局部血液循環(huán)障礙理論課件

局部血液循環(huán)障礙理論課件1LocalHemodynamicDisorders

局部血液循環(huán)障礙病理學(xué)系彭勁武LocalHemodynamicDisorders

2Contents循環(huán)血量的異常(充血、缺血)血液內(nèi)出現(xiàn)異常物質(zhì)(血栓、空氣、脂滴、羊水等)血管內(nèi)成分逸出血管外（水腫、出血）Contents循環(huán)血量的異常(充血、缺血)3HyperemiaAndCongestion

Alocalincreasedvolumeofbloodinaparticulartissue充血和淤血局部組織血管內(nèi)血液含量增多

HyperemiaAndCongestion4

Hyperemia

Arterialhyperemia/ActivehyperemiaAnactiveprocessresultingfromaugmentedbloodflowduetoarteriolardilation

動(dòng)脈性充血

主動(dòng)性充血/動(dòng)脈性充血?jiǎng)用}輸入血量增多Hyperemia5局部血液循環(huán)障礙理論課件6局部血液循環(huán)障礙理論課件7原因：血管舒張神經(jīng)興奮性↑

血管收縮神經(jīng)興奮性↓舒張血管活性物質(zhì)釋放分類：生理性充血

病理性充血減壓后充血Causes:excitabilityofvasodilatator↑

excitabilityofvasoconstrictor↓diliveryofrelaxingvasoactivesubstanceClassification:physiologiccongestionpathologicalcongestioncongestionafterdecompression原因：血管舒張神經(jīng)興奮性↑Causes:exc8hyperemiaofappendix

闌尾充血hyperemiaofappendix9pathologicalchanges:Consequence:病變：后果：pathologicalchanges:10hyperemiahyperemia11

Congestion

Venoushyperemia/PassivehyperemiaApassiveprocessresultingfromimpairedvenousreturnfromatissue

淤血靜脈性充血/被動(dòng)性充血靜脈血流回流受阻Congestion12局部血液循環(huán)障礙理論課件13Reasons:

Localcongestion：Externalpressure／

Thrombosis／Venousvalves

Systemiccongestion：Heartfailures原因：局部：靜脈受壓／靜脈腔阻塞全身：心力衰竭Reasons:14局部血液循環(huán)障礙理論課件15

Pathologicalchanges：

cyanosis---ablue-redcolor病變：發(fā)紺

Pathologicalchanges：16

FateAtrophy/Degeneration/NecrosisCongestiveedemaCongestivehemorrhageCongestivesclerosis萎縮/變性/壞死淤血性水腫淤血性出血淤血性硬化Fate17LungcongestionLungcongestion18局部血液循環(huán)障礙理論課件19Lungcongestion

Lungbrowninduration

Heartfailurecells肺淤血肺褐色硬化（慢性肺淤血）心衰細(xì)胞Lungcongestion20LungbrownindurationLungbrowninduration21局部血液循環(huán)障礙理論課件22局部血液循環(huán)障礙理論課件23局部血液循環(huán)障礙理論課件24局部血液循環(huán)障礙理論課件25heartfailurecellsheartfailurecells26HeartFailurecellsHeartFailurecells27Livercongestion

Nutmegliver

Congestivelivercirrhosis肝淤血檳榔肝（慢性肝淤血）淤血性肝硬化Livercongestion28NutmegliverNutmegNutmegliverNutmeg29NutmegliverNutmegliver30NutmegliverNutmegliver31局部血液循環(huán)障礙理論課件32局部血液循環(huán)障礙理論課件33局部血液循環(huán)障礙理論課件34局部血液循環(huán)障礙理論課件35CongestivelivercirrhosisCongestivelivercirrhosis36Thrombosis／ThrombusThrombosisistheprocessofformationofasolidfromthebloodwithinlivingbloodvesselsortheheart,theresultantistermedathrombus.血栓形成/血栓在活體的心臟和血管內(nèi)，血液發(fā)生凝固或血液中某些有形成分凝集形成固體質(zhì)塊的過(guò)程.Thrombosis／Thrombus37mixedthrombusmixedthrombus38紅色血栓紅色血栓39Threeprimaryinfluencespredisposetothrombusformation:Endothelialinjury(mostimportant)AlonecaninducethrombosisStasisorturbulenceofbloodflowBloodhypercoagulability血栓形成的三個(gè)條件:心血管內(nèi)皮細(xì)胞的損傷血流狀態(tài)的改變(緩慢,渦流)血液凝固性增高Threeprimaryinfluencespredi40Ulcerