Ventilation Perfusion
$NXVWLVFKH,PSHGDQ]
-HGH6FKDOOZHOOHEHUWUlJWLKUH6FKZLQJXQJVHQHUJLHDXIGLH8PJHEXQJJOHLFK]HLWLJ KDW DEHU DXFK MHGH 0DVVH GDV %HVWUHEHQ LQ HLQHP GHILQLHUWHQ =XVWDQG 5XKH]X VWDQG ]X YHUEOHLEHQ XQG GHU bQGHUXQJ GLHVHV =XVWDQGHV HLQHQ :LGHUVWDQG HQWJH JHQ]XVHW]HQ'LHVH6FKDOOGXUFKOlVVLJNHLWHLQHV0HGLXPVLVWFKDUDNWHULVWLVFKIUMHGHV
*HZHEH7DEXQGZLUGDOVDNXVWLVFKH,PSHGDQ]EH]HLFKQHW:(66(/6X:(%(5 'LHDNXVWLVFKH,PSHGDQ]HUJLEWVLFKDXVGHU*HVFKZLQGLJNHLWGHU6FKDOOZHOOH XQGGHU'LFKWHGHV0HGLXPV= YρY 6FKDOOJHVFKZLQGLJNHLW>PV@ρ 'LFKWH
>NJP@
$QGHU*UHQ]IOlFKH]ZLVFKHQ]ZHL*HZHEHQPLWXQWHUVFKLHGOLFKHUDNXVWLVFKHU,PSH GDQ] ZLUG HLQ 7HLO GHU 6FKDOOZHOOHQ UHIOHNWLHUW 6ROFKH )OlFKHQ EH]HLFKQHW PDQ DOV DNXVWLVFKH*UHQ]IOlFKHQ)/h&.,*(5/LHJWHLQJURHU,PSHGDQ]XQWHUVFKLHG YRU ZHUGHQ 6FKDOOZHOOHQ IDVW JlQ]OLFK UHIOHNWLHUW %HL JHULQJHP ,PSHGDQ]ZHFKVHO ZLUGGDJHJHQHLQJURHU7HLOGHU6FKDOOZHOOHQLQWLHIHUHV*HZHEHZHLWHUJHOHLWHW/LHJW GLH *UHQ]IOlFKH LP :LQNHO ]X GHQ 6FKDOOZHOOHQ NHKUHQ GLHVH RKQH $EOHQNXQJ ]XP6FKDOONRSI]XUFNEHLDQGHUHQ$XIWUHIIZLQNHOQHQWVWHKHQ6WUHXHFKRV'LH*U|H
GHU ,PSHGDQ]XQWHUVFKLHGH XQG GHU $XIWUHIIZLQNHO EHVWLPPHQ VRPLW GLH 6WlUNH GHV (FKRV%$55
7DE %HLVSLHOH GHU DNXVWLVFKHQ ,PSHGDQ] YHUVFKLHGHQHU *HZHEH (%(563b&+(5
0HGLXP $NXVWLVFKH ,P SHGDQ]
>NJPðV@
)HWW
%OXW 0XVNHO .QRFKHQ /XIW
)OVVLJNHLWHQHU]HXJHQNDXP6FKDOOHFKRVGDVLHRKQH(QHUJLHYHUOXVWGXUFKGUXQJHQ ZHUGHQ /XIW UHIOHNWLHUW GHQ 6FKDOOVWUDKO IDVW YROOVWlQGLJ ZlKUHQG PLQHUDOLVLHUWH 6WUXNWXUHQ ZLH .QRFKHQ GHQ 6FKDOOVWUDKO DEVRUELHUHQ 2UJDQH KLQWHU OXIWKDOWLJHP RGHUPLQHUDOLVLHUWHP*HZHEHN|QQHQVRPLWQLFKWGDUJHVWHOOWZHUGHQZHLOVLHLPVR JHQDQQWHQ6FKDOOVFKDWWHQOLHJHQ)/h&.,*(5
,Q$EKlQJLJNHLWYRQGHU6WUXNWXUGHVEHWUHIIHQGHQ*HZHEHVZLUGHLQPHKURGHUZH QLJHUJURHU$QWHLOGHU6FKDOOZHOOHQUHIOHNWLHUWKRPRJHQH)OVVLJNHLWHQ]HLJHQVLFK DXIGHP%LOGVFKLUPDOVKRPRJHQHVFKZDU]H)OlFKHHFKRIUHLDQHFKRLVFK=HOOUHLFKH )OVVLJNHLWHQ $EV]HVVH /\PSKNQRWHQ XQG 1LHUHQPDUN VWHOOHQ VLFK DOV GXQNHOJUDXH )OlFKHPLWZHQLJHQVFKZDFKHQ(FKRVHFKRDUPK\SHFKRLVFKSDUHQFK\PDW|VH2U JDQHZLH0LO]/HEHUXQG1LHUHQULQGHDOVPLWWHOJUDXH%LOGIOlFKHPLWWHOJUDGLJHFKRJHQ
