AEROFISIOLGI

Tika Hamidah
15.092
Aeorfisiologi
• Ilmu tentang kesehatan tubuh ketika berada di dalam penerbangan atau dalam
misi penjelajahan ruang angkasa
• Manuver penerbangan dapat
mengganggu faal tubuh seperti faal
system kardiovaskular, system
pernapasan, penglihaan,
keseimbangan, pendengaran dsb..
Pengaruh ketinggian pada faal tubuh
• Tekanan parsial oksigen makin menurun Hk. Boyle, Hk. Dalton, Hk.
• Tekanan barometer makin menurun dysbarism
• Suhu atmosfer menurun (-2 derajat/1000 feet)
• Radiasi meningkat
SISTEM RESPIRASI PADA TEMPAT TINGGI

• Pada ketinggian permukaan laut total tekanan atmosfer 760 mmHg, ketika di atas
12.000 kaki tekanan barometernya hanya 483mmHg Dalam hal ini terjadi
penurunan total tekanan atmosfer, yang berarti lebih sedikit 40% molekul
0ksigen per pernapasan pada saat berada di tempat tinggi dibandingkan dengan
permukaan laut.
• Penurunan tekanan barometer merupakan dasar penyebab semua persoalan
hipoksia pada fisiologi manusia di tempat tinggi.
• Apabila seseorang berada di tempat yang tinggi selama beberapa hari, minggu,
atau tahun, menjadi semakin teraklimatisasi terhadap tekanan parsial oksigen
yang rendah, sehingga efek buruknya terhadap tubuh makin lama semakin
berkurang.
Aklimatisasi
• Penurunan tekanan atmosfer O2 akan membuat menurunnya tekanan parsial
oksigen alveolar  << oxygen delivery.
• Acclimatization is the process by which the body response to this challenge
• This adaptation is achieved by
• increasing oxygen delivery through respiratory (increase in ventilation ),
• haematological (memproduksi sel darah merah lebih banyak dan memproduksi
lebih banyak enzim 2,3 biphosphoglyserate yang memfasilitasi pelepasan oksigen
dari hemoglobin ke jaringan tubuh) ,
• and cardiavascular changes (tekanan arteri pulmonalis meningkat)
 Hypoxic ventilatory response (HVR)
is the increase in ventilation triggered
by exposure to acute hypoxia, it is
classically explained by peripheral
chemoreceptor stimulation
 Decreased in oxygen arterial partial
pressure is detected in the glomus
cells of the carotid bodies \, resulting
in increase in respiration rate,
ventilation, and PaO2
 Increased ventilation also leads to a
decrease in arterial pressure of CO2,
this reduces overall respiratory drive,
allowing return to normal capnia over 20
to 30 min.
• Decreases in PaO2 also cause the pulmonary vascular bed to rapidly
constrict (hypoxic pulmonary vasoconstriction)
• HPV results in increased pulmonary arterial pressures
Cardiovascular responses to acute hypobaric
hypoxia
• In the resting subject, heart rate increases immediately
when breathing air above 6000–8000 feet.
• At 15 000 feet, he average increase is about 10–15 per
cent above the sealevel value;
• it rises to a 20–25 per cent increase at 20 000 feet,
• and the heart rate is approximately doubled at 25
000 feet.
• However, the systolic pressure is usually raised, and there
is an overall reduction in peripheral resistance, with a
resulting increase in the pulse pressure. There is a
redistribution of blood flow by local and vasomotor
mechanisms. Although hypoxia causes vasodilation in
most vascular beds, there are some important features of,
and differences in, the responses of certain
regional circulations.
• REGIONAL CARDIOVASCULAR
CHANGES
• Acute hypoxia causes immediate
increases in blood flow through the
coronary and cerebral circulations, but
renal blood flow is markedly reduced.
Blood flow through skeletal muscle may
increase by 30–100 per cent. Thus, there
is a redistribution of cardiac output, with
flow to essential organs such as the
heart and brain increased at the expense
of other less acutely essential organs,
such as the viscera, skin and kidneys.
WHAT IS G “G-force adalah gaya gravitasi pada bagian tubuh akibat
kekuatan akselerasi”

