Fisiología respiratoria
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
ASIGNATURA: FISIOLOGÍA CÓDIGO: 153-3018
UNIDAD IV FISIOLOGÍA RESPIRATORIA
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA - Ventila lacción pulm lmo onar. - Pr Prop opie ieda dade dess fís físic icas as del del sist sistem ema a resp respir irat ator orio io.. - In Inte terc rcam ambi bio o ga gase seos oso o en en el el pul pulmó món. n. - Transporte de ga gases.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. FUNCIONES RESPIRATORIAS -
El ob obje jetitivo vo de la resp respir iraci ación ón es pr prop opor orcio cionar nar O2 y retirar CO2 de los tejidos.
-
Funcion Funci ones es princ principa ipales les del del sistem sistema a respi respira rato tori rio o (Guyt (Guyton) on):: - Vent Ventilac ilación ión pulm pulmona onar. r. Flujo Flujo de aire aire entre entre atmósfer atmósfera a y alvéolos alvéolos pulmo pulmonar nares. es. - Difusión de O2 y CO2 entre alvéolos y sangre. - Transporte de O2 y CO2 entre sangre y tejidos corporales. - Re Regu gula laci ción ón de la ven ventitila laci ción ón..
-
Funci Fu ncion ones es pri princ ncipa ipales les de dell sistem sistema a respi respira rato tori rio o (Fox) (Fox)::
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
El si sist ste ema re resp spiiratorio. - Vía Víass aéreas aéreas superior superiores es (calent (calentami amiento ento,, humidifi humidificaci cación, ón, limp limpiez ieza): a): - Na Nari riz, z, boc boca, a, far farin inge ge,, lari laring nge. e.
- Vía Víass aérea aéreass inferi inferiore oress (ma (mayor yor área área con con cada cada gene generac ración) ión):: - De conducción conducción (vías aéreas aéreas superior superiores es e inferiores inferiores desde desde tráquea tráquea hasta hasta bronquio bronquiolos los membranosos (16 generaciones desde la tráquea)). - Tráqu Tráquea. ea. Mayo Mayorr resistencia resistencia al flujo flujo junto junto con bronqu bronquios ios superior superiores. es. - Bronq Bronquios. uios. Múscul Músculo o liso. Bron Broncocon coconstricci stricción ón para parasimpá simpática tica y broncod broncodilata ilatación ción simpá simpática. tica. - Bronq Bronquiolo uiolos. s. Acción Acción del músculo músculo liso igual igual al bronqu bronquial. ial. Aumenta Aumenta mucho mucho la resistenci resistencia a en la broncoconstricción. - De tr tra ansici ció ón:
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
Mecáni Mecá nica ca de la ve vent ntililac ació ión n pul pulmo mona nar. r. 1) Músculos respiratorios. Inspiración: - Respiración normal tranquila. Alargamiento o acortamiento de la caja torácica (diafragma). (diafragm a). Aumento Aumento y reducción del diámetro AP de la caja torácica por desplazamiento de las costillas (intercostales externos). - Respiración forzada. Se adiciona la acción de de esternocleidomastoideos, serratos anteriores, anteriores, escalenos.
Espiración: - Respiración normal normal tranquila. Alargamiento Alargamiento y acortamiento de la caja torácica (elasticidad). - Respiración forzada. forzada. Rectos abdominales, abdominales, intercostales internos.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
Mecáni Mecá nica ca de la ve vent ntililac ació ión n pul pulmo mona nar. r. 2) Movimientos de entrada y salida del aire de los pulmones (1/2). - El puImón puImón está adosad adosado o a la pared pared torácica, torácica, separ separado ado por por la pleura, pleura, con con líquido líquido pleura pleurall entre entre ambas hojas pleurales, sometido a presión negativa por el flujo linfático, que permite deslizamiento. - Pr Pres esió ión n ple leu ural al.. - Pre Presió sión n al comi comienz enzo o de la la inspi inspirac ración ión ((-5 5 cm H 2O). Presión inspiratoria máxima (-7,5 (-7,5 cm H2O). - Pr Pres esió ión n alv alve eola larr. - Var Varía ía de de forma forma simil similar ar a la presi presión ón pleu pleura rall (-1 a +1 cm de H2O). Presión Presi ón tran transpulm spulmonar onar.. Es una una medid medida a de la fuerza fuerza elást elástica. ica.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
Mecáni Mecá nica ca de la ve vent ntililac ació ión n pul pulmo mona nar. r. 2) Movimientos de entrada y salida del aire de los pulmones (2/2). - Diste Distensibil nsibilidad idad pulmo pulmonar. nar. Camb Cambio io de volumen volumen por unidad unidad de presión presión (200 mL/cm H 2O).