LVRHFKRLVFK XQG .QRFKHQ XQG GLFKWHV %LQGHJHZHEH DOV KHOOHV JUDXHV ELV ZHLHV (FKRELOGHFKRUHLFKK\SHUHFKRLVFKGDU+RPRJHQVLQGJOHLFKPlLJ VFKDWWLHUWH )Ol FKHQGXUFKJOHLFKPlLJH9HUWHLOXQJGHU(FKRVXQUHJHOPlLJH(FKRYHUWHLOXQJLQ*H ZHEHVWUXNWXUHQ XQG )OVVLJNHLWHQ PLW XQUHJHOPlLJ YHUWHLOWHQ NRUSXVNXOlUHQ (OH PHQWHQ RGHU 'LFKWHXQWHUVFKLHGHQ EH]HLFKQHW PDQ DOV LQKRPRJHQ )5,76&+ X
*(5:,1*)/h&.,*(5
8OWUDVFKDOOIHOG
'LH $XVELOGXQJ GHV 6FKDOOIHOGHV ZLUG DXFK DOV 6FKDOOIHOGJHRPHWULH EH]HLFKQHW :(66(/6 X :(%(5 8QPLWWHOEDU QDFK GHP $XVWUHWHQ DXV GHP 6FKDOONRSI EUHLWHQVLFKGLH6FKDOOZHOOHQLQHLQHP%HUHLFKDXVZHOFKHUGHU*U|HGHV6FKDOONRS IHV ZHLWJHKHQG HQWVSULFKW 1DKIHOG 'LH %HJUHQ]XQJ GLHVHV 1DKIHOGHV EHUHFKQHW VLFKDXVGHP'XUFKPHVVHUGHV6FKDOONRSIHVXQGGHU)UHTXHQ]+LQWHUGHP1DKIHOG EHJLQQWGHU6WUDKO]XGLYHUJLHUHQGLHVHU%HUHLFKZLUGDOV)HUQIHOGEH]HLFKQHW$EE 0(,(5
$EE 6FKHPDWLVFKH'DUVWHOOXQJGHV8OWUDVFKDOOIHOGHVPLW1DKXQG)HUQIHOG EHUHLFKD'XUFKPHVVHUGHV6FKZLQJHUVG1DKIHOGα gIIQXQJV ZLQNHOGHV)HUQIHOGHV:(66(/6X:(%(5
1DKIHOG )HUQIHOG
G
,P 1DKIHOG VLQG GLH 6FKDOOZHOOHQ SDUDOOHO JHEQGHOW DEHU HV NRPPW ]X JURHQ 6FKDOOGUXFNVFKZDQNXQJHQ 'LHVH IKUHQ GD]X GD *UHQ]IOlFKHQ PLW LGHQWLVFKHP :HOOHQZLGHUVWDQGLQJOHLFKHU(QWIHUQXQJ]XP6FKDOONRSIDQYHUVFKLHGHQHQ2UWHQGHV 6FKDOOIHOGHVXQWHUVFKLHGOLFKH(FKRDPSOLWXGHQDXIZHLVHQ(QWVSUHFKHQGLVW GDV 1DK IHOGIU$XVVDJHQEHUGHQ*HZHEH]XVWDQGXQJHHLJQHW:(66(/6X:(%(5
$XIO|VXQJVYHUP|JHQXQG(LQGULQJWLHIH
8QWHUGHP$XIO|VXQJVYHUP|JHQYHUVWHKWPDQGLH)lKLJNHLWUlXPOLFKEHQDFKEDUWH 2EMHNWH JHWUHQQW GDU]XVWHOOHQ ,Q GHU 8OWUDVFKDOOGLDJQRVWLN XQWHUVFKHLGHW PDQ GDV ODWHUDOH XQG GDV D[LDOH $XIO|VXQJVYHUP|JHQ $EE XQG 'DV ODWHUDOH $XIO|
VXQJVYHUP|JHQ EH]LHKW VLFK DXI 2EMHNWH GLH TXHU ]XU $XVEUHLWXQJVULFKWXQJ GHU 6FKDOOZHOOHQ OLHJHQ HV LVW DEKlQJLJ YRQ GHU 6FKDOOIHOGJHRPHWULH 'DV D[LDOH $XIO|
