房收缩期心房收缩期):end-diastolic volume(心舒末期容积心舒末期容积)(2)Period of ventricular systole (心室收缩期心室收缩期)：1.Period of

14、 isovolumic contraction(等容收缩期等容收缩期):Semilunar valve is still closed,atrioventricular valve is closed(半月瓣仍关半月瓣仍关,房室瓣关闭房室瓣关闭)Period of rapid blood ejection(快速射血快速射血期期):Semilunar valve is opened,ejectingblood (半月瓣开半月瓣开,射血射血)Period of slow blood ejection(减慢射血减慢射血期期):End-systolic volume (心缩末期容积心缩末期容积)(3)

15、Period of Ventricular Diastole (心室舒张期心室舒张期)：Period of isovolumic relaxation(等容舒张期等容舒张期):Semilunar valve is closed,atrioventricular valve is closed (半月瓣关半月瓣关,房室瓣仍关房室瓣仍关)Period of rapid filling(快速充盈期快速充盈期):Atrioventricular valve is opened.(房室瓣开房室瓣开)Period of reduced filling(减慢充盈期减慢充盈期):Fig 7-223.Heart

16、 Sound(心音心音)First heart sound(第一心音第一心音):The tone is low and long,mostly caused by closing of atrioventricular valve,it is the symbol of cardiac contraction.(音调低而长音调低而长,主要由于房室瓣关闭引起主要由于房室瓣关闭引起,标志心室收缩开始标志心室收缩开始)Second heart sound(第二心音第二心音):The tone is high and short,mainly caused by the close of semilu

17、nar valve,the symbol of cardiac relaxation.(音调高而短音调高而短,主要由于半月瓣关闭引起主要由于半月瓣关闭引起,标志心室舒张开始标志心室舒张开始)Section 4 Cardiac Output and Its Regulation (心输出量及其调节心输出量及其调节)Cardiac output(心输出量心输出量):The volume of blood pumped by each ventricle per minute;equal to the stroke work output times the heart rate per minut

18、e.(一侧心室每分钟射出的血量一侧心室每分钟射出的血量)Cardiac Output=Heart RateStroke VolumeCO=HRSV =75 70 =5250（ml）CO(Cardiac output)quiet(安静时安静时)：5L/min movement(运动时运动时)：180-200 150-170 25-30L/min Cardiac reserve(心力心力贮备贮备)Maximal output(最大输出量最大输出量):Maximal volume of blood pumped by each ventricle per minute.(一侧心室每分钟射出的最大血量

19、一侧心室每分钟射出的最大血量)Cardiac reserve(心力贮备心力贮备):The ability that cardiac output increases along with the need of body metabolism.(心输出量随机体代谢需要而增加的能力心输出量随机体代谢需要而增加的能力)Heart rate reserve(心率贮备心率贮备):2-2.5 times 200 beat/min Stroke volume reserve:140ml 160(ml)15 Reserve of relaxation period 145 70 75 55 Reserve

20、of contraction period 20 (搏出量贮备搏出量贮备)(舒张期贮备舒张期贮备)15 ml(收缩期贮备收缩期贮备)55-60 ml1.The Regulation of Heat Rate(心率的调节心率的调节)Nerve regulation(神经调节神经调节):Sympathetic nerve(交感神经)(+)Vagus nerve (迷走神经)(-)Tab.7-2Hormone regulation(激素调节激素调节):adrenal hormone 肾上腺素(+)2.Regulation of cardiac output(心搏量的调节心搏量的调节)(1)Heter

21、ometric autoregulation(异异长调节调节)Cardiac regulation(心脏自身的调节心脏自身的调节)Cardiac law (心脏定律心脏定律)Fig 7-29(2)Homometric Regulation(等长调节等长调节)Nerve regulation(神经调节神经调节)sympathetic nerve(交感神经交感神经)(+)vagus nerve (迷走神经迷走神经)(-)Hormone regulation(激素调节激素调节)adrenal hormone (肾上腺素肾上腺素)(+),thyroid hormone(甲状腺素甲状腺素)(+)Sect

22、ion 5 Physiology of Blood Vessel (血管生理血管生理)1.Structures and function characters of various vessels (各类血管的结构与机能特点各类血管的结构与机能特点)一 Artery(动脉动脉)1)Aorta(大动脉大动脉)windvessel vessel (弹性贮器血管)Function：buffering high pressure are related to continual flow of blood(缓冲高压与血流的持续流动有关)Elasticity and age(弹性与年龄弹性与年龄):2)

23、Distribution vessel(分配血管分配血管)Function:Transfusing blood to organs and tissues (输送血液至器官组织输送血液至器官组织)3)Arteriole(微动脉微动脉)Resistance vessel before capillary(Cap前阻力血管前阻力血管)Structure characters:Vessel wall is mainly smooth muscle(SM).(管壁以平滑管壁以平滑肌为主肌为主.)Function：Regulating peripheral resistance/BP;调节外周阻力调节外

