Frequency of breath movements. Risks of frequent, rare breathing and pauses. Age norms of respiratory rate

Respiratory rate (RR) and VC. Breathing at rest should be rhythmic and deep. Normally, the respiratory rate in an adult is 14-18 times per minute. When loaded, it increases by 2-2.5 times. An important indicator respiratory function is vital capacity lungs (ZHEP) - the volume of air obtained during the maximum exhalation made after the maximum breath. Normal in women is 2.5-4 liters, in men it is 3.5-5 liters.

Blood pressure (BP). Systolic pressure (max) is the pressure during systole (contraction) of the heart, when it reaches its highest value during the cardiac cycle. Diastolic pressure (min) - is determined by the end of diastole (relaxation) of the heart, when it is cardiac cycle reaches the minimum value.

Ideal pressure formula for each age:

Max. BP = 102+ (0.6 x number of years) min. BP = 63+ (0.5 x number of years)

The World Health Organization suggests that blood pressure for systolic (max.) - 100 - 140 mm Hg be considered normal numbers; for diastolic 80-90 mm Hg.

58. Functional trials and tests

The level of the functional state of the body can be determined using functional tests and tests.

orthostatic test. The pulse is calculated in the supine position after 5-10 minutes of rest, then you need to get up and measure the pulse in the standing position. The difference between the pulse lying and standing is judged on functional state cardiovascular and nervous systems. Difference up to 12 beats / min - good condition physical fitness, from 13 to 18 beats / min - satisfactory, 19-25 beats / min - unsatisfactory, i.e. lack of physical fitness, more than 25 beats / min - indicates overwork or illness.

Stange's test (holding the breath on inspiration). After 5 minutes of rest while sitting, do 2-3 deep breaths and exhalation, and then, having taken a full breath, hold the breath, the time is noted from the moment the breath is held until it stops.

The average indicator is the ability to hold your breath while inhaling for untrained people for 40-55 seconds, for trained people - for 60-90 seconds or more. With an increase in training, the breath holding time increases; in case of illness or overwork, this time decreases to 30-35 seconds.

This test characterizes the resistance of the body to a lack of oxygen.

Single test.

Before performing a one-stage test, they rest while standing, without moving for 3 minutes. Then measure the heart rate for one minute. Then 20 deep squats are performed in 30 seconds from the initial position of the legs shoulder-width apart, arms along the body. When squatting, the arms are brought forward, and when straightened, they return to their original position. After performing squats, the heart rate is calculated for one minute.

When assessing, the magnitude of the increase in heart rate after exercise is determined in percent. A value of 20% means excellent response of cardio-vascular system on the load, from 21 to 40% - good,

from 41 to 65% - satisfactory,

from 66 to 75% - bad,

from 76 and more - very bad.

Genchi test (breath holding on exhalation). It is performed in the same way as the Stange test, only the breath is held after a full exhalation. Here, the average indicator is the ability to hold your breath on exhalation for untrained people for 25-30 seconds, for trained people for 40-60 seconds. and more.

Ruffier test. To assess the activity of the cardiovascular system, you can use the Ryuffier test. 1 After a 5-minute calm state in a sitting position, count the pulse for 10 seconds (P1), then perform 30 squats within 45 seconds. Immediately after squats, count the pulse for the first 10 s (P2) and one minute (P3) after the load. The results are evaluated by the index, which is determined by the formula:

6 x (P1 + P2 + P3) - 200

Ruffier index =

Assessment of the performance of the heart:

Ruffier index

0 - athletic heart

0, 1 - 5 - "excellent" (very good heart)

5, 1 - 10 - "good" (good heart)

10, 1 - 15 - "satisfactory" (heart failure)

15 1 - 20 - "poor" (severe heart failure)

25 - 50% - good,

from 50 - 75% bad.

Validation and assessment test general endurance.

It is carried out with the help of control exercises of 2 types: overcoming an average, long distance or overcoming the largest possible distance in a certain time. Examples of these exercises are:

1) running and cross-country for 1000, 2000, 2500, 3000, 5000m;

swimming at 200. 400, 500 m,

2) run 12 min.

The most substantiated estimates of general endurance according to the K. Cooper test. This is a 12-minute run with a maximum distance (km).