VXQJVYHUP|JHQ EH]LHKW VLFK GDJHJHQ DXI 2EMHNWH GLH LQ GHU 6FKDOODXVEUHLWXQJV ULFKWXQJOLHJHQ(VLVWDEKlQJLJYRQGHU/lQJHGHU6FKDOOLPSXOVHGLHZLHGHUXPYRQ GHU :HOOHQOlQJH EH]LHKXQJVZHLVH GHU )UHTXHQ] GHU 6FKZLQJXQJHQ DEKlQJHQ 'DV D[LDOH$XIO|VXQJVYHUP|JHQLVWXPGHQ)DNWRUELVK|KHUDOVGDV ODWHUDOH $XIO|
VXQJVYHUP|JHQ :lKUHQG GDV D[LDOH $XIO|VXQJVYHUP|JHQ EHU GLH $XVEUHLWXQJV VWUHFNHNRQVWDQWEOHLEWlQGHUWVLFKGDVODWHUDOH$XIO|VXQJVYHUP|JHQLQ$EKlQJLJNHLW YRQGHU(QWIHUQXQJ]XP8OWUDVFKDOONRSI:(66(/6X:(%(5
'LH(LQGULQJWLHIH GHU 6FKDOOZHOOHQ LQ *HZHEH LVW YRQ GHU )UHTXHQ] DEKlQJLJ 0LW ]XQHKPHQGHU7LHIHQLPPWGLH(QHUJLHGHU6FKDOOZHOOHQXQGGHUHQ(FKRVDE$XIO|
VXQJVYHUP|JHQXQG(LQGULQJWLHIHYHUKDOWHQVLFKXPJHNHKUWSURSRUWLRQDO]XHLQDQGHU 0LW ]XQHKPHQGHU 6FKDOOIUHTXHQ] YHUEHVVHUW VLFK GDV $XIO|VXQJVYHUP|JHQ GLH (LQ GULQJWLHIH QLPPW DE 0LW HLQHU 6FKDOOIUHTXHQ] YRQ 0+] N|QQHQ 2UJDQH LQ HLQHU 7LHIHYRQELV]XFPGDUJHVWHOOWZHUGHQKLQWHUHLQDQGHUOLHJHQGH6WUXNWXUHQZHU GHQHUVWEHLHLQHP$EVWDQGYRQPHKUHUHQ0LOOLPHWHUQXQWHUVFKLHGHQ0LWHLQHU)UH TXHQ]YRQ0+]ZHUGHQ6WUXNWXUHQELVFP7LHIHRSWLPDOGDUJHVWHOOW%HLGLHVHU
$EE 'DV ODWHUDOH $XIO|VXQJVYHUP|JHQ GHV 8OWUDVFKDOOIHOGHV D JHWUHQQWH 'DUVWHOOXQJ ]ZHLHU .XJHOQ E $XIO|VXQJVJUHQ]H F NHLQH JHWUHQQWH 'DUVWHOOXQJGHU.XJHOQG$EVWDQGGHU.XJHOQ:(66(/6X:(%(5
$EE 6FKHPDWLVFKH 'DUVWHOOXQJ GHV D[LDOHQ $XIO|VXQJVYHUP|JHQV D JH WUHQQWH'DUVWHOOXQJ]ZHLHU.XJHOQE$XIO|VXQJVJUHQ]HXQWHUVFKULWWHQ G $EVWDQGGHU.XJHOQ:(66(/6X:(%(5
D .XJHO
G G
E F
6FKDOO
LPSXOV .XJHOQ .XJHOQ
G G
D E
G
)UHTXHQ] ODVVHQ VLFK 6WUXNWXUHQ PLW QXU PP $EVWDQG JHWUHQQW GDUVWHOOHQ
%5$81$EHUDXFKGLHXQWHUVXFKWHQ6WUXNWXUHQVHOEHUEHHLQIOXVVHQGLH(LQ GULQJWLHIHVRIKUHQHFKRUHLFKH2UJDQH]XHLQHUVFKQHOOHQ6FKZlFKXQJGHV6FKDOO VWUDKOHVXQGVFKUlQNHQGDPLWGLH(LQGULQJWLHIHHLQ%HLP1XW]WLHUZHUGHQLQGHU5H JHO 6FKDOON|SIH PLW ELV 0+] YHUZHQGHW )U REHUIOlFKOLFK JHOHJHQH 2UJDQH ZLHDXFKGLH/XQJHHUZHLVHQVLFK6FKDOON|SIHPLW0+]XQGHLQHU(LQGULQJWLHIH YRQFPDOVRSWLPDO5$17$1(1