24、周阻力/BP calamus is small,and velocity of flow is high;(管径小管径小,流速快流速快)Function：Controlling local hemoperfusion,blood flow is directly proportional to r4,and relates to continuous flow of blood.(控制局部血液灌流量控制局部血液灌流量,血流量与血流量与r4成正比成正比 与血流持续有关与血流持续有关)Blood pressure fall(血压降落血压降落):aorta(主大主大A)small artery(小小

25、A)arteriole(微微A)Vein(静脉静脉)Capacitance vessel(容量血管容量血管)Function:Contain 60-70%blood(容纳容纳60-70%的血的血)Capillary(毛细血管毛细血管)Exchange vessel Structure and function characters (结构与机能特点结构与机能特点):管壁很薄管壁很薄,只有一层内皮细胞和一层很薄的基膜只有一层内皮细胞和一层很薄的基膜,内皮内皮层可有空隙层可有空隙,孔道等孔道等,故通透性很大故通透性很大,血管内的血液与血管血管内的血液与血管外的组织液间能够进行物质交外的组织液间能够

26、进行物质交换换.Exchange vessel(交换血管交换血管)Function：The place where substances exchange (物质交换的场所物质交换的场所)2.Blood Pressure and Its Measuration (血压与血压的测定血压与血压的测定)BP(血压血压):The force exerted by the blood against any unit area of vessel wall (血液血液对单位面积血管壁的侧对单位面积血管壁的侧压力压力)Unit(单位单位):kPa/mmHg(1)The Mensuration of Blo

27、od Pressure (血压的测定血压的测定)测侧压 直接测定法血压的测定 测终端压 间接测定法(2)The Forming of Blood Pressure (血压的形成血压的形成)Basic factors：Enough blood volume in cardiovascular center (心血管内有足够的血量心血管内有足够的血量)Ventricular ejection (心室射血心室射血)Peripheral resistance(外周阻力外周阻力)(3)Arterial blood pressure(动脉血压动脉血压)Systolic pressure(收缩压收缩压)Wh

28、en ventricle is contracting,the maximal arterial pressure is called the systolic pressure.(心室收缩时动脉压升到的最高值心室收缩时动脉压升到的最高值)Normal(正常值正常值):100-120 mmHg/13.3-16kPaDiastolic pressure(舒张压舒张压)when ventricle is relaxing,the minimal arterial pressure is called diastolic pressure.(心室舒张时动脉压降到的最低值心室舒张时动脉压降到的最低值)

29、Normal(正常值正常值):60-80 mmHg/8-10.6 kPaBlood pressure:age,sex and others(血压与年龄血压与年龄,性别及其它性别及其它)Effect Factors of Arterial Blood Pressure(动脉血压的动脉血压的影响因素影响因素)1.Stroke volume(搏出量搏出量)2.Heart rate(心率心率)3.Peripheral resistance(外周阻力外周阻力)4.Function of elastic reserve of aorta (主主 大动脉的弹性贮器作用大动脉的弹性贮器作用)5.Proport

30、ion of circular volume and vascular volume (循环血量与血管容量的比例循环血量与血管容量的比例)(4)Venous Pressure&Venous Return (静脉血压和静脉回流静脉血压和静脉回流)VP(V血压血压)Peripheral VP(外周外周V压压)VP of different organs(各器官各器官V的血压的血压)15-20 mmHg1.Central VP(中心中心V压压)2.VP of main line in right atrium and thoracic cavity 3.(右心房和胸腔内大右心房和胸腔内大V的血压的血

31、压)4.0-12 mmHg V return power=Peripheral VP-Central VP V回流动力回流动力=外周外周V压压-中心中心V压压Systole(心脏收缩心脏收缩)心肌收缩力量心肌收缩力量 正变正变 (左、右心衰左、右心衰)Gravity and pose(重力与体位重力与体位)血液重力引起静水压血液重力引起静水压 lie:VP are approximately same in different part.各处各处V压大致相同压大致相同 stand:VP are different in different parts,各处各处V压大不相同压大不相同 Effec

32、t factors of venous return (影响影响V回流的因素回流的因素)Gravity and pose(重力与体位重力与体位)The degree of V engorge is affected by transmura pressure.(V充盈程度受跨壁压的影响大充盈程度受跨壁压的影响大)VP of lower parts are expanded because of the transmura pressure increased,and the blood volume are also increased.(身体低垂部分的身体低垂部分的V压因跨壁压增大而扩张压因