The normal respiratory rate (RR) at rest in an adult is 12-18 per minute.

In children, it is more superficial and more frequent than in adults.

In newborns, the respiratory rate is 60 in 1 min.

In children aged 5 years, the respiratory rate is 25 in 1 min.

Breathing depth

The depth of respiratory movements is determined by the amplitude of excursions chest using special methods.

The pressure in the pleural fissure and in the mediastinum is normally always negative..

During a quiet breath of the pleural fissure, it is 9 mm. rt. Art. below atmospheric pressure, and during a quiet exhalation by 6 mm. mercury column.

Negative pressure (intrathoracic) plays a significant role in hemodynamics, providing venous return of blood to the heart and improving blood circulation in the pulmonary circle, especially during the inspiration phase. It also promotes the movement of the food bolus through the esophagus in the lower section, which has a pressure of 3.5 mm. rt. Art. below atmospheric.

Gas exchange in the lungs (2nd phase of respiration)

- this is gas exchange between the alveolar air and the blood of the pulmonary capillaries.

Alveolar air is located in the alveoli - pulmonary vesicles. The wall of the alveolus consists of a single layer of cells, easily passable for gases. The alveoli are braided with a dense network of pulmonary capillaries, which greatly increases the area on which gas exchange takes place between air and blood.

The wall of the pulmonary capillaries also consists of a single layer of cells. The exchange of gases between blood and alveolar air is carried out through membranes formed by a single-layer epithelium of capillaries and alveoli.

Gas exchange in the lungs between alveolar air and blood is carried out due to the difference in the partial pressure of oxygen and carbon dioxide in the alveoli and the tension of these gases in the blood.

Voltage is the partial pressure of the gas in the liquid.

Each of these gases moves from an area of ​​higher partial pressure to an area of ​​lower partial pressure.

Venous blood has a higher partial pressure of carbon dioxide than blood, so carbon dioxide moves from an area of ​​higher pressure to an area of ​​lower pressure - from the blood to the alveolar air, and the blood releases carbon dioxide.

The partial pressure of oxygen is greater in the alveolar air than in the blood, so oxygen molecules move from an area of ​​higher pressure to an area of ​​lower pressure - from the alveolar air into the blood of the pulmonary capillaries, and the blood becomes arterial.

Inhaled (atmospheric) air contains:

20.94% oxygen;

0.03% carbon dioxide;

79.03% nitrogen.

Exhaled air contains:

16.3% oxygen;

4% carbon dioxide;

79.7% nitrogen.

Alveolar air contains:

14.2 - 14.6% oxygen;

5.2 - 5.7% carbon dioxide;

79.7 - 80% nitrogen.

Transport of gases by blood (3rd phase of respiration)

This phase involves the transport of oxygen and carbon dioxide by the blood.

Oxygen transport

Oxygen is transported from the lungs to the tissues.

It is carried out in one way - by combining oxygen with hemoglobin - oxyhemoglobin.

Hb + O 2 ↔ НbО 2 (Oxyhemoglobin)

Oxyhemoglobin is an unstable, easily decomposing compound.

Oxyhemoglobin is formed in the lungs when hemoglobin in the blood of the pulmonary capillaries combines with oxygen in the alveolar air. In this case, the blood becomes arterial.

One molecule of hemoglobin combines with 4 oxygen molecules with the help of 4 iron atoms contained in heme.

And oxyhemoglobin breaks down in the capillaries of the systemic circulation, when the blood gives oxygen to the tissues.

Transport of carbon dioxide

Normal performance BP, heart rate, NPV.

The heart is a hollow muscular organ, the "pump" of our body, which pumps blood through blood vessels: arteries and veins.

Through the arteries, blood flows from the heart to organs and tissues, while it is rich in oxygen and is called arterial. Blood flows through the veins to the heart, while it has already given oxygen to each cell of the body and taken carbon dioxide from the cells, so this blood is darker and is called venous.

Arterial called pressure, which is formed in the arterial system of the body during heart contractions and depends on complex neuro-humoral regulation, size and speed cardiac output, frequency and rhythm of heart contractions and vascular tone.