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
Mecáni Mecá nica ca de la ve vent ntililac ació ión n pul pulmo mona nar. r. 3) Efecto de la caja torácica sobre la expansibilidad expansibi lidad pulmonar. - Diste Distensibil nsibilidad idad pulmo pulmonar nar y torácic torácica a en conjunt conjunto. o. Por efecto efecto de elasti elasticidad cidad y viscosidad. viscosidad.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. VENTILACIÓN PULMONAR -
Volúm Vo lúmen enes es y capa capacid cidad ades es pulm pulmon onar ares es (esp (espir irom ometr etría ía). ). -
Volume Volu men n co corr rrie ient nte e (V (Vc) c) (5 (500 00 mL mL). ). Volume Vol umen n de rese reserva rva ins inspir pirato atoria ria (VR (VRI) I) (300 (3000 0 mL). mL). Vol de r irator ira toria ia (VR (VRE) E) (110 (1100 0 mL). mL).
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FISIOLOGÍA RESPIRATORIA. FÍSICA DE LOS GASES Y DIFUSIÓN -
La difusi difusión ón es el prin principa cipall mecan mecanism ismo o de de desplaz desplazami amiento ento de los los gases gases de importancia en la fisiología fisiol ogía respiratoria, tanto en vías respiratorias, como en sangre y otros tejidos.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES FUNCIÓN DE LA HEMOGLOBINA EN EL TRANSPORTE DE OXÍGENO -
La hem hemogl oglob obina ina com como o amor amortitigua guado dorr (esta (estabi biliz lizad ador or)) de la PO PO2 tisular: -
La PO2 tisular no puede exceder los 40 mm Hg Hg (porque debe liberar unos 5 mL de O 2/1 /100 00 mL de sangre). En ejerc rcic icio io in inte tens nso o la la PO2 tisula tisularr es de 15 mm Hg y liber libera a 15 mL de de O 2/100 mL de sangr sangre. e. Lo ant anteri erior or se debe debe a que que con una peq pequeñ ueña a redu reduccíó ccíón n de la la P O2 se liberan grandes cantidades de O2, estabilizando la P O2 entre 15 y 40 mm Hg. Cuando la PO2 atmosférica se modifica mucho, la P O2 tisular se mantiene estable. Si se reduce la PO2 alveolar (altura) (altura) (con 60 mm Hg, la saturación es 89% y si se extraen 5 mL de O 2, se reduce la PO2 tisular sólo a 35 mm Hg). Si se aumenta la P O2 a 500 mm Hg, la saturación saturación de Hb sólo sube 3% (al 100%) y sólo se disuelve un poco más de O en plasma, al ceder el O a los tejidos, la P
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES FUNCIÓN DE LA HEMOGLOBINA EN EL TRANSPORTE DE OXÍGENO - Fac Factor tores es que desp desplaz lazan an la curva curva de disoci disociació ación n oxí oxígen geno-h o-hemo emoglob globina: ina: -
-
Efecto Bohr Efecto Bohr:: la acidif acidifica icació ción n de de la sangr sangre e (pH 7,2) 7,2) y el aume aumento nto del del CO 2 desplazan la curva de disociación hacia la derecha y abajo. El efecto Bohr se produce en los tejidos normalmente. Este desplazamiento aumenta aumenta la disociación del oxígeno para una misma mis ma P O2, facilitando su cesión a los tejidos. Ocurre el efecto contrario (se desplaza a la izquierda y arriba) en los pulmones. También Tambié n despla desplazan zan la curva hacia la derecha derecha el aumento aumento de la la tempera temperatura tura y el aume aumento nto de de BFG (DPG). El DPG aumenta significativamente en hipoxia que dura más de varias horas.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES FUNCIÓN DE LA HEMOGLOBINA EN EL TRANSPORTE DE OXÍGENO - Co Comb mbin inaci ación ón de la hem hemogl oglob obina ina con el el CO (desp (desplaz lazam amie ient nto o de O2): -
