제6장 호흡기계의 구조와 기능

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부산가톨릭대학교 물리치료학과 김 난 수

제6장 호흡기계의 구조와 기능

(Anatomy and Physiology of Respiratory system)

심 호 흡 계 물 리 치 료

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호흡(Respiration)

• 외호흡(external respiration) : gas exchange, lungs

& blood

- 폐환기(Pulmonary ventilation)—inspiration and expiration

- 폐확산(Pulmonary diffusion)—exchange of oxygen and carbon dioxide between the lungs and the blood

• 내호흡(internal respiration) :gas exchange, blood &

tissues

- 산소의 세포내 대사과정(metabolic process)

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pump-handle movement

bucket-handle movement

1. 호흡기계의 뼈대 - 갈비뼈들의 움직임

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Figure 1.9. Movements of thoracic wall. A. When the upper ribs are elevated, the AP dimension of the thorax is increased (pump- handle movement), with a greater excursion (increase) occurring inferiorly, at the end of the pump handle. B. The middle parts of the lower ribs move laterally when they are elevated, increasing the transverse dimension (bucket-handle movement). C. The

combination of rib movements (arrows) that occur during forced inspiration increase the AP and transverse dimensions of the

thoracic cage. D. The thorax widens during forced inspiration as the ribs are elevated (arrows). E. The thorax narrows during

expiration as the ribs are depressed (arrows). F. The primary

movement of inspiration (resting or forced) is contraction of the diaphragm, which increases the vertical dimension of the thoracic cavity (arrows). When the diaphragm relaxes, decompression of the abdominal viscera pushes the diaphragm upward, reducing the vertical dimension for expiration.

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2. 호흡기계의 근육

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호흡역학(Mechanics of Respiration) 흡식에 필요한 근육 : diaphragm

external intercostal muscle 호식에 필요한 근육 : internal intercostal muscle abdominal rectus

흡식을 방해하는 인자 : recoil force (lung tissue, thoracic cage) airway resistance

표면활성제(Surfactant) : 표면장력을 줄여주는 역할

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가슴막(pleurual membrane)과 가슴막안(pleural cavity)

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흡식과 호식 (INSPIRATION AND EXPIRATION)

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호흡(Respiration)

Upper respiratory system:

Nose

Pharynx

Lower respiratory system:

Larynx Trachea

Bronchi (1 ,2 ,3 ,bronchioles,14X, terminal bronchioles) Lungs (respiratory bronchioles, alveolar ducts & sacs)

Larynx

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THE RESPIRATORY SYSTEM

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무효공간 (dead space)

호흡공간

(respiratory zone)

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혈중 PO

₂

와 PCO

₂

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폐용적과 용량 (Pulmonary volumes & capacities)

폐용적(lung volumes)

① 일회호흡량(tidal volume:TV) – 500ml

② 흡식예비용적(inspiratory reserve volume:IRV) – 3,300ml

③ 호식예비용적(expiratory reserve volume:ERV) – 1,000ml

④ 잔기용적(residual volume:RV) – 1,200ml (cf.사강 – 150ml)

폐용량(lung capacities)

① 흡식용량 (inspiratory capacities) – TV + IRV

② 기능적 잔기량(functional residual capacity) – ERV + RV

③ 폐활량(vital capacity) – IRV + TV + ERV

④ 총폐활량(total lung capacity) – IRV + TV + ERV +RV

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숨뇌

들숨중추/날숨중추

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근육의 동정맥산소차( a-vO- ₂ DIFF ACROSS THE MUSCLE)

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V/Q =1

V/Q =∞

V/Q =0

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DPG(2,3-disphosphoglycerate): 2,3-DPG는 적혈구 속에 다량으로 존재하는 물질로 해당과정산물인 2,3-phosphoglyceraldehyde에서 생성됨. 헤모글로빈내의 사슬 사이의 이온 결합력을 약화 시켜 산소 해리를 촉진

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Reference

• 심장호흡계 물리치료 중재학. 대한심장호흡물리치료학 회. 범문에듀케이션. 2014

• 김경 외. 심장호흡물리치료. 정담미디어. 2013

• 심폐물리치료학. 이석민 외. 현문사. 2014

• https://www.wikidoc.org/index.php/Respiratory_exa mination

• http://www.radiationoncology.ca/ascm/physical_exa mination/ascm1/Respiratory/teaching_points.htm

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