Distinguish between systolic (SD) and diastolic pressure(DD). Blood pressure is recorded in millimeters of mercury (mm Hg). Systolic is the pressure that occurs in the arteries at the time of maximum rise pulse wave after ventricular systole. Normally, in a healthy adult, DM is 100 - 140 mm Hg. Art. The pressure maintained in arterial vessels in ventricular diastole, called diastolic, normal in an adult healthy person it is equal to 60 - 90 mm Hg. Art. Thus, human blood pressure consists of two values ​​- systolic and diastolic. SD is written first (higher indicator), the second through a fraction - DD (lower indicator). An increase in blood pressure above the noma is called hypertension or hypertension. The difference between SD and DD is called pulse pressure(PD), whose indicators are normally 40 - 50 mm Hg. Blood pressure below normal is called hypotension or hypotension.

In the morning, blood pressure is lower than in the evening by 5-10 mm Hg. Art. A sharp drop in blood pressure is life-threatening! It is accompanied by pallor, severe weakness, loss of consciousness. At low pressure, it breaks normal course many vital important processes. Yes, when falling systolic pressure below 50 mm Hg. Art. there is a cessation of urine formation, kidney failure develops.

Measurement of blood pressure is performed by an indirect sound method, proposed in 1905 by the Russian surgeon N.S. Korotkov. Apparatus for measuring pressure are the following names: Riva-Rocci apparatus, or tonometer, or sphygmomanometer.

Currently, electronic devices are also used to determine blood pressure by a non-sound method.

For the study of blood pressure, it is important to consider the following factors: the size of the cuff, the condition of the membrane and tubes of the phonendoscope, which can be damaged.

Pulse are rhythmic oscillations of the artery wall due to the ejection of blood into arterial system during one heartbeat. Distinguish central (on the aorta, carotid arteries) and peripheral (on the radial, dorsal artery of the foot and some other arteries) pulse.

IN diagnostic purposes the pulse is also determined on the temporal, femoral, brachial, popliteal, posterior tibial and other arteries.

More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process. radius and tendon of the internal radial muscle.

When examining the pulse, it is important to determine its frequency, rhythm, filling, tension and other characteristics. The nature of the pulse also depends on the elasticity of the artery wall.

Frequency is the number of pulse waves per minute. Normally, in an adult healthy person, the pulse is 60-80 beats per minute. An increase in heart rate over 85-90 beats per minute is called tachycardia. A heart rate slower than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. With an increase in body temperature on GS, the pulse increases in adults by 8-10 beats per minute.

Rhythm pulse is determined by the intervals between pulse waves. If they are the same, the pulse is rhythmic (correct), if they are different, the pulse is arrhythmic (incorrect). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals.

Filling pulse is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then it is probed normal pulse(full); if not, then the pulse is empty. Voltage heart rate depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure the artery is compressed with a moderate effort, therefore, the pulse of moderate (satisfactory) tension is normal. At high pressure the artery is squeezed by strong pressure - such a pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.

With low blood pressure, the artery is compressed easily, the voltage pulse is called soft (non-stressed).

An empty, relaxed pulse is called a small filiform.

Pulse data are recorded in two ways: digitally - in medical records, magazines, and graphic - in temperature sheet in red pencil in the column "P" (pulse). It is important to determine the division value in the temperature sheet.

Respiratory system provides the gas exchange necessary to maintain life, and also functions as a voice apparatus. The function of the respiratory system is only to supply the blood with a sufficient amount of oxygen and remove carbon dioxide from it. Life without oxygen is not possible for humans. The exchange of oxygen and carbon dioxide between the body and the environment is called respiration.

Breath- it consists of 3 parts:

1. external respiration- gas exchange between external environment and blood in the pulmonary capillaries.

2. Transfer of gases (using blood hemoglobin).

3. Internal tissue respiration - gas exchange between blood and cells, as a result of which cells consume oxygen and release carbon dioxide. Watching over breath, Special attention should be given to color change skin, determining the frequency, rhythm, depth respiratory movements and assess the type of breathing.

Respiratory movement is carried out by alternating inhalation and exhalation. The number of breaths per minute is called the respiratory rate (RR).

