下列何者不屬於傳導區／呼吸區，有無軟骨:
bronchioles 細支氣管、terminal bronchioles 終末細支氣管無軟骨
The respiratory system also performs several other functions, including
1. participating in defense against pathogens 致病原 and foreign particles 外來顆粒 in the airways.
2. enhancing venous return (through the respiratory pump).
3. activating certain plasma proteins (e.g. angiotensin I) as they pass through the pulmonary circulation.
Nasal cavity 鼻腔
oral cavity 口腔
epigiottis 會厭；Giottis聲門
conducting zone： 傳遞，no exchange
respiratory zone： exchange
cartilage 軟骨(a dense connective tissue)固定conducting zone
Unlike the larger bronchi, bronchioles 細支氣管 have no cartilage and are thus capable of collapsing 塌陷：elastic fibers(有彈性)
呼吸區：呼吸性支氣管／肺泡，交換氣體
終末細支氣管(傳導區)接(呼吸區)呼吸性支氣管接肺泡
To keep food from entering the respiratory tract, the opening to the larynx, called the glottis 聲門, is covered by a flap of tissue 垂下的組織 called the epiglottis 會厭.
vocal cords (or vocal folds) 聲帶
C-shaped bands of cartilage (C型軟骨) provides structural rigidity for the trachea.
Goblet cells： mucus 黏液
1. coats the airways
2. traps foreign particles in inhaled air
Goblet cells and Cartilage 越往下越少
The alveolar wall contains type I alveolar cells, which make up the structure of the wall, and type II alveolar cells, which secrete surfactant 表面作用劑 & also found in alveoli are macrophage 巨噬細胞, which engulf foreign particles and pathogens inhaled into the lungs
surfactant 表面作用劑減少表面張力
什麼叫做respiratory membranes？
for gas exchange 有type I alveolar cells, 血管內皮細胞
Each lung is surrounded by a separate pleural sac 胸膜囊.
Intra-alveolar pressure (Palv) 肺泡內壓
Intrapleural pressure (Pip) 胸膜內壓
1. is the pressure inside the pleural space
2. is always negative & always < Palv
Pip是closed system，所以符合Boyle’s law，吸氣時胸腔擴大壓力變小
Common diseases that may cause spontaneous pneumothorax include pneumonia 肺炎 and emphysema 肺氣腫
何時大氣壓力=肺泡內壓？
兩者相同時代表無氣體進出，即吸氣或吐氣的起始和終止時
The diaphragm 橫膈肌 and the external intercostal muscles 外肋間肌 are the
primary inspiratory 吸氣 muscles, whereas the internal intercostals 內肋間肌and abdominal muscles 腹肌 are the primary expiratory 呼氣 muscles
Transpulmonary pressure (Palv – Pip)肺間壓=胸腔擴張的力量，準備吐氣吸飽氣時最大
Lung compliance is defined as the change volume (△V) that results from a given change in transpulmonary pressure [△(Palv – Pip)]
More elastic → less compliant 彈性愈大，順應性愈差（籃球彈性好但不好打氣）
Greater tension → less compliant 表面張力愈大，順應性愈差
typeII的surfactant 就是為了減少表面張力
Surfactant interferes with the hydrogen bonding 氫鍵 between water molecules → surfactant increases lung compliance and decreases the work of breathing
Compliance is decreased if lung tissue thickens, such as occurs with the formation of scar tissue in tuberculosis 肺結核, or if surfactant production is decreased, such as occurs in infant respiratory distress syndrome 新生兒呼吸窘迫症
Airway resistance can be increased in a number of pathological states, such as asthma 氣喘, chronic obstructive pulmonary diseases (COPD)慢性阻塞性肺臟疾病
Extrinsic control of bronchiole radius外因性
1. Autonomic nervous system
2. Epinephrine → relaxation of smooth muscle 平滑肌
Intrinsic control of bronchiole radius內因性
1. Histamine released during asthma 氣喘 and allergies 過敏→bronchoconstriction 支氣管收縮
2. Carbon dioxide 二氧化碳 →bronchodilation 支氣管擴張
Spirometry 肺計量測定法 is a technique for measuring the volumes of inspired and expired air using a device裝置 called spirometer 肺計量器
Resting tidal volume 靜態潮氣容積：普通吸氣
Inspiratory capacity 最大吸氣量：一次吸最大
Inspiratory reserve volume 吸氣儲備容積：Inspiratory capacity－ Resting tidal volume
Expiratory reserve volume 呼氣儲備容積：吐出來的
Residual volume肺餘容積無法測量，只能換算，所以功能肺餘量也量不到
Functional residual capacity 功能肺餘量=肺餘容積+呼氣儲備容積
chronic obstructive pulmonary disease (COPD) is largely preventable 可預防的 because it is most often associated with cigarette smoking.