%LOGZLHGHUJDEHYHUIDKUHQ
0DQ XQWHUVFKHLGHW GUHL %LOGZLHGHUJDEHYHUIDKUHQ 'HU$0RGH LVW QDFK GHP HQJOL VFKHQ :RUW Ä$PSOLWXGH PRGXODWLRQ³ EHQDQQW (V KDQGHOW VLFK XP HLQ =HLW
$PSOLWXGHQ6LJQDO 'LH /DXI]HLW GLH GDV DXVJHVHQGHWH 6LJQDO ELV ]XP (PSIDQJ EUDXFKW ZLUG DXIGHP.DWKRGHQVWUDKORV]LOORJUDSKHQDOV $PSOLWXGH GDUJHVWHOOW GHV VHQ+|KHYRQGHU*U|HGHV,PSHGDQ]XQWHUVFKLHGVDEKlQJLJ LVW 'LH %H]HLFKQXQJ GHV%0RGHLVWDXIGHQHQJOLVFKHQ%HJULIIÄ%ULJKWQHVVPRGXODWLRQ³]XUFN]XIKUHQ 'DEHLZLUGGDV(FKRQLFKWDOV$PSOLWXGHVRQGHUQDOV+HOOLJNHLWVZHUWZLHGHUJHJHEHQ :(66(/6X:(%(5XQGNDQQGXUFKHQJHV$QHLQDQGHUHLKHQGHU(FKRVDOV ]ZHLGLPHQVLRQDOHV%LOGGDUJHVWHOOWZHUGHQ%5$81GLHVHV9HUIDKUHQZLUGDP KlXILJVWHQ LQ GHU 8OWUDVFKDOOGLDJQRVWLN YHUZHQGHW %HLP00RGH HQJOLVFK 0RWLRQ PRGXODWLRQHUVFKHLQWGDV(FKRGHV8OWUDVFKDOOVWUDKOVDOV3XQNWDXIHLQHUYHUWLNDOHQ (EHQHZREHLGLH3RVLWLRQGHV3XQNWHVGHU7LHIHGHUUHIOHNWLHUWHQ6WUXNWXUGLH+HOOLJ NHLW GHV 3XQNWHV GHU 6WlUNH GHV (FKRV HQWVSULFKW 'LH GDUJHVWHOOWHQ (FKRV ZHUGHQ ODXIHQGDNWXDOLVLHUWXQGKRUL]RQWDOYHUVFKREHQ%$55
=XU 'LDJQRVWLN YRQ +HU]HUNUDQNXQJHQ EHLP 3IHUG ZLUG KDXSWVlFKOLFK GLH %0RGH 7HFKQLNYHUZHQGHWVLHGLHQWGDEHLGHU$QDO\VHGHU+HU]GLPHQVLRQHQ8QWHUVWW]XQJ ILQGHW GLH %0RGH7HFKQLN EHL GHU 'LDJQRVWLN DP +HU]HQ GXUFK GLH 'RSSOHUWHFKQLN
]XU$QDO\VHGHU+lPRG\QDPLNXQGGLH00RGH7HFKQLNGLHGLH$QDO\VHGHU.LQHWLN YRQ+HU]ZlQGHQXQG+HU]NODSSHQHUP|JOLFKW67$'/(5X52%,1(
6FKDOONRSIZDKO
)UGLH6RQRJUDSKLHVWHKHQ/LQHDU.RQYH[XQG6HNWRUVFKDOON|SIH]XU9HUIJXQJ (%(563b&+(5/LQHDUVFKDOON|SIHEHVWHKHQDXVELVQHEHQHLQDQGHU OLHJHQGHQ.ULVWDOOHQ(LQ7HLOGLHVHU.ULVWDOOHZLUGZHFKVHOZHLVHDNWLYLHUWZRGXUFKHLQ UHFKWHFNLJHV%LOGHQWVWHKW'HU9RUWHLOHLQHVVROFKHQ6FKDOONRSIHVLVWGDULQ]XVHKHQ GDXQWHUVHLQHU$QNRSSOXQJVIOlFKHHLQEUHLWHV%OLFNIHOGRKQHJHRPHWULVFKH9HU]HU UXQJGHV%LOGHVEHVWHKWQDFKWHLOLJZLUNWVLFKVHLQHJURH$QNRSSOXQJVIOlFKHDXV
