呼吸科呼吸系統(tǒng)3

1、5.3. Gas transport,Oxygen is transported by the blood in both physically dissolved and hemoglobin-bond forms.Carbon monoxide binds the same site on hemoglobin as oxygen does and is dangerous to life.Carbon dioxide (CO2

2、) is transported in three forms: physically dissolved, bicarbonate, and carbaminohemoglobin,2024/3/20,1,Oxygen Transport in the Blood,2024/3/20,2,2024/3/20,3,Hemoglobin (Hb),Each Hb molecule consists of four globular pro

3、tein (globin, 珠蛋白) subunits. Each subunit is composed of a protein chain tightly associated with a non-protein heme（血紅素） group. Oxygen binds to iron (Fe2+) on heme.,,Two Forms of Oxygen Exist in the Blood,Physically di

4、ssolved: 2%Dissolved O2 (ml/dL) = 0.003 (ml/dL/mmHg) X Pa O2 (mmHg)Combined with Hb: 98%Both physically dissolved and chemically bond are important.Oxyhemoglobin (HbO2): Hemoglobin binds to oxygen.Deoxyhemoglobin (

5、Hb): Hemoglobin that does not bind with oxygen.,2024/3/20,4,Oxygen Binds to Hemoglobin,The binding of oxygen to hemoglobin is reversible and very quick.The reaction of this biding is oxygenation but not oxidation (ferro

6、us remains as ferrous).Each hemoglobin molecule can bind four oxygen molecules.Each gram of hemoglobin can bind up 1.34~1.39 ml of O2 (depending on methemoglobin levels).,2024/3/20,5,Positive Cooperativity,Changes in t

7、he affinity of hemoglobin as each successive O2 molecule binds to a heme site.Binding of the first O2 molecule increases the affinity for the second O2 molecule, and so forth.The affinity for the forth O2 molecule is

8、 the highest.This change in affinity facilitates the loading of O2 in the lungs and the unloading of the O2 at the tissues.,2024/3/20,6,Quantitative Description of O2 Binding to Hb,Oxygen capacity is the maximum of oxy

9、gen that hemoglobin can carry per 100 ml blood .Hb-bound oxygen content is the amount of oxygen actually carried by hemoglobin per100 ml blood.Oxygen saturation (SO2) is the percentage saturation of hemoglobin with

10、oxygen that is calculated from the ratio of oxygen content over capacity.The relationship between and PO2 and SO2 (or oxygen content) is oxyhemoglobin equilibrium curve (oxygen dissociation curve).,2024/3/20,7,Oxygen

11、Dissociation Curve,2024/3/20,8,Analysis of Oxygen Dissociation Curve,When PaO2 is increased from 60 and 100 mmHg, SaO2 rises only by 7%. The clinical significance of the flat portion of oxygen dissociation curve is that

12、a drop PO2 from 100 to 60 mmHg still results in hemoglobin saturation of 90%.Rising PaO2 above 100 mmHg barely affects oxygen content.In the steep portion of this curve, blood oxygen content and thus oxygen delivery

13、to tissues are compromised upon PO2 falls below 60 mmHg. The significance of this portion of the curve is that a large amount of O2 is released from hemoglobin with a small change in PO2.,2024/3/20,9,Changes in Blood C

14、hemistry Alter Hemoglobin’s Affinity for O2,2024/3/20,10,To rememberJust think that an exercising muscle is hot and acidic and produces large amount of carbon dioxide, all of which favor the unloading of more oxygen to

15、the metabolic needs of muscles,DPG = 2,3-diphosphoglycerate,Bohr Effect,Bohr effect (after the Danish physiologist, Christin Bohr) refers to the effect of CO2 on the affinity of hemoglobin on oxygen.Increased CO2 shifts

16、 the oxyhemoglobin dissociation curve to the right, promoting oxygen release. Bohr effect is caused in part by the change in pH that occurs as CO2 increases.,2024/3/20,11,P50 Indicates the Binding Activity of Hemoglobin

17、 for O2,The PO2 value at which 50% of hemoglobin is saturated.The normal range is between 26 and 28 mmHg in arterial blood.High P50 allows more O2 to be released.,2024/3/20,12,Carbon Monoxide Poisoning,2024/3/20,13,P

18、roperties of Carbon Dioxide,2024/3/20,14,CO is an odorless, colorless, and non-irritating gas; it is virtually undetectableCO is produced by incomplete combustionWith enough O2, CO2 is generatedWith less O2, CO is ge

19、nerated,Carbon Monoxide Binds to the Site of Hb as Oxygen Does,2024/3/20,15,It binds to Hb at the same site as oxygen does, forming carboxyhemoglobin (HgbCO) and preventing O2 binding. The binding affinity for CO is 20