In a healthy adult, the rate of respiratory movements at rest is 16-20 per minute, in women it is 2-4 breaths more than in men. The NPV depends not only on gender, but also on the position of the body, condition nervous system, age, body temperature, etc.

Breathing monitoring should be carried out imperceptibly for the patient, as he can arbitrarily change the frequency, rhythm, depth of breathing. NPV refers to heart rate on average as 1:4. With an increase in body temperature by 1 ° C, breathing quickens by an average of 4 respiratory movements.

Distinguish between shallow and deep breathing. Shallow breathing may be inaudible at a distance. Deep breathing, heard at a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed type. In women, chest type of breathing is more often observed, in men - abdominal. At mixed type breathing occurs uniform expansion of the chest of all parts of the lung in all directions. Types of breathing are developed depending on the influence of both external and internal environment organism. With a disorder in the frequency of the rhythm and depth of breathing, shortness of breath occurs. Distinguish inspiratory shortness of breath - this is breathing with difficulty inhaling; expiratory - breathing with difficulty exhaling; and mixed - breathing with difficulty inhaling and exhaling. Rapidly developing severe shortness of breath called suffocation.

Respiration (respiratio) is a set of processes that ensure the entry of atmospheric oxygen into the body, its use in biological oxidation reactions, as well as the removal of carbon dioxide formed in the process of metabolism from the body. Reflex irritation respiratory center occurs when the level of carbon dioxide in the blood rises.

There are several stages of respiration: 1. External respiration - the exchange of gases between the atmosphere and the alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. O2 and CO2 exchange between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell. There are several stages of respiration: 1. External respiration - the exchange of gases between the atmosphere and the alveoli. 2. Exchange of gases between the alveoli and the blood of the pulmonary capillaries. 3. Transport of gases by blood - the process of transferring O2 from the lungs to the tissues and CO2 from the tissues to the lungs. 4. O2 and CO2 exchange between capillary blood and body tissue cells. 5. Internal, or tissue, respiration - biological oxidation in the mitochondria of the cell.

In a healthy adult, the rate of respiratory movements at rest is 1620 per minute. NPV (Respiratory Rate) depends on: 1. Gender: Women have 2-4 breaths more than men; 2.From body position; 3. From the state of the nervous system; 4.From age; 5.From body temperature; With an increase in body temperature by 1 ° C, breathing quickens by an average of 4 respiratory movements. 1. From gender: Women have 2-4 breaths more than men; 2.From body position; 3. From the state of the nervous system; 4.From age; 5.From body temperature; With an increase in body temperature by 1 ° C, breathing quickens by an average of 4 respiratory movements. Breathing monitoring must be carried out imperceptibly for the patient, since he can involuntarily change the respiratory rate, rhythm, and depth of breathing. ATTENTION!

Distinguish between shallow and deep breathing. Shallow breathing may be inaudible at a distance or slightly audible. It is often combined with pathological rapid breathing. Deep breathing, heard at a distance, is most often associated with a pathological decrease in breathing.

Physiological types of breathing include thoracic, abdominal and mixed types. In women, chest type of breathing is more often observed, in men, abdominal. With a mixed type of breathing, there is a uniform expansion of the chest, all parts of the lung in all directions.

It is desirable that the ward before the check was not excited about something, did not eat, was not subjected to physical activity. For "one breath" consider the inhalation-exhalation. The calculation is carried out without informing the patient about NPV study in order to prevent arbitrary changes in breathing. It is desirable that the ward before the check was not excited about something, did not eat, was not subjected to physical activity. For "one breath" consider the inhalation-exhalation. The calculation is carried out without informing the patient about the study of respiratory rate in order to prevent arbitrary changes in breathing. It is convenient to read the respiratory rate when the patient lies on his back and is visible. top part his chest or epigastric region(at abdominal type breathing) Take the patient's hand as if to study the pulse, count the number of breaths per minute, using a stopwatch, simulating the study of the pulse. Assess the frequency of the patient's respiratory movements. By movements (raising and lowering) of the chest or abdominal wall watch: how high the chest rises, whether the inhalations and exhalations are the same, whether the pauses between them are equal. At the end of the procedure, conduct data registration to ensure continuity in work and control of respiratory rate. It is convenient to count the respiratory rate when the patient is lying on his back and the upper part of his chest or epigastric region is visible (with abdominal breathing) Take the patient’s hand as if to study the pulse, count the number of breaths per minute, using a stopwatch, simulating the study of the pulse Assess the frequency of the patient’s respiratory movements . Follow the movements (raising and lowering) of the chest or abdominal wall: how high the chest rises, whether the inhalations and exhalations are the same, whether the pauses between them are equal. At the end of the procedure, conduct data registration to ensure continuity in work and control of respiratory rate.