%HL GHQ.RQYH[VFKDOON|SIHQ KDQGHOW HV VLFK XP /LQHDUVFKDOON|SIH PLW HLQHU JH NUPPWHQ $QNRSSOXQJVIOlFKH $Q GHQ 5lQGHUQ GHU %OLFNIHOGHU GLYHUJLHUW GDV %LOG OHLFKW%HLGLHVHP6\VWHPLVWGLH$QNRSSOXQJVIOlFKHDEHUGDPLW DXFK GDV %OLFNIHOG HWZDVNOHLQHUDOVEHLP/LQHDUVFKDOONRSI
'LH6HNWRUVFKDOON|SIHHU]HXJHQHLQIlFKHUI|UPLJHV%LOG 8QWHUVFKLHGHQ ZLUG ]ZL VFKHQPHFKDQLVFKHQ6HNWRUVFKDOON|SIHQEHLGHQHQHLQRGHU ZHQLJH .ULVWDOOH GXUFK HLQHQ 0RWRU EHZHJW ZHUGHQ 'DEHL SHQGHOW HLQ HLQ]HOQHU .ULVWDOO KLQ XQG KHU RGHU PHKUHUH .ULVWDOOH URWLHUHQ XP GLH HLJHQH $FKVH (LQH ZHLWHUH $UW GHV 6HNWRUVFKDOO NRSIHVELOGHWGHU3KDVHG$UUD\6HNWRUVFKDOONRSI%HLGLHVHP6\VWHPZLUGHLQH*UXS SH IHVW LQVWDOOLHUWHU .ULVWDOOH HOHNWURQLVFK NXU] QDFKHLQDQGHU DNWLYLHUW %$55 'HU9RUWHLOGHV6HNWRUVFKDOONRSIHVEHUXKWDXIVHLQHUNOHLQHQ$QNRSSOXQJVIOlFKHXQG GHUIlFKHUI|UPLJHQ$XVEUHLWXQJGHU6FKDOOZHOOHQ'HU1DFKWHLOGHV6HNWRUVFKDOONRSIHV LVW VHLQ NOHLQHV %OLFNIHOG GDV LP 1DKIHOG NDXP ]X EHXUWHLOHQ LVW Ä6FKOVVHOORFKHI IHNW³(%(563b&+(5
)U GLH 8QWHUVXFKXQJ GHV +HU]HQ ELHWHW GHU 6HNWRUVFKDOONRSI GLH JQVWLJVWH 6FKDOODXVEUHLWXQJ .$(00(5(5 HW DO ZHLO GXUFK GLH 5LSSHQ GDV 8QWHUVX FKXQJVIHOG HLQJHVFKUlQNW ZLUG %HL GHU 8QWHUVXFKXQJ NDQQ GDV YROOH 8QWHUVX FKXQJVIHOGGHVYRP6FKDOONRSIYRUJHJHEHQHQ6HNWRUVJHQXW]WZHUGHQ5HGX]LHUWLVW OHGLJOLFK GHU $QNRSSOXQJVEHUHLFK IU GLH 6FKDOOVRQGH GD GLDJQRVWLVFK DXVZHUWEDUH
%LOGHUQXUEHL$QNRSSOXQJDXI+|KHGHU,QWHUNRVWDOUlXPHHQWVWHKHQ'XUFKGLHVUH ODWLY HQJH ÄDNXVWLVFKHQ )HQVWHU³ HPSILHKOW VLFK GHU 6HNWRUVFKDOONRSI ]XU 8QWHUVX FKXQJ5$17$1(1)UGLH8QWHUVXFKXQJGHU/XQJHHLJQHQVLFK/LQHDUXQG 6HNWRUVFKDOON|SIHJOHLFKHUPDHQ%5$81
'DGLH/XQJHQREHUIOlFKHHWZDELVFPXQWHUGHU.|USHUREHUIOlFKHOLHJWLVWIU HLQHVROFKH8QWHUVXFKXQJHLQ6FKDOONRSIPLWHLQHU)UHTXHQ]YRQ±0+]EHVRQ GHUVJHHLJQHW5$17$1(1
$UWHIDNWH
$OV $UWHIDNWH ZHUGHQ %LOGVWUXNWXUHQ EH]HLFKQHW GLH QLFKW GHQ DQDWRPLVFKHQ 6WUXN WXUHQ HQWVSUHFKHQ 6LH UHVXOWLHUHQ HQWZHGHU DXV HLQHU IDOVFKHQ *HUlWHHLQVWHOOXQJ RGHUDXISK\VLNDOLVFKHQ(LJHQVFKDIWHQGHU6FKDOOZHOOHQ6&+:(5.(LQ]HOQH
$UWHIDNWHN|QQHQDQGHUHUVHLWVIUGLH'LDJQRVWLNGXUFKDXVKLOIUHLFKVHLQ)/h&.,*(5