El CO se un une e en en el el mis mismo mo si sititio o del del O2, desplazándolo desplazándolo.. Se une con una afi afinid nidad ad 250 vec veces es may mayor or que que el el O2, desplazando la curva a un nivel 1/250 de la curva para el oxígeno. oxígeno. El CO satura la Hb con una presión 1/250 de la PO 2 (0,4 mm Hg saturan 50% de la Hb; para el O 2, P50 = 27 mm Hg). Una P CO de 0,6 mm Hg es mortal.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES TRANSPORTE DE DIÓXIDO DE CARBONO (CO2) - Se tra transp nspor orta ta en en canti cantidad dades es mu mucho cho may mayor ores es que que el oxí oxíge geno no.. - El CO2 se transporta disuelto, como bicarbonato o en combinación c ombinación con hemoglobina y otras proteínas plasmáticas.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES TRANSPORTE DE DIÓXIDO DE CARBONO (CO2) - El CO2 como HCO3- (70%, 3,0 3,0 mL/100 mL/100 mL mL de sangre): sangre): -
-
En eritroci eritrocitos tos se form forma a ácido carbó carbónico nico por acción acción de la anhid anhidrasa rasa carb carbónica ónica (aum (aumenta enta veloci velocidad dad de + reacción 5000 veces), el cual se disocia en HCO 3 y H . La mayor pa parte del H+ se une a la Hb. El H + no unido acidifica la sangre. Gran pa parte del HC HCO3- difunde hacia el plasma, intercambiándose con Cl - (efec (efecto to Hamburg Hamburger er o de desplazamiento de cloruro). La inhibición de la anhidrasa carbónica aumenta aumenta la P CO2.
El CO2 combin combinado ado con hemoglobina hemoglobina y otras proteínas proteínas (23%, 1,0 mL/100 mL de sangre): -
Reacciona Reacc iona con radic radicales ales amino de la la Hb, Hb, formando formando carba carbaminomino-Hb. Hb. Es una una unión unión débi débill que que se rompe rompe
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES TRANSPORTE DE DIÓXIDO DE CARBONO (CO2) - Curva de de dis diso ocia iaci ción ón del CO CO2: -
En las las co cond ndici icion ones es fifisio sioló lógi gica cas, s, el CO CO 2 en sangre es aproximadamente 50 volúmenes por ciento (50% de saturación), aunque sólo se intercambian 4 volúmenes por ciento. Oscila entre 48 y 52%.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA RESPIRATORIA. TRANSPORTE DE GASES TRANSPORTE DE DIÓXIDO DE CARBONO (CO2) - Efecto Haldane: -
Cuando el O2 se une a la Hb, se libera CO2, aumentando el transporte de CO 2.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA FISIOLOG ÍA RESPIRATORIA. REGULACIÓN DE LA RESPIRACIÓN CENTRO RESPIRATORIO - La ven ventila tilación ción alv alveol eolar ar es es regula regulada da por por el el SNC, SNC, mante mantenien niendo do est estable abless la PO2, la PCO2 y el pH en sangre arterial.
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UNIVERSIDAD DE ORIENTE. NÚCLEO DE ANZOÁTEGUI ESCUELA DE CIENCIAS DE LA SALUD. DEPARTAMENTO DE CIENCIAS FISIOLÓGICAS ASIGNATURA FISIOLOGÍA
FISIOLOGÍA FISIOLOG ÍA RESPIRATORIA. REGULACIÓN DE LA RESPIRACIÓN CENTRO RESPIRATORIO. GRUPO RESPIRATORIO DORSAL (GRD) - Loca Localiz lizado ado en bulbo bulbo raquí raquídeo, deo, esen esencial cialmen mente te en el núcle núcleo o del del tracto tracto solit solitari ario o (NTS) y en algunas neuronas de la sustancia reticular adyacente.
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