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Respiratory System
He ho hap
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Chng 6. H H HP
I. CC HNH THC H HP
1. B mt h hp
2. Mang
3. ng kh
4. Phi
II. S TRAO I KH
1. S trao i kh phi
2. S trao i kh m
III. S IU HA H HP
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Ho hap ben ngoai
(ExternaI Respiration):
su trao doi kh xay ra
giua mau va cac phe
nang
Ho hap ben trong
(InternaI Respiration):
Su trao doi khong kh
xay ra giua dong mau
va cac te bao cua mo
Ho hap te bao (CeIIuIar Respiration): xay ra trong ty
the (Mitochondria) Ia phan ung bien duong su dung C
2
va phong thch CC
2
trong suot qua trnh tong hop ATP
Thuat ngu
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Su ho hap
Su ho hap Ia qua trnh dong vat trao
doi kh voi moi truong.
Ho hap gom su thu nha n C
2
, va n
chuyen va cung cap C
2
cho cac te
bao, su van chuye n va thai CC
2
.
Can phan biet va kho ng b| Ian Io n
giua su ho hap cua co the va qua
trnh ho hap te bao
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Cac hnh thuc cua ho hap
(a) Khong kh duoc khuech tan truc tiep qua be mat
cua cac sinh vat don bao.
(b) Luong cu va nhieu Ioai dong vat ho hap qua da cua
chung.
(c) Da gai co mot nhu nho ra, giup Iam gia tang be mat
ho hap.
(d)Ho hap o con trung thong qua he thong ong kh
thong ra ngoai.
(e) Mang cua ca cung cap mot be mat Ion va tao ra
dong nguoc de trao doi khong kh.
(f) Phe nang cua dong vat co vu cung cap mot be mat
Ion de ho hap, nhung khong cho phep trao doi dong
nguoc.
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Cac hnh thuc cua ho hap
2
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Cac hnh thuc cua ho hap
1. Be mat ho hap
C dong vat don bao va da bao bac thap
(giun dep nho) kh C
2
va CC
2
Ia su khuech
tan truc tiep qua mang te bao.
C giun dat va ech nhai, C
2
khuech tan qua
be mat am uot va vao trong cac mao mach
nam duoi da va CC
2
khuech tan theo chieu
nguoc Iai.
Toc do trao doi kh cham
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2. Mang
C moi truong nuoc co quan ho hap Ia
mang, qua trnh trao doi kh duoc thuc
hien khi nuoc duoc ep qua cac Ia mang.
Mang ca co dac die m Ia nuoc va dong
mau chay theo cac huong nguoc nhau do
do cai tien viec thu nhan C2.
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C dang sau khoang mieng, trong hau nuoc di qua bo ben
tren be mat trao doi khong kh cua mang, dong thoi mau
trong cac mang mao mach o mang chay theo huong
nguoc Iai goi Ia trao doi dong nguoc
Khong co dong nguoc ve Iy thuyet ca ch thu nhan duoc
50% oxy hoa tan trong nuoc, con voi trao doi dong
nguoc nhau mot vai Ioai ca co the thu nhan toi 85% oxy
hoa tan trong nuoc.
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3. Cng kh
Moi truong can o con trung Ia ong kh, cac
ong nay mo ra ngoai qua Io tho. Cac ong rong
chua day khong kh phan nhanh trong mot he
thong cac duong ong dan khong kh rat nho
xuyen sau vao trong co the dong vat.
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4. Phoi
C Iuong the - bo sat -
chim - thu Ia phoi.
Phoi khac nhau ve hnh
dang va cau truc: C
ech nhai phoi Ia nhung
tui nho, thanh nhan, be
mat tuong doi nho.
Bo sat co phoi phuc
tap hon, voi be mat
rong hon.
Chim va dong vat co
vu co nhieu phe nang
nho Iam tang dien tch
tiep xuc.
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Phoi cua Iuong cu
Ech nhai, ky giong va ca phoi co nhung
tui gio ng trai banh , thanh nhan voi be
mat tuong doi nho de trao doi kh
3
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Chim ho hap nhu the nao?
Chim c mt h thng ti khng kh c bit
lun lun chun b cho khng kh mi ti cc
ni trao i kh.iu ny gip cho con vt
mt lng ln O2 cn cho nhng chuyn bay
trn khong cch di, cao ln.