33、跨壁压增大而扩张,容容纳血量也增多纳血量也增多)Respiratory movement/respiratory pump(呼吸运动呼吸运动/呼吸泵呼吸泵)Inspiration(吸气吸气)(+)Extrusion action of skeletal muscle /muscle pump(骨骼肌的挤压作用骨骼肌的挤压作用 /肌泵肌泵)Muscle contraction(+)(肌肉收缩肌肉收缩)Respiratory pump(呼吸泵呼吸泵)呼气时右房回心血呼气时右房回心血 量减少量减少(左房相反左房相反)吸气时右房回心血吸气时右房回心血 量增多量增多(左房相反因为左房相反因为 肺扩张容纳

34、血量增多肺扩张容纳血量增多)3.Microcirculation(微循环微循环)Def:The blood circulation in microangium between arteriole and venule.(微动脉和微静脉之间微血管中的血液循环微动脉和微静脉之间微血管中的血液循环)(1)The component of microcirculation (微循环的组成微循环的组成)Arteriole(微动脉微动脉);Metarteriole(后微动脉后微动脉);Precapillary sphincter(毛细血管前括约肌毛细血管前括约肌);True capillary(真毛细血

35、管真毛细血管);Thoroughfare channel(通血毛细血管通血毛细血管);Arteriovenous anastomoses(动动-静脉吻合支静脉吻合支);Venule(微静脉微静脉)Fig 7-38Arteriole(微动脉微动脉):Precapillary resistance vessel;master valve(毛细血管前阻力血管毛细血管前阻力血管;总闸门总闸门)Capillary(毛细血管毛细血管):Structure characters:Big area,slow velocity,high permeability (面积大面积大,流速慢流速慢,通透性大通透性大)

36、Fig.7-39 Function:exchange of substancesVenule(微微静脉静脉):capacitance vessel(容量血管容量血管)(2)The Methods and Mechanisms of Substance Exchange(物质交换的方式和机制物质交换的方式和机制)Diffusion(扩散扩散):Concentration(浓度浓度),Distance(距离距离),Area(面积面积),Temperature(温度温度),Molecular weight(分子量分子量),Membranous permeability(膜的通透性等膜的通透性等)Fi

37、ltration and reabsorption(滤过与重吸收滤过与重吸收)Starling Hypothesis(Starling假说)Power(动力动力):Effective filtration pressure=(Cap pressure+colloid osmotic pressure of tissue fluid)-(colloid osmotic pressure of blood plasma +lentic pressure of tissue fluid)有效滤过压有效滤过压 =（Cap压压+组织液胶体渗透压组织液胶体渗透压）（血浆胶体渗透压（血浆胶体渗透压+组织液静

38、水压组织液静水压)Process(过程过程):Effective filtration pressure of Cap A terminal is positive,and the fluid is filtrated and forms tissue fluid;effective filtration pressure of Cap V terminal is negative,and tissue fluid returns Cap.Cap A端的有效滤过压为正值，液体滤出而端的有效滤过压为正值，液体滤出而成组织液；成组织液；Cap V端的有效滤过压为负值，组端的有效滤过压为负值，组织液

39、回流入织液回流入Cap。Filtration and Reabsorption(滤过与重吸收滤过与重吸收)血浆胶体渗透压 组织液静水压 +32-21-10+15+14-29-10+15动脉端静脉端+16-10组织液 淋巴液 Effect Factors of Tissue Fluid Forming (组织液生成的影响因素组织液生成的影响因素)Cap压压 静脉回流受阻静脉回流受阻,右心衰右心衰 Cap压压 组织液生成组织液生成血浆胶渗压血浆胶渗压 蛋白尿或肝功蛋白尿或肝功 血浆胶渗压血浆胶渗压 组织液生成组织液生成 Permeability of Cap(Cap通透性通透性)Permeabil

40、ity(通透性通透性)forming of tissue fluid(组织液生成组织液生成)burn,allergy(烧伤、过敏烧伤、过敏)Pinocytosis(胞饮作用胞饮作用)Two dimensional action(双向作用双向作用)Exchange of macromolecular protein(大分子蛋白质的交换大分子蛋白质的交换)4.Lymph circulation(淋巴循环淋巴循环)(1)Component(组成组成):Lymphatic capillary,lymphatic vessel,lymph node.(毛细淋巴管毛细淋巴管,淋巴管淋巴管,淋巴结淋巴结)P

41、ermeability:lymphatic capillary capillary (毛细淋巴管通透性毛细淋巴管通透性 毛细血管毛细血管)(2)Effect Factors of Lymph Fluid Forming and Return(影响淋巴液生成与回流的因素影响淋巴液生成与回流的因素)The pressure difference between tissue fluid and lymphatic capillary (组织液与毛细淋巴管内的压力差)Skeletal muscle movement(骨骼肌运动)(3)The Physiological Significance of