Emphysema肺氣腫 is a permanent 永久性的 enlargement of airspaces in the respiratory zone accompanied by destruction of air walls
tissue destruction is a result of the action of proteases 蛋白水解酶, enzymes secreted by
macrophages 巨噬細胞 and other white blood cells 白血球細胞 during chronic inflammation 慢性發炎
Treatments for COPD include bronchodilators 支氣管擴張劑 (such as beta2 adrenergic receptor agonists) and anti-inflammatory drugs 消炎藥 (such as corticosteroids 類固醇)
低劑量類固醇才可以持續控制過敏
Obstructive Pulmonary Diseases： increase in resistance 呼吸道阻力增加
Restrictive Pulmonary Diseases： structural damage
Forced Vital Capacity (FVC) 強迫肺活量：maximum inspiration and then forcefully exhales 最大吸氣後用力呼出
forced expiratory volume (FEV)
(FEV1) 測量在第一秒內能被呼出的肺活量的百分比
The combined volume of these non-exchanging airways is referred to as the anatomical dead space 解剖死腔
因為有解剖死腔的關係，提高tidal volume比呼吸頻率效率高
呼吸商：消耗二氧化碳除以消耗氧氣
Dalton’s law 道耳吞定律：分壓相加
In air and in solution，雖然平衡時壓力一樣，但在空氣和液體的莫爾數不同
細胞內二氧化碳最高
whenever the respiratory membrane is effectively thickened 變厚, gas exchange is hampered 阻礙, such as pulmonary edema 肺水腫
right ventricle 右心室 into pulmonary artery 肺動脈
Hyperpnea 呼吸增強 = increased ventilation due to increased demand → minimal changes in arterial PO2 and PCO2
Hypoventilation 換氣不足 = ventilation does not meet demands arterial PO2 decreases & arterial PCO2
increases
Hyperventilation 換氣過度 = ventilation exceeds demands arterial PO2 increases & arterial PCO2 decreases
Hb contains of four subunits
4 globins 球蛋白(2 alpha & 2 beta)
4 heme 血基質 groups that contain iron (Fe2+) 鐵離子
Because respiring tissues need only about 250ml of O2 per minute.
only 25% of the O2 diffuses into respiring cells, while means that 75% of the binding sites on Hb are still occupied (75% saturated)只用¼的氧氣量
氧氣100mmHg時有98%結合率，但40mmHg時還有75%結合率
At least four other factors (temperature, pH, PCO2, and 2,3-DPG) affect the affinity of Hb for O2
Synthesis of 2,3-DPG is inhibited by oxyhemoglobin 氧合血紅素 & 2,3-DPG decreases affinity 降低親和力 of Hb for O2 enhancing O2 unloading 卸下無氧呼吸時，2,3-DPG促使血紅素將氧氣給組織
As metabolic of tissues increases, temperature increases → decrease Hb affinity for O2 → increases O2 unloading in tissue
Bohr effect 伯爾氏效應 when O2 binds to Hb, certain amino acids in the protein release hydrogen ions (H+)
Hb + O2 →←Hb.O2 + H+
記法：運動時H+多，親和力降低
運動時，溫度變高，二氧化碳變多，pH值下降，血紅素曲線往右，結合率變差。
Increased metabolic activity → increases CO2 → pushes the reaction to the right → HbCO2 changes Hb’s conformation and decreases its affinity for O2 → increases O2 unloading in active tissue→ carbamino effect 碳醯胺基效應
carbonic anhydrase (CA) 碳酸酐脫水酶，在血紅素裡面：促使CO2與水形成碳酸(H2CO3)
As HCO3-levels in RBC increases, HCO3- are transported into the plasma in exchange to chloride ions (Cl-) via a transport protein in the RBC plasma membrane → H+is buffered by binding to Hb
The couple movement of Cl into the RBC and HCO3-into the plasma is called chloride shift 氯移轉
HCO3-出來，Cl-進去，重要
氧氣親和力曲線右移親和力變差
Haldane effect：Increased PO2 in blood decreases the affinity of Hb for CO2, which decreases the ability of the blood to transport CO2
Haldane effect：氧氣越少，二氧化碳在血紅素運輸最多
氧氣太多的話二氧化碳無法在血紅素運輸，也就是那個組織看是氧還是二氧化碳多，血紅素就運送哪一個
In respiring tissues, where PO2 is low and PCO2 is high, the Haldane effect promotes the loading of CO2 onto Hb while both the Bohr effect (effect of pH on Hb’s affinity for O2) and the carbamino effect (effect of CO2 levels on Hb’s affinity for O2) work to promote O2 unloading
也就是那個組織看是氧還是二氧化碳多，血紅素就運送哪一個
alveolar ventilation depends on the frequency (RR 呼吸速率) and volume of breaths (VT 潮氣容積)
In quiet breathing 平靜呼吸, expiration is a passive process, and thus no neural or muscle activity of the expiratory muscles is present
During active ventilation 主動換氣, inspiratory neurons and muscles become more active, and
expiratory neurons and muscles become active.
Two respiratory control centers are located on each side of the medulla
- a ventrally located ventral respiratory group (VRG) 腹側呼吸群
- and a more dorsally located dorsal respiratory group (DRG) 背側呼吸群
The respiratory center of the pons 橋腦, called the pontine respiratory group 橋腦呼吸群 (PRG; pneumotaxic center 呼吸調節中心) → may facilitate the transition轉換 between in inspiration and expiration
Chemoreceptors detect blood levels of O2 and CO2 → relay 轉播 this information to the respiratory control centers
Peripheral chemoreceptors 週邊化學接受器 are located in the carotid bodies 頸動脈體 near the carotid sinus 頸動脈竇
The central chemoreceptors 中樞化學接受器 are located in the medulla oblongata 延腦
Peripheral chemoreceptors are respond to changes in PO2, PCO2 or pH ，主要是氫離子濃度
Central chemoreceptors are neurons in the medulla that respond directly to changes
in H+ concentration in the CSF 腦脊髓液 surrounding this area
中樞只看腦脊髓液的氫離子
H+ cannot cross the blood-brain barrier (BBB) 血腦障壁, but CO2 can.
CO2 does not affect the central chemoreceptors directly, but instead is converted to H+ and HCO3- by carbonic anhydrase (CA) in the CSF
透過二氧化碳態進入血腦障壁再透過CA溶解
Ventilation-perfusion ratios
The relationship of ventilation to perfusion is called the ventilation perfusion ratio and is abbreviated VA/Q in the normal lung, VA/Q is approximately 1 the PO2 and PCO2 of the alveoli are at the normal values of 100 and 40 mmHg
O2 acts primarily on the pulmonary arterioles 肺臟小動脈
a low PO2 causes a vasoconstriction 血管收縮 (Q下降)
CO2 acts primarily on the bronchioles 細支氣管
a high PCO2 causes bronchodilation 支氣管擴張 (VA上升)
acidosis 酸中毒 = blood pH < 7.35 CNS depression
– alkalosis 鹼中毒 = blood pH > 7.45 CNS over-excitation
[HCO3-] : [CO2] must be 20:1
Respiratory acidosis 呼吸性酸中毒 is an increase in the acidity of the blood due to increased CO2, which occurs, for example, during hypoventilation
Respiratory alkalosis 呼吸性鹼中毒 is decrease in the acidity of the blood due to decreased CO2, which occurs, for example, during hyperventilation or at high altitudes 高海拔