Hai phi chim tng i nh v c m xp
c. Tuy nhin n cn thm chn hay nhiu hn
ti khng kh rng ni vi phi v cha y
trong khoang c th. Nhng ti ny ging nh
nhng tri banh lm nh c th v lm ni d
tr cho khng kh s ti phi sau .
Khi chim ht vo, khng kh cc ti khng kh sau chuyn vo cc mch
khng kh rt nh ca phi l ni trao i kh. ng thi khng kh mi s
vo trong mm i qua kh qun v nu khng c s trao i O2 th khng kh
tp trung ch yu cc ti sau.
Trong khi ht vo mt s khng kh cn mi t cc ti sau i v pha trc v
vo cc mch khng kh nh trao i kh, khng kh di chuyn lin tc theo
mt hng c khi ht vo v th ra.
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Qua trnh ho hap cua chim gom hai
chu k.
Chu kh 1: Kh ht vao duoc
dan tha ng tu kh qua n ra cac
tui sau va sau do di de n phoi.
Chu k 2: Khong kh duoc da n
tu phoi ra cac tui khong kh
truoc va sau do duoc tho ra
ngoai thong qua kh quan.
ng i ca khng kh i qua phi lun lun theo mt hng,
t cc ti sau ra cc ti trc ri ra ngoi. Do s trao i O
2
v CO
2
xy ra cc mch khng kh nh ca phi c trong lc
ht vo v th ra.
Chim ho hap nhu the nao?
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Cac sac to ho hap
C
2
co do hoa tan thap trong
nuoc (~0,5 mI/100mI nuoc), do
do huyet tuong trong mau
khong the mang du C
2
thoa
man cho tong nhu cau cua cac
te bao trong co the, neu su trao
doi chat xay ra o muc cao. e
giai quyet van de nay cac sac
to ho hap dac biet chua trong
cac te bao mau. Nhung phan tu
nay Iien ket voi C
2
mot cach
thuan ngh|ch.
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HemogIobin
Van chuyen oxy
Hemocyanin: tm thay o huyet tuong
cua dong vat chan dot va than mem (Cu)
HemogIobin: C dong vat co xuong song (Fe)
Van chuyen carbon dioxid
Huyet thanh (T%)
HemogIobin (23%)
Bicarbonate ion (T0%)
MyogIobin: du tru oxy o co
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He ho hap o nguoi
Bao gom: Phoi(Iung) va mot he thong ong dan kh
ket noi cac cau truc trao doi kh voi moi truong ben
ngoai.
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Co quan ho hap o nguoi
He ho hap chia thanh hai phan
chnh:
Phan dan kh (conducting
portion) gom: khoang mui,
mui hong, thanh quan, kh
quan, phe quan, cac tieu phe
quan va tieu phe quan tan.
Phan ho hap (respiratory
portion) gom: cac tieu phe
quan ho hap, cac ong phe
nang va phe nang.
4
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Khoang mui
Khoang mui kha rong duoc cau tao bang
xuong va sun.
Khoang mui duoc Iot boi Iop mang nha y
co Iop thuong b o pha tren.
Ve mat chuc nang: vung tren co chu c
nang khuu giac, vung duoi co chuc nang
ho hap.
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{Lcu no ga tang)
{Lcu no dct tang)
{Lcu no dct tang)
Mui - hau (Nasopharynx)
Mieng - hau (Cropharynx)
Thanh quan - hau (Laryngopharynx)
Hau (pharynx)
Noi khoang mui va khoang mieng den thanh
quan (Iarynx) va thuc quan (esophagus). uoc
chia thanh ba doan:
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Thanh quan (Iarynx)
Hnh ong khong deu, noi hau voi kh quan.
Ben trong Iop dem co mot so sun thanh quan.
Cac sun Ion (sun giap, sun nhan va phan Ion
sun pheu) Ia mo sun trong; cac sun nho (nap
thanh thiet, sun chem, sun sung va chop sun
pheu) Ia mo sun dan hoi.
Ngoai vai tro nang do ( duy tr ong dan kh,
cac sun noi tren con co vai tro van ngan thuc
an hoac d|ch di vao kh quan, ngoai ra chung
con tham gia hoat dong phat am
Nap thanh thiet (EpigIottis): xuat phat tu bo
thanh quan, keo dai den hau.
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Thanh quan (Iarynx)
Niem mac Iot trong thanh quan co nhieu
tuyen chum tiet d|ch. Tren Iop te bao thuong
b, co Iong th|t Iam rung dong theo huong tu
ben trong ra ben ngoai de day cac vat Ia
khong cho roi vao kh quan.
Niem mac thanh quan rat nhay cam, khi co
vat Ia tiep xuc se gay ra cac phan xa ho de
day vat Ia ra ngoai.
Trong thanh quan co cac day am thanh. Phat
am Ia do khi tho ra, Iuong khong kh vuot
qua khe thanh mon Iam rung giay am thanh.
Su phat am con co su tham gia cua ma,
Iuoi, moi.
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Sun giap trang
Sun thanh quan
Sun kh quan
Nap thanh thiet
Mang
tuyen
giap
Day chang sun
thanh quan
Xuong
mong
Thanh quan
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Pha trong thanh quan
Nep gap tien dnh: nep gap cua niem mac
Cap nep gap o pha tren tao ra day thanh am gia
Cap nep gap o pha duoi tao nen day thanh am
that
Cac bo soi chun chay song song voi nhau
tao nen day chang am thanh nam ben trong
nep gap thanh am, co bieu mo Ia bieu mo Iat
tang khong sung
Thanh mon: day thanh am va khoang giua
cac nep gap
5
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Pha trong thanh quan
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Pha trong thanh quan
Xuong mong
Amidan
Nap thanh thiet
Day
thanh am
that
Khe thanh
mon
Thanh mon
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Thanh mon
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Kh quan
Tiep theo sun nhan cua thanh quan
Ia ong kh quan dai khoang 10 cm,
duong knh 2 cm, nam phai truoc
thuc quan. Lot trong kh quan Ia
mang nhay. Tren Iop te bao thuong
b cung co nhieu Iong rung dong de
quet ra ngoai d|ch nhay do cac
tuyen nhay tiet ra. Khi quan Ia mot
ong dai dan toi phoi
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Bieu mo tru gia
tang
Tang duoi
nhay voi cac
te bao tiet
dch loang
Sun trong
Kh quan
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Kh quan (Trachea)
Kh quan gom ba Iop
Nhay: duoc tao boi cac te bao hnh chen bieu
mo gia tru tang co Iong rung Duoi nhay: gom
cac mo Iien ket
Mo ngoai: Ia Iop ngoai cung, Ia sun trong co
dang hnh chu C
6
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Phe quan
Kh quan xuong den ngang dot song nguc IV-V
th chia doi thanh phe quan trai va phai.
Moi phe quan dai khoang 3 cm, phe quan trai
dai va hep hon phe quan phai. en ron phoi
phe quan phai Iai chia 3, chay vao 3 thuy
phoi. Phe quan trai chia 2, chay vao hai thuy
phoi.
C thuy phoi cac phe quan Iai phan nhanh nho
chay vao cac tieu thuy phoi goi Ia cac tieu phe
quan. Cac tieu phe quan Iai phan nhanh vao
cac phe nang
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Phe quan
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Bieu mo tru don
Bronchiole Histology
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Khi quan
Thanh quan
Phe quan cap l trai
Phe quan cap l phai
Phe quan
thuy
Phe quan
thuy
uong di cua
khong kh
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Phoi (Lung)
Gom hai Ia trai va phai. Phoi co hnh
chop, day rong va hoi Io m theo chieu
cong cua co hoanh, phan dnh hep va nho
Ien pha tren xuong don.
Hai Ia phoi mem, xop va dan hoi, Ia tap
hop cua cac phe nang va phe qua n. Moi Ia
phoi nang khoang 400g.
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Phoi
phai
tren
Phoi
phai
duoi
Phoi
trai
tren
Phoi
trai
duoi
T
a
c
h
x
i
e
n
T
a
c
h
n
g
a
n
g
T
a
c
h
x
i
e
n
V
e
t
k
h
u
y
e
t
nh
ay
Ron
phoi
Phoi phai co 3 thuy, phoi trai co 2 thuy
7
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La phoi trai be hon Ia phoi phai do cung
dong mach chu vong qua ben trai va tim
cung nam Iech va pha ben trai.
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Mang phoi
Moi Ia phoi duoc boc kn boi mot
mang so cap, phan nam sat mat phoi
goi Ia Ia tang, phan Iat mat trong cua
Iong nguc goi Ia Ia thanh.
Giua hai Ia Ia khoang gian mang,
trong khoang co chua cac d|ch Iam
tron, giam ma sat khi mang truot Ien
nhau trong cu dong ho hap
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Su phan nhanh cua cay phe quan
Kh quan
Phe quan cap I
Phe quan cap II
Phe quan cap III
Tieu phe quan
Phe quan tan
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Phe nang (BronchioIe)
Phe nang ho hap : uoc
pha n ra tu phe quan Ia
noi xay ra qua trnh trao
doi kh thong qua qua
trnh khuech tan don
gian.
Phe nang co duong knh
khoang 100 -300 m.
Hai phoi co khoang T00
trieu phe nang.
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Phe nang ho hap
Cng phe nang Tui phe nang
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Tui phe nang co cau truc gio ng nhu
chu m nho
Tui phe nang Phe nang
8
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uong di cua khong kh
Khi khong kh vao trong co the nguoi, no
duoc Ioc, Iam am va suoi am do cac bo phan
khac nhau cua duong ho hap. Lo mui, cho
mo cua mui dan vao trong mui duoc Iot bang
cac Iong nho. Nhung Iong nay hoat dong nhu
mot may Ioc ngan can nhung vat Ion trong
khong kh khoi Iot vao he ho hap. Khoang
mui suoi am, Iam am khong kh va thu thap
cac vat trong khong kh tren mot Iop nhay.
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Ht vao/Tho ra
Ht vao: Tang kch thuoc khoang nguc
Cac co tham gia ht vao
Cac co Iien suon ngoai (nang Iong nguc Ien)
Co hoanh (Diaphragm) (Tro nen bang)
Tho ra :Lam gia m kch thuoc khoang nguc
Cac co tham gia tho ra
Su tha Iong cua cac co tham gia vao qua trnh
ht vao (qua trnh thu dong)
Co Iien suon trong B cac co thuoc phan bung
ch duoc dung de tho ra
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Su tho
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Khi ht vao
The tch Iong nguc tang Ien theo ba chieu.
Chieu tren-duoi tang Ien nho co hoanh co. Khi
ht vao, the tch Iong nguc tang, bung phnh ra
do cac co quan trong bung b| don nen. Dien
tch co hoanh khoang 250 cm
2
. Co hoanh co
cung anh huong den xuong suon va xuong uc.
Khi ht vao theo nh|p bnh thuong, cac co
tham gia gom co: co suon, co bac thang, co
rang cua sau va tren.
Khi ht vao co suc, cac co tham gia gom co:
co uc - don - chum nang xuong uc, co rang
cua Ion, co nguc Ion, co nguc be
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Khi tho ra
Cac co ht vao gian ra, Iong nguc tro Iai the
ngh ngoi ban dau. The tch Iong nguc giam
Iam cho phoi xep xuong, day khong kh ra
ngoai. Su giam the tch phoi con do tnh dan
hoi cua chnh no.
Khi tho ra gang suc mot so co Iam ha thap
them xuong suon va day co hoanh Ien cao
hon. Cac co tham gia gom co: co rang cua be
truoc - sau, co tam giac cua xuong uc, co
vuong that Iung, cac co thanh bung nho co
treo to, treo be, co ngang, co thang to.
9
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Mang ho hap
La noi xay ra qua trnh trao doi kh
giua mau va khong kh, hay con goi Ia
hang rao khong kh - mau, co be day
khoang 0.2 - 2.0 m.
No Ia su ket hop cua phe nang va vach
mao mach (gom 3 Iop)
1. Bieu mo phe nang:
2. Mang day hop nhat
3. Bieu mo mao mach
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Mang ho hap
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Mang ho hap
Qua phe nang co tha nh mong C
2
duoc
pha n phoi vao mau va CC
2
duoc thai ra
khoi mau. Trong phe nang C
2
khuech ta n
toi mau trong mao ma ch, muon toi duoc
huyet tuong mau C
2
phai di qua:
Mot Iop chat d|ch mong co chua surfactant,
Iam giam suc cang be mat cua chat d|ch va
giup phe nang khong b| xep
Lop mong cua cac te bao bieu b phe nang
Te bao noi b cua thanh mao mach
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Su thong kh o phoi
Nh|p tho:
Nh|p tho (Ian/phut) cua nguoi Viet
Nam: Nam 16 3, nu 1T 3.
Nh|p tho thay doi theo trang thai
hoat dong. Nh|p tho nhanh thay do i
theo trang thai sinh Iy.
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The tch ho hap
Kh Iuu thong (TidaI VoIume TV)
The tch kh Iuu thong vao hoac ra khoi phoi trong
dieu kien tho bnh thuong o nguoi truong thanh
khoang 500 mL.
Kh du tru ht vao (Inspiratory Reserve VoIume IRV)
Sau mot Ian ht vao bnh thuong (chua tho ra) nguoi
truong thanh cung co the ht them co suc voi the
tch khoang 2500mL.
Kh du tru tho ra (Expiratory Reserve VoIume ERV)
Sau mot Ian tho ra bnh thuong (chua ht vao) nguoi
truong thanh cung co the tho ra them voi the tch
khoang 1500mL.
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The tch ho hap
The tch kh can (ResiduaI VoIume RV )
The tch kh ton dong trong phoi o moi thoi diem
Ia 1200 mL.
Dung tch song (VitaI Capacity VC)
La the tch kh Ion nhat duoc the ra sau khi co
gang ht vao het suc
VC = TV + IRV + ERV
Tong dung Iuong phoi (TotaI Lung Capacity TLC)
Tong the tch kh ma phoi co the chua.
TLC = VC + RV
T0
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Su trao doi kh o phoi va mo
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5,0-5,2 18-20 Kh trong mau roi phoi
5,5-5,T 10-12 Kh trong mau den phoi
6,2 T4,5 3,6 15,T Kh tho ra
6,2 T4,9 5,3 13,6 Kh phe nang
0,5
T8,6
2
0,04 20,84 Kh troi
H
2
C N
2
CC
2
C
2
T Ie phan tram cac Ioai kh o tung v| tr khac nhau
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Su trao doi kh o phoi
Su trao doi kh o phoi goi Ia ho ha p
ngoai. o Ia qua trnh trao doi kh o cac
phe nang va mau trong he thong mao
mach phan bo day dac tren ma ng cu a
cac phe nang do. Su trao doi kh nay
thuc hien theo nguyen tac khuech tan.
Chieu khuech tan phu thuoc vao a p
suat rieng phan cua ca c Ioai kh, chung
di tu noi co ap suat cao den noi co ap
suat thap hon
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Mot chat kh o the tu do hay hoa tan trong
mot chat d|ch deu co ap suat rieng goi Ia
phan ap, nong do kh cang dam th phan ap
cang cao.
Chat kh Iuon khuech tan toi noi co phan ap
cao sang noi co phan ap thap.
Trong khong kh den phe nang
PC
2
= 104 mmHg
PCC
2
= 40 mmHg
Trong mau den phoi
PC
2
= 40 mmHg
PCC
2
= 46 mmHg
Su chenh Iech ap suat rieng phan
PC
2
= 104 - 40 = 64 mmHg
PCC
2
= 46 - 40 = 4 mmHg
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Su trao doi kh o mo
Nho tim co bop, mau duoc chuyen den mo. C day Iai
xay ra su trao doi kh giua mau trong mao mach va mo.
Qua trnh trao doi cung theo nguyen tac khuech tan
dua vao su phan ap cua hai Ioai kh C
2
va CC
2
trong
mau va mo.
Cac phan ung sinh hoc xay ra can rat nhieu C
2
, dong
thoi thai ra ra t nhieu CC
2
, Iam cho phan ap kh C
2
giam
thap, ch con khoang 40 mmHg, con phan ap kh CC
2
dat toi 45 - 46 mmHg. Trong khi
Trong mau den cac mo
PC
2
= 102 mmHg
PCC
2
= 40 mmHg
Trong mo
PC
2
= 40 mmHg
PCC
2
= 46 mmHg
Do vay kh C
2
khuech tan tu mau vao mo va kh CC
2
khuech tan theo chieu nguoc Iai
TT
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Su trao doi kh o mo
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62
Su van chuyen C
2
va CC
2
Su van chuyen C
2
va CC
2
trong mau thong qua hai dang
Ia hoa tan va ket hop.