• The human body is acted on continuously by the force of the Earth’s gravity and is
well adapted to an existence in this environment. However, aircraft and spacecraft
are capable of generating sustained acceleration resulting in much larger forces,
often up to nine or more times those due to gravity (+9 Gz).
• The G value of an applied acceleration (a) on a pilot in a manoeuvre is given by:

For example, if a pilot was accelerated at 58.9 m/s2, they

would be exposed to 6 G, which is six times the acceleration
due to gravity (9.81 m/s2). The term G is often used to
represent force, and its magnitude does determine the force
produced.
Acceleration
• A linear acceleration is an acceleration produced by a change of speed without a change in
direction. In aviation, prolonged linear accelerations (such as takeoff and landing)
• “perubahan kecepata tapi arah tetap take off, ditching (pendaratan darutat dilaut), take off
• Radial acceleration A radial acceleration is an acceleration produced by a change of direction
of motion without a change of speed.
• “perubahan arah dan gerak pesawat tapi kecepatan tetap”loop and dive

where a is the radial acceleration, v is the circumferential

velocity and r is the radius of the circular path.

• this equation, the radial acceleration of an aircraft travelling at 500 knots (258 m/s) around a circular path with a
diameter of 1 km can be calculated as 66.3 m/s2 or 6.8 G. Small changes in the speed of the object will have a
proportionally greater effect on the radial acceleration than small changes in radius, due to the velocity term being
squared in the equation above. In this setting, the acceleration towards the centre of the circle is sometimes termed
centripetal acceleration.
• G dianggap sebagai gaya atau kekuatan ‘tarikan’ gravitasi pada tubuh . Di permukaan
bumi, kekuatan tarikan tersebut menjadi penyebab adanya berat badan.
• Gaya gravitasi pada saat duduk, berdiri atau berbaring dianggap sama dengan berat
badan dan disebut 1G. Satuan G akan meningkat pada akselerasi. Jika kita mengatakan
bahwa satuan G meningkat menjadi 5G selama akselerasi, maka perkataan ini berarti
kalau gaya gravitasi pada tubuh di saat itu sama dengan lima kali lipat berat badan.
• Ketika naik pesawat udara, elevator atau mobil dan terjadi perubahan kecepatan atau arah
yang mendadak, maka penumpangnya akan terlempar atau terputar pada arah yang
berlawanan. Hal ini terjadi karena perubahan pada satuan G. Satuan G dapat meningkat
atau menurun. Peningkatan satuan g dinamakan G positif dan penurunan satuan G
dinamakan G negatif. G positif terjadi ketika kecepatan ditingkatkan (akselerasi). G negatif
terjadi ketika kecepatan dikurangi ( diperlambat-deselerasi). Satuan G juga berubah jika
terjadi perubahan arah.
Selama terbang, baik G positif maupun G negatif akan menimbulkan perubahan fisiologis
dalam tubuh.
 • Inertial force/gaya inersia
adalah kecenderungan semua
benda fisik untuk menolak
perubahan terhadap arah
geraknya
Back to chest • Benda yg diam akan terus
Right to left side terdiam, benda yang bergerak
Left to right side akan terus bergerak,
diperlukan kekuatan lain untuk
mengatasi inersia.
• Benda yang besar, inersia lebih
besar
+Gz acceleration (Head to foot)
• Cardiovascular effects of +Gz
acceleration
1. blood volume redistribution
• Acceleration increases the weight of the
column of blood above and below the
heart. In a person with an intact
circulation, the vascular pressure above
the level of the heart is decreased and
the pressure below the heart is
increased.

