[Professional title exam] Key points you can't miss Advanced Anesthesiology Course Anesthesia and Respiratory System (1)

AUTUMN Chapter VII Anesthesia and Respiratory System (1) by Chen Lingjun AUTUMN Section 1, Anatomy of the Respiratory System 1.
Airway 1.
With the lower border of the cricoid cartilage as the boundary, the upper and lower airways are divided
.

2.
The trachea is between T5/6 and the sternal angle bifurcates into the left and right bronchi
.

The right bronchus is 2.
5-3cm long, and the left bronchus is 4-5cm long
.

In children under 3 years old, the angle between the left and right bronchi and the trachea is basically the same
.

The second section of AUTUMN, the ventilation of the lungs, the compliance of the chest and the lungs: the change of the gas volume in the lung caused by the unit pressure change is called lung-thoracic compliance
.

1.
The influencing factors of static compliance: the elasticity of lung tissue; the influencing factors of dynamic compliance: airway resistance
.

2.
Factors that reduce compliance: ① Increased residual capacity, such as emphysema or asthma; ② Lung tissue consolidation or chest wall deformity; ③ prone position; ④ General anesthesia; ⑤ Laparotomy and thoracotomy
.

2.
Alveolar surface tension and alveolar surfactant 1.
Alveolar surfactant has the effect of reducing alveolar surface tension
.

2.
The intra-alveolar pressure is inversely proportional to the alveolar radius and proportional to the surface tension
.

3.
Factors affecting the abnormal production of pulmonary surfactant: ①Congenital deficiency ②Reduced pulmonary blood flow ③Inhalation anesthetics ④Acute pancreatitis ⑤Smoking and COPD patients
.

AUTUMN Section III, Pulmonary Circulation Physiology The pulmonary circulation is a low-pressure system, and the mean pulmonary artery pressure is only 1/6-1/5 of the aorta
.

AUTUMN Section IV, Lung Volume and Pulmonary Function Test 1.
Parameters and their significance 1.
Tidal volume: male: 350-550ml, female: 260-540ml, pediatric: 6-8ml/kg
.

2.
Residual capacity RV and functional residual capacity FRC are the most reliable indicators for judging obstructive pulmonary disease
.

Normal RV/TLC <35%
.

3.
The maximum spontaneous ventilation volume MVV: refers to the maximum gas volume that the human body can breathe in 1 minute
.

Generally, MVV40L or MVV accounting for 50%-60% of the predicted value is used as the surgical safety index, and if it is less than 50%, it means low lung function; if it is less than 30%, surgery is contraindicated
.

4.
Forced vital capacity (FVC), also known as time vital capacity, refers to the volume of air that can be inhaled as much as possible, exhaled as soon as possible, and exhaled as much as possible
.

5.
Maximum mid-expiratory flow rate MMFR: The expiratory flow rate has nothing to do with the force, and reflects the elastic recoil force of the alveoli and airway resistance
.

2.
Alveolar ventilation and dead space volume 1.
Physiological dead space = anatomical dead space + alveolar dead space 2.
The ratio of dead space/tidal volume (VD/VT) in healthy adults is less than 0.
33.
Use a mask to breathe.
The cavity is a mechanically dead cavity
.

Section 5 of AUTUMN, gas exchange 1, gas distribution in the lung and closed volume 1, gas distribution in the alveoli: the ventilation distribution in the lower lung is more than that in the upper lung
.

2.
Closing volume: refers to the volume of air exhaled after the small bronchi at the bottom of the lung begin to close
.

Sensitive indicator for early detection of small airway obstruction lesions
.

The closed volume plus the residual volume is called the closed volume
.

2.
Lung ventilation and the causes of hypoxemia 1.
V/Q ratio of ventilation to blood flow: in the upright position of normal people, the ventilation blood flow in the upper part of the lung is less; in the lower part of the lung, the ventilation blood flow is more acceptable, and Blood flow is still proportionally high
.

The total V/Q ratio of normal people is 0.
8
.

2.
Intrapulmonary shunt: Intrapulmonary blood flow is directly mixed with oxygenated and arterialized blood without oxygenation, resulting in a decrease in blood oxygen
.

Including airway obstruction, pneumonia, atelectasis, pulmonary edema,
etc.

3.
Intrapulmonary diffusion: The gas exchange between the alveoli and blood depends on the gas partial pressure difference, the pulmonary blood flow velocity, the thickness of the alveolar-pulmonary capillary wall, the total alveolar area and the gas diffusing capacity
.

During anesthesia, carbon dioxide accumulation is more common than hypoxia
.

4.
Causes of hypoxia and hypoxemia: V/Q ratio imbalance; increased right-to-left shunt in the lung; oxygen diffusion disorder; pulmonary hypoventilation
.

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