Lez III Pressione Prima Parte Def
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Transcript of Lez III Pressione Prima Parte Def
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Sistema vascolare
E
caratteristiche del
circolo ematico
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Flusso:
Pressione
Resistenze
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PRESSIONE
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Pi = +/- 0.74 mmHg/cm
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Pressione
arteriosa
Pd + 1/3 differenziale 3-5 mmHg
Pressione
venosa
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120
80
Pressione differenziale
Ps - Pd
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>Resistenze
Periferiche
>Pd
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93
120
120
> GC
> R
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Determinazione
Pressione arteriosa
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SFIGMOMANOMETRI
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POLSI PERIFERICI
RADIALE
BRACHIALE
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POLSO CAROTIDEO
ANTERIORMENTE
MUSCOLO
STERNOCLEIDO-
MASTOIDEO -
SOTTO ANGOLO
MANDIBOLA NON PALPARE ENTRAMBE LE CAROTIDI
CONTEMPORANEAMENTE !!
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POLSI PERIFERICI
FEMORALE
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POLSI PERIFERICI
POPLITEO
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POLSI PERIFERICI
PEDIDIO
TIBIALE POSTERIORE
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IL POLSO FORNISCE
INFORMAZIONI SU:
> ENERGIA CONTRATTILE DEL MIOCARDIO
GITTATA SISTOLICA
>elasticità del vaso
> FREQUENZA E RITMICITA’ DEL CUORE
> VOLEMIA
PERVIETA’ DELL’ARTERIA
STATO ANATOMICO DEL VASO
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AMPIEZZA • Espansione dell’arteria in rapporto a gittata sistolica,
elasticità del vaso
180
mmHg
120
75
AMPIO
NORMALE
PICCOLO
FILIFORME
o ASSENTE
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POLSO DISEGUALE
Es. extrasistole
POLSO ALTERNANTE
Gravi miocardiopatie
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Velocità onda sfigmica
4m/s – 10 m/s
Velocità di flusso
15-20 cm/s
Onda
sfigmica
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Pressione
V
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Massa sanguigna
almeno uguale al contenitore
(albero circolatorio)
Variazioni da :
introduzione o perdita di liquidi
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V
Pressione
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-Accolgono massa
-Restituiscono forza elastica
per la propulsione durante
la diastole (flusso continuo)
Pompa intermittente e Continuità di flusso Pressione
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Pressione
R
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Compliance vascolare
R= 8 l /π r4
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R= 1/r4
Resistenza vascolare
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R = 1/r4
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Somma delle conduttanze
R= 8 l /π r4
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Resistenza vascolare
e pressione arteriosa
Regolatori di pressione
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REGOLAZIONE
DELLE RESISTENZE
SISTEMICHE E
DISTRETTUALI
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REGOLAZIONE
DELLE RESISTENZE
SISTEMICHE
Vasi di resistenza
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Centro bulbopontino
Ventrolaterale rostrale
Centro bulbopontino
Ventrolaterale caudale
ambiguo
_
+
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SNC
-Controllo
ormonale (catecolamine)
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Regolazione
sistemica
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REGOLAZIONE
DELLE RESISTENZE
DISTRETTUALI
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iperemia funzionale Regolazione distrettuale
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Acetilcolina agisce sull’endotelio come regolatore della muscolatura liscia vasale
Il meccanismo d’azione dell’NO
Ca2+
calmodulina Ca-calmodulina
ACh
NOS inattiva
NOS attiva
L-arginina
+ NO
NO GC
basale GC
attiva
GTP cGMP
rilassamento
cellula
endoteliale
cellula
m. liscia
Endothelial-Derived Relaxing Factor
= EDRF)
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Mecchanismi di regolazione vasomotoria
guanosina
ADH (V1)
Natriuretico
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Meccanismo della
risposta miogena
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Shear Stress
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endotelina
Ca++
trombossano
Guanina
guanosina
P1
H2 5-HT
(vasocostrittori)
NPY ENDOTELIO
MUSCOLO
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Pressione
distrettuale
Pd + 1/3 differenziale 3-5 mmHg
R= 8 l /π r4
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R= 8 l /π r4
Hagen-Poiseuille
F = π(P1-P2) r4/ 8 l
F = DP/Resistenza
FLUSSO
REGOLAZIONE FLUSSO EMATICO
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DP
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R= 8 l /π r4
F = π(P1-P2) r4/ 8 l
F = DP/Resistenza EFFETTO DELLA
RESISTENZA SUL
FLUSSO
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-Regola il flusso
F = π(P1-P2) r4/ 8 l
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F = π(P1-P2) r4/ 8 l
Resistenza al flusso
Dovuta alla viscosità
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Viscosità e diametro vascolare
> viscosità
< viscosità
> ematocrito
< ematocrito
Deformabilità , rotolamento e <viscosità nei capillari
>pH < viscosità Aumento deformabilità
F = π(P1-P2) r4/ 8 l
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LA VISCOSITÀ DEL SANGUE DIPENDE
DALLA
VELOCITÀ DI SCORRIMENTO
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Flusso laminare
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Modalità di flusso
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Variazione del
Flusso con
L’attività
fisica
13%
3%
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Le Resistenze al flusso nel sistema circolatorio dipendono
quindi da:
• Calibro dei vasi
• Tipo di scorrimento (laminare o turbolento)
• Viscosità del sangue
• Disposizione in serie e in parallelo
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