Figure 7.4 Immediate effect of exposure to +1 and +4.5 Gz

The pressure in the femoral vein rises progressively during the first 30–60 seconds of the exposure to
+Gz acceleration as blood accumulates in the capacity vessels of the lower limbs
+Gz acceleration (Head to foot)
• Cardiovascular effects of +Gz acceleration
2.. Baroreceptor reflex
Reflexes at the local level are also likely to influence the blood pressure response to
acceleration exposure. Arterial baroreceptors are located in the adventitial layer of the
carotid sinus and aortic arch.
Heart rate is increased by reduced vagal inhibition and vasoconstriction occurs
(predominantly in muscle and the splanchnic region), leading to increased peripheral
resistance.
Cardiac contractility is increased, both directly and by release of adrenaline (epinephrine)
from the adrenal medulla.
Increase in renal sympathetic nerve activity stimulates renin secretion, activating the renin–
angiotensin system to produce angiotensin II (resulting in generalized vasoconstriction) and
aldosterone (resulting in salt and water retention), although these are of very limited
significance in acute acceleration exposure.
 +Gz acceleration
(Head to foot)
• Visual effects of +Gz acceleration
Ø Grayout
Grayout merupakan pengelihatan yang berubah
menjadi abu-abu ketika aliran darah ke mata
berkurang. Keadaan ini terjadi kerena retina lebih
sensitif terhadap hipoksia ketimbang otak. Meskipun
gangguan fisik tidak terjadi, namun gejala grayout
dianggap sebagai tanda peringatan akan penurunan
aliran darah ke otak. Figure 7.5 Effects of a 15-second exposure to +4.2 Gz on head-
level arterial blood pressure and peripheral vision. Note that
Ø Blackout peripheral vision is lost progressively as arterial blood pressure
Blackout merupakan kehilangan total pengelihatan falls, with blackout (zero peripheral vision) occurring some six
yang terjadi ketika fungsi retina terkena hipoksia. seconds after the point of lowest pressure. Thereafter, both
Kesadaran dan aktivitas muskular masih terdapat. blood pressure and vision recover as compensatory
Akan tetapi, gejala blackout mengindikasikan risiko reflexes develop.
kehilangan kesadaran
+Gz acceleration (Head to foot)
• G-Induced loss of consciousness (G-LOC)
Ketika gaya gravitasi meningkat melebihi 5G, hipoksia sudah mencapai tingkat kritis yang
akan menimbulkan kehilangan kesadaran. Keadaan tidak sadarkan diri dapat berlangsung
sekiatar 15 detik. Sesudah pulih dari keadaan tidak sadar, pasien masih memerlukan 10-
15 menit lagi untuk pemulihan daya orientasinya. Jika pasien itu kebetulan seorang pilot
yang terbang sendiri, maka dia akan kehilangan kontrol atas pesawatnya.
• Effect of +Gz acceleration on skin capillaries
• +Gz acceleration not only gives rise to transudation of fluid but also may cause rupture of
these vessels, with the formation of petechial haemorrhages. It is not unusual to find multiple
petechiae on the foot, leg, buttocks and forearm after repeated or prolonged exposures to
accelerations greater than about +6 Gz.
• This appearance is commonly termed ‘G-measles’.
• Occasionally, a larger vessel (usually a small vein or venule) may rupture, leading to a
subcutaneous collection of blood. The condition generally resolves without complication.
+Gz acceleration (Head to foot)
• Musculoskeletal effects of +Gz acceleration
• The most readily apparent effects of exposure to increased +Gz acceleration are brought
about by the increased weight of the soft tissues, head, limbs and trunk. Upward
movement of the arms becomes very difficult above +7 Gz, although fine movement, such
as that in the fingers, tends to be preserved due to their relatively low mass.
• Above +3 Gz, it is impossible for most people to stand up from the seated position, making
unassisted escape (e.g. from a damaged aircraft) impossible.
• For this reason, among many others, assisted-escape systems such as ejection seats are
employed in high-performance aircraft.
• For all these reasons, repeated exposures to long-duration +Gz acceleration lead to fatigue
and, in particular, neck pain and associated soft-tissue injury.
• Ø Fraktur Tulang
Ketika gaya gravitasi meningkat hingga sekitar 20G, tulang khususnya vertebrata akan
menjadi rentan terhadap fraktur bahkan dalam postur tubuh duduk.
+Gz acceleration (Head to foot)
• Effect of +Gz acceleration on cardiac rhythm
• Benign cardiac dysrhythmias have been observed in centrifuge studies during and
immediately following exposures to high sustained +Gz acceleration (Shubrooks 1972).
• Dysrhythmias have also been observed in flight (Zawadzka– Bartczak and Kopka 2011) but
no clinically significant episodes in flight have been reported. Most common are
premature ventricular contractions, which tend to occur during the acceleration exposure
itself, although occasionally premature supra-ventricular contractions are also observed.
• Sinus bradycardia and brief atrioventricular dissociation may occur after acceleration
exposure has ended. T
• hese changes are probably related to the profound changes in heart rate induced by
autonomic imbalance during and following G-exposure. It is generally considered that
these rhythm changes represent a normal physiological response to acceleration stress.
+Gz acceleration (Head to foot)
• Hormone response to +Gz acceleration
• Acceleration stress induces a specific endocrine response with increases in serum
cortisol, adrenaline and noradrenaline levels (Mills 1985). The cortisol response is
too slow to have an effect on tolerance to an acute exposure to acceleration, but it
may be significant in prolonged or repeated exposures. The acute release of
catecholamines and vasopressin (antidiuretic hormone) may also enhance G
tolerance by increasing peripheral resistance.
+Gz acceleration (Head to foot)
• Pulmonary effects of +Gz
acceleration
• PULMONARY VENTILATION AND
LUNG VOLUMES.