20、0-250 times as that for oxygen.,Carbon Monoxide-Hemoglobin Dissociation Curve,2024/3/20,16,Carbon Monoxide Reduces O2 Content,2024/3/20,17,2024/3/20,17,Higher Concentration of Carboxyhemoglobin in Cigarette Smokers,In he

21、althy individuals, carboxyhemoglobin occupies 1~2% of the Hb binding sitesIn people who smoke cigarettes, occupation of Hb binding sites can be increased up to 10%

22、 Stop smoking,2024/3/20,18,,No Hyperventilation Response to Carbon Monoxide Poisoning,Because arterial PO2 is normal, no feedback mechanism to warn that the oxygen content is low, so people with CO poisoning will die pea

23、cefully,2024/3/20,19,Treatments of Carbon Monoxide Poisoning,The appropriate treatment is the administration of pure oxygenHigh CO2 (5%) is helpful in stimulating respiration and consequently promoting the removal of C

24、O from the blood,2024/3/20,20,Carbon Dioxide Transport,2024/3/20,21,The Source and Forms of Carbon Dioxide,2024/3/20,22,Carbon Dioxide Transport,Carbon dioxide is carried in the blood in three distinct forms:Physically

25、dissolved in the plasma (10%)As bicarbonate ions in the plasma and in the red cells (60%)As carbamino proteins (30%),2024/3/20,23,Formation of Bicarbonate and Bicarbonate Ions,2024/3/20,24,HCO3- moves out of RBC in exc

26、hange for chloride,Chloride shift,Carbaminohemoglobin Formation,Carbon dioxide molecule reversibly attaches to an amino portion of hemoglobin to form carbaminohemoglobin（氨基甲酰血紅蛋白）,2024/3/20,25,CO2 Dissociation Curve and

27、the Haldane Effect,2024/3/20,26,The Relationship among O2, CO2 and H+,Bohr Effect The effect of PCO2 and H+ on the affinity of hemoglobin on oxygen (or the oxygen-hemoglobin equilibrium curve).Haldane EffectFor any g

28、iven PCO2, the blood will hold more CO2 when the PO2 is being reduced.,2024/3/20,27,The Haldane Effect,For any given PCO2, the blood will hold more CO2 when the PO2 is being diminished.The effect is reversed in the lun

29、g when O2 is transported from the alveoli to the red blood cells.,2024/3/20,28,Summaries on Gas Exchange and Gas Transport,The uptake of oxygen is determined by the diffusion properties of the alveolar-capillary membrane

30、, the oxygen partial pressure gradient, and pulmonary capillary blood flow.Oxygen is transferred by the blood in two forms: dissolved and oxyhemoglobin.Oxygen dissociation curve is the functional relationship between o

31、xygen partial pressure and the percentage of hemoglobin saturated with oxygen.P50 is a measure of Hb affinity to bind with oxygen. Hb affinity is inversely related to P50.Changes in blood chemistry (pH, PaCO2, and temp

32、erature) and 2.3, DPG alter the oxygen dissociation curve.,2024/3/20,29,Summaries on Gas Exchange and Gas Transport-Continued,As a product of non-complete combustion, CO is dangerous to life. It binds to Hb in a competi

33、tive manner.The binding affinity for Hb is 250 times higher than that of oxygen’s.PaO2 is normal, so there is lack of feedback mechanism to indicate that oxygen content is low.The appropriate treatment is the administ

34、ration of high concentration of oxygen; high CO2 may be helpful in the case of spontaneous breathing is still existed.,2024/3/20,30,Summary on Oxygen Transport,Oxygen is transported by the blood in two forms: oxyhemoglob

35、in and physically dissolved.The relationship between oxygen partial pressure and the saturation of hemoglobin is the oxygen dissociation curve.Changes in blood chemistry (pH, PaCO2, temperature and 2.3-DPG) alter oxy

36、hemoglobin equilibrium curve.P50 is a measure of Hb affinity to bind oxygen. When Hb affinity increases, the P50 changes in the opposite direction.,2024/3/20,31,Summary on Carbon Monoxide,As a product of non-complete b

37、urn, CO is odorless, colorless, and non-irritating gas; it is virtually undetectable.It binds to Hb at the same site as oxygen does.The binding affinity for Hb is 210 times as that of oxygen’s.PaO2 is normal, so the

38、re is lack of feedback mechanism to indicate that oxygen content is low.The appropriate treatment is the administration of high concentration of oxygen; high CO2 may be helpful in the case of spontaneous breathing is s

39、till existed.,2024/3/20,32,Summary on Gas Transport-Carbon Dioxide,Carbon dioxide is transported in three distinct forms: Dissolved (10%)Bicarbonate in the plasma and in the red cells (60%)Hemoglobin (carbamino protei