Pathological types breathing. For a patient with a heart or lung disease a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breaths per minute) is a sign of a threat to life. If superficial and redundant rapid breathing occurs with noise, sometimes gurgling, this indicates improper gas exchange in the lungs. In asthma, wheezing, in bronchitis with wheezing. For a patient with a heart or lung disease, a sharp increase in breathing is a sign of a complication or worsening of the condition. Rare breathing (less than 12 breaths per minute) is a sign of a threat to life. If shallow and excessively frequent breathing occurs with noise, sometimes gurgling, this indicates an incorrect gas exchange in the lungs. In asthma, wheezing, in bronchitis with wheezing.

Kussmaul's big breath is rare, deep breathing With loud noise, observed in deep coma (prolonged loss of consciousness); Biott's breathing is periodic breathing, in which there is a correct alternation of the period of superficial respiratory movements and pauses, equal in duration (from several seconds to a minute);

Cheyne-Stokes respiration is characterized by a period of increase in the frequency and depth of respiration, which reaches a maximum at the 57th breath, followed by a period of decrease in the frequency and depth of respiration and another long pause, equal in duration (from several seconds to 1 minute). During a pause, patients are poorly oriented in environment or lose consciousness, which is restored with the resumption of respiratory movements (with severe damage to the brain, kidneys, heart vessels).

"Medical art consists of the amount of knowledge necessary to understand the causes and pathophysiological mechanisms diseases, from clinical experience, intuition and a set of qualities that together make up the so-called "clinical thinking".

Counting respiratory movements is a standard item for examining a child by a pediatrician. Despite the apparent simplicity and obviousness of this manipulation, NPV can give important information about how healthy the baby is and whether everything is in order with him. Since the number of breaths per minute in children is much greater than in adults, a special table of the rate of respiratory rate has been developed for them.

The respiratory system of babies and its features

The first opening of the lungs in a newborn occurs immediately after the baby is born. By this time, the respiratory system of the child is not yet fully developed and has a number of features. So, babies have narrow and short nasal passages that cannot always cope with full breathing. sharpened under breast-feeding the respiratory system does not allow children to breathe through their mouths, so they may develop shortness of breath and blockage of the nasal passages.

A small child is not yet able to independently clear the nasal passages by blowing his nose, so for normal breathing he especially needs the care and care of an adult.

Interesting: during sleep, babies can hold their breath when moving from the phase REM sleep in slow and back, it's absolutely normal.

How to correctly calculate NPV

This the simplest procedure which can be carried out at home. It will only require a stopwatch and the baby at rest, otherwise the data will be unreliable. perfect time sleep, as the child's crying or restlessness can distort the results of the study.

You can measure the respiratory rate of the baby visually, by the movements of the chest, or by placing a palm on it. An older child can be taken by the wrist (under the base thumb) and, observing the pulse, count the number of inhalations and exhalations.

Norm of respiratory rate in children

The table shows the average values ​​of the normal frequency of respiratory movements in children from 0 to 12 years. In the future, the norm of the respiratory rate of the child coincides with the norm of an adult.

The table clearly shows that with age, the respiratory rate decreases, while the rate of respiration does not depend on the gender of a person. This is due to the fact that with age, the respiratory system gradually becomes stronger, changing at each stage of development.

What do NPV data say?

If at correct measurement If you find that your child's breathing is fast or difficult, you should immediately consult a doctor. This may indicate a breach in respiratory system as well as the presence of an infectious disease.

At the same time, increased breathing during physical activity, increased emotionality or enthusiasm for a child in some activity is completely normal and does not require contacting a specialist.