Figure 7.9 Effect of +Gz acceleration on

functional residual capacity (FRC) and closing
capacity (CC) expressed as a percentage of
total lung capacity (TLC) for a subject wearing
an anti-G suit that starts to inflate at +2 Gz
Tolerance to +Gz acceleration
• terbentuknya
varises di
tungkai,
• terbentuknya
penyakit
haemoroid
(wasir),
• bertambah
beratnya
penyakit
hernia,
• Edema pada
tumit dan
tungkai
bawah pada
penderita
gagal jantung
EXPOSURE TO –GZ ACCELERATION
(Foot to head)
• Cardiovascular effects of –Gz acceleration
• The rapid increase of arterial pressure in the neck stimulates the baroreceptors of the carotid
sinus. The intense stimulation of the carotid baroreceptors causes a large discharge of vagal
efferent impulses, which, in turn, produce bradycardia and may cause a variety of cardiac
dysrhythmias, ranging from simple prolongation of the P–R interval to complete
atrioventricular dissociation, with ectopic beats and asystole (periods of asystole of five to
seven seconds are not uncommon at –2.5 Gz). The bradycardia and generalized arteriolar
vasodilation cause mean arterial pressure at head level to decline after the initial increase
caused by the acceleration.
• The increase in pressure in cerebral vessels produced by –Gz acceleration exposure generally is
balanced externally by similar increases in the pressure of the cerebrospinal fluid, such that
there is no rise in transmural pressure and little risk of rupture of vessels within the skull. After a
few seconds, cerebral blood flow becomes increasingly compromised and mental confusion and
unconsciousness may result due to the reduction of cardiac output produced by stimulation of
the carotid sinus. Immediate loss of consciousness on exposure to high levels of –Gz
acceleration is usually related to a prolonged cardiac asystole or a slow ectopic rhythm.
• Ø Hiperemia
Ketika gaya gravitasi menurun hingga -4 sampai -6G, maka akan terjadi hiperemia dalam kepala (karena
peningkatan abnormal aliran darah) lantaran darah didorong ke kepala. Kadang-kadang darah akan bertumpuk
dalam kepala sehingga terjadi edema serebri.
Pada keadaan ini terdapat kongesti, flushing wajah dan sakit kepala yang ringan. G negatif pada tingkat ini masih
dapat ditolerir dan efek yang ditimbulkannya hanya bersifat sementara. Otak juga dapat bertahan terhadap
hiperemia pada keadaan semacam ini.
Kecenderungan aliran darah ke organ otak pada saat terjun bebas dengan posisi berdiri atau flat spin, menjadikan
pembuluh darah otak mengalami vasodilasi untuk menampung peningkatan volume darah yang mengalir ke organ
otak (hyperemia). Serta merta pula tekanan hidrostatis dalam pembuluh kapiler otak meningkat yang diikuti dengan
perembesan cairan plasma ke jaringan otak di sekitar pembuluh darah kapiler otak. Dengan demikian terjadi edema
otak dengan memberikan sensasi rasa berat atau penuh pada daerah kepala.
Pada individu tertentu, edema otak memunculkan gangguan psikosis berupa disorientasi dimana individu tidak
menyadari fenomena atau gangguan kesehatan yang sedang menimpa dirinya. Selain itu, peningkatan aliran darah