42、 Lymphatic Return (淋巴回流的生理意义淋巴回流的生理意义)Regulating the balance of blood volume and tissue fluid volume.(调节血量与组织液量的平衡调节血量与组织液量的平衡)Recycling protein of tissue fluid.(对组织液中的蛋白质的回收作用对组织液中的蛋白质的回收作用)The transportation of Chyle vessel to fat (乳糜管对脂肪的运输乳糜管对脂肪的运输)Defense barrier action of lymph node1.(淋巴结的防御屏障

43、作用淋巴结的防御屏障作用)Macrophage(巨噬细胞巨噬细胞)Lymphocyte(淋巴细胞淋巴细胞)Section 6 Regulation of Cardiovascular Activity (心血管活动的调节心血管活动的调节)1.Nervous regulation(神经调节神经调节)(1)Cardiovascular innervation (心血管心血管的的N支配支配)Cardiac innervation(心脏心脏的的N支配支配)Cardiac sympathetic nerve and its regulation (心交感心交感N及其作用及其作用):T1-5 (NE+1R

44、)different parts of heart (NE+1R)心脏各部分心脏各部分 Function：正性变时变力变传导正性变时变力变传导Cardiac vagus nerve and its regulation (心迷走心迷走N及其作用及其作用):Function：负性变时变力变传导负性变时变力变传导 Vessel innervation(血管血管的的N支配支配)Dorsal nucleus and ambiguous nucleus of medulla(延髓背核、疑核延髓背核、疑核)(ACh+MR)different parts of heart(ACh+MR)心脏各部分心脏各部分

45、 Vasoconstrictor fiber(缩血管神经纤维缩血管神经纤维):The nerve fiber which can cause contraction of smooth muscle of blood vessel (能引起血管平滑肌收缩的神经纤维能引起血管平滑肌收缩的神经纤维)Sympathetic vasoconstrictor nerve (交感缩血管交感缩血管N)：T1-L2.3NE+smooth muscle of blood vessel R(NE+血管血管平滑肌平滑肌R)Contraction(收缩收缩)Function:Keeping tonic contrac

46、tion of blood vessel smooth muscle,peripheral resistance is increased,and the organic hemoperfusion is reduced.(维持血管壁平滑肌的紧张性收缩维持血管壁平滑肌的紧张性收缩,外周阻力升外周阻力升高高,该器官血液灌流量下降该器官血液灌流量下降)Distribution density(分布密度分布密度)：blood vessel of skin blood vessel of skeletal muscle and viscus blood vessel of cardiac muscle

47、 and cerebrovascular system (皮肤血管皮肤血管 骨骼肌及内脏血管骨骼肌及内脏血管 心肌血管及心肌血管及脑血管脑血管)A V The thinner of the calibre,the higher of the distribution density.(口径愈细，分布密度愈高口径愈细，分布密度愈高)Vasodilator fiber(舒血管神经纤维舒血管神经纤维)：sympathetic ACh.MR vasodilator nerve fiber parasympathetic ACh.MR vasodilator nerve fiber (交感舒血管交感舒血

48、管NF)(副交感舒血管副交感舒血管NF)Vasodilator nerve fiber of spinal dorsal root (脊髓背根舒血管脊髓背根舒血管NF)Vasoactive intestinal polypeptide neuron (血管活性肠肽神经元血管活性肠肽神经元)VIPVIPR (2)Cardiovascular Center(心血管中枢心血管中枢)Concentrative site of neuron which related with cardiovascular reflex (与心血管反射有关的神经元集中的部位与心血管反射有关的神经元集中的部位)Spina

49、l cord(脊髓脊髓)Primary cardiovascular center (初级心血管中枢初级心血管中枢)脊髓的胸腰段有支配心脏和血管的交感节脊髓的胸腰段有支配心脏和血管的交感节前前N元，元，具紧张性活动具紧张性活动Bulb延髓延髓 Basic cardiovascular center (基本心血管中枢基本心血管中枢)心迷走N元 心迷走紧张心交感N元 心交感紧张交感缩血管N元 交感缩血管紧张Vasoconstrictor region(缩血管区缩血管区)延髓头端腹外侧部延髓头端腹外侧部 cause cardiac sympathetic tension、sympathetic va

50、soconstrictor tension(引起心交感紧张、交感引起心交感紧张、交感缩血管紧张缩血管紧张)Vasodilator region(舒血管区舒血管区)延髓尾端腹外侧部延髓尾端腹外侧部 inhibit activity of vasoconstrictor region (抑制缩血管区的活动抑制缩血管区的活动)Substitution station of afferent nerve (传入传入N接替站接替站)孤束核孤束核 Inhibitory region of heart(心抑制区心抑制区)Dorsal nucleus and ambiguous nucleus of bulb