Dang hoa tan:
Kha nang hoa tan cua C
2
(2 - 3%)va CC
2
trong huyet
tuong Ia rat nho. Trong 100 mI mau co khoang 0,18 mI
C
2
va 0,2 mI CC
2
hoa tan.
Dang ket hop:
Cxy duoc van chuyen trong mau o dang ket hop voi
hemogIobin de tao thanh oxyhemogIobin (HbC
2
) (9T -
98%), 100 mI mau ket hop duoc 20 mI C
2
.
CC
2
co the ket hop voi H
2
C cua huyet tuong, voi H
2
C
cua hong cau, nhung quan trong nhat Ia ket hop voi
hemogIobin de tao thanh carboxyhemogIobin (HbCC
2
),
100 mI mau ket hop duoc 1,5 mI CC
2
.
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Chu ky tho theo nh|p bnh thuong
o nguoi Ia tu dong. Nhung co mot
co che dieu hoa chu ky do.
Su dieu hoa ho hap
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64
Cac trung khu ho hap
Trung khu o tuy song:
Sung xam tuy song cua dot co 3-4 phat cac day dieu
khien co hoanh.
Sung xam tuy song o doan nguc phat cac day dieu
khien co Iien suon
Trung khu o hanh tuy va cau VaroI
co 4 trung khu ho hap:
Trung khu ht vao va tho ra nam o day cua nao that
thu 4, ben canh phan but Iong cua hanh tuy
Trung khu dieu hoa ho hap nam o cau VaroI
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65
Su dieu hoa the d|ch
Su dieu hoa the d|ch doi voi ho hap chu
yeu thong qua ap suat rieng phan cua C2
va CC
2
.
Co che nay dieu hoa thong qua cac te
bao thu cam hoa hoc tai cung dong mach
chu, xoang dong mach canh va trong
hanh tuy co trung tam nhay cam hoa hoc
tiep nhan cac xung tu cac te bao thu cam
hoa hoc ve.
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Bnh thuong cac te bao ht vao cua trung khu
ho hap hung phan mot cach tu dong, cac xung
tu day gui xuong tuy song kch thch cac co
ht vao, gay ra tac dong ht vao.
ong thoi gui den trung khu tho ra va trung
khu pneumotaxic o cau VaroI. Phoi cang Ien
va kch thch cac thu quan nam trong phoi, tu
day cac xung huong tam theo day so X ve
trung khu tho ra.
Vai tro cua than kinh phe v|
T2
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67
Vai tro cua than kinh phe v|
Khi tiep nhan xung cua trung khu ht
vao, trung khu tho ra chuyen da n sang
trang thai hung phan, den khi nhan
tiep xung tu phoi th trung khu tho ra
duoc hung phan hoan toan va gay ra
tac dong tho ra. ong thoi cung goi
xung sang trung khu ht vao de uc
che. ong tac ht vao cham dut.
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Cac yeu to khac anh huong
den ho hap
Huyet ap: Khi huyet ap tang th ho hap giam va nguoc
Iai.
Cam giac dau: co the gay ra tho nhanh, tho cham hoac
ngung tho phu thuoc vao tnh chat, cuong do, nguyen
nhan, thoi gian cua cam giac dau.
Nhiet do: nhiet do cao gay tho nhanh. Lanh dot ngot
Iam ngung tho mot thoi gian ngan roi sau do tho nhanh
mot thoi gian.
Ho va hat hoi: mang nhay kh quan, phe quan b| kch
thch Iam day manh khong kh ra ngoai Iuc thanh quan
dang dong Iai gay ra phan xa ho. Khi mang nhay khoang
mui b| kch thch, se gay phan xa co phe quan, ht vao
sau va cham nhung tiep ngay sau Ia dong tac tho ra
nhanh va manh gay ra phan xa hat hoi
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Mo phoi nguoi bnh thuong
Mo phoi nguoi hut thuoc Ia