ke otak memicu kemoreseptor pada otak untuk meningkatkan aliran darah ke ginjal dengan maksud eksresi urine
ditingkatkan untuk mengurangi volume cairan total tubuh yang sesungguhnya mengarah ke dehidrasi.
Karena organ mata tidak terlindung oleh tulang kepala secara penuh, hyperemia dapat pula melanda bagian dalam
mata. Akibatnya, rongga mata dan bola mata penuh dengan darah, sehingga menyebabkan mata tampak merah
seperti pada penyakit konjungtivitis. Juga organ keseimbangan (vestibular) sehingga penerjun mengalami gangguan
keseimbangan tubuh beberapa saat sebelum berhasil mencapai keseimbangan tubuhnya kembali.
• Ø Red-out dan Sakit Kepala
Red-out merupakan pengelihatan yang menjadi kabur (tidak jelas) dan warna merah yang
timbulmendadak pada lapang pengelihatan sebagai akibat dari penggembungan
pembuluh darah di dalam kepala. Ketika G negatif mencapai sekitar -15 hingga -20, maka
akan terjadi dilatasi dan kongesti pembuluh darah dalam kepala dan mata sehingga timbul
gejala red-out serta sakit kepala.
Pembuluh darah dalam otak mungkin tidak banyak terpengaruh karena adanya cairan
serebrospinal. Ketika darah menumpuk dalam otak, pada saat yang sama akan terjadi
pooling cairan serebrospinal dalam kranium. Dan tekanan tinggi yang ditimbulkan oleh
cairan serebropinal ini bertindak sebagai bantalan (pendapar) dan melindungi pembuluh
darah otak.
• Ø Kehilangan Kesadaran
Akan tetapi, G negatif akan mempengaruhi tubuh dengan cara lain. G negatif akan
meningkatkan tekanan dalam pembuluh darah dada dan leher. Peningkatan tekanan ini
menyebabkan bradikardia atau irama jantung yang tidak teratur sehingga menambah
stagnasi darah di dalam kepala. Semua faktor ini pada akhirnya akan menimbulkan
kehilangan kesadaran
EXPOSURE TO –GZ ACCELERATION
(Foot to head)
Paparan akselerasi -Gz menghasilkan perpindahan kearah diafragma dan
mengurangi kapasitas vital dan kapasitas residual fungsional. Ini juga mengurangi
ventilasi paru. Distribusi regional ventilasi dan aliran darah dalam paru-paru
diubah oleh paparan -Gz dengan cara yang sama seperti yang dihasilkan oleh
akselerasi + Gz, tetapi secara anatomi terbalik. Karena tingkat di dalam paru di
mana tekanan vaskulaar paru tidak berubah oleh percepatan adalah di
persimpangan pertiga tengah dan basal, sebagian besar paru-paru tetap perfusi di
bawah akselerasi -Gz. Penutupan saluran udara terminal terjadi, menjebak gas di
daerah apikal, dan aliran darah yang terus-menerus melalui alveoli yang tidak
terventilasi membentuk desaratasi oksigen kanan-ke-kiri dan desaturasi oksigen
arteri seperti dengan akselerasi + Gz.
Tolerance to –Gz acceleration
(Foot to head)
• –Gz acceleration is not tolerated well. The limit is set by discomfort in the head,
oedema of the soft tissues of the face, petechial and subconjunctival
haemorrhages and loss of consciousness.
• The maximum acceleration that can be tolerated is around –5 Gz for 5 seconds. A
level of −3 Gz can be tolerated by most individuals in the seated posture for 10–
15 seconds, while –2 Gz can be tolerated for several minutes. A degree of
adaptation may develop with repeated exposures, and experienced aerobatic
display competitors may tolerate brief exposure to up to –9 Gz without
immediate problems.
+GX ACCELERATION (Chest to back)
• Increase in the weight of the limbs becomes apparent at +2 Gx, with difficulty in breathing
usually noted at +3 Gx.
• At and above +5 Gx there is a consistent ache in the chest, which is generally most severe
at the lower third of the sternum or epigastrium and which frequently radiates along the
costal margins.
• The pain is aggravated by inspiration, which becomes progressively more difficult and
shallow with increasing acceleration until around +9 to +12 Gx, at which point there is
severe difficulty in breathing.
• At about +15 Gx, inspiration is extremely difficult and there is a severe vice-like pain in the
chest. The limbs cannot be lifted at +8 Gx, although with the forearms supported fine
controlled movements of the wrist and fingers are possible up to and above +15 Gx. Lifting
the head is impossible at +7 to+9 Gx, or less when heavy headgear is worn. Petechial
haemorrhages may occur in the unsupported regions of the posterior surface of the body.
–Gx acceleration (back to chest)
• exposure to –Gx acceleration causes difficulty in breathing, nasal drip, salivation, sagging
of the lower eyelid and petechial haemorrhage. As with +Gx acceleration, the major
physiological disturbances occur in the respiratory system. The reduction of vital capacity
and the functional residual capacity produced by –Gx acceleration is markedly less than
that produced by +Gx acceleration, as the inertial forces pull the abdominal contents and
diaphragm away from the thoracic cavity. The proportion of anterior lung alveoli that are
not ventilated during –Gx exposure is correspondingly less than at a comparable level of
+Gx which results in an arterial oxyhaemoglobin saturation of 94 per cent on exposure to –
6 Gx compared with 80 per cent at +6 Gx. The head and the chest may be raised from the
horizontal positioning order to improve forwards vision, adding a small +Gz component,
but even with the chest and head elevated to an angle of 25 degrees from the horizontal,
vision is unimpaired on exposure to –12 Gx. Tolerance to sustained –Gx acceleration by a
person supported by a couch in the prone or semi-prone position is in excess of five
minutes at –5 Gx and two minutes at –10 Gx
Gy (lateral) acceleration
(right to left and left to right)
• Significant Gy (lateral) acceleration does not occur under normal fast jet flight
conditions, although forces around ±2 Gy may be generated by some high
performance aircraft during roll manoeuvres at high angles of attack, or in aircraft
featuring thrust vectoring. This level of Gy acceleration has little effect, but may
impede head mobility and increase the risk of neck injury, and possibly spatial
disorientation. At ±3 to ±4 Gy or more, there are profound effects on pulmonary
function due to the weight of the mediastinal contents acting on the dependent
lung to induce airway closure, right to left shunting and susceptibility
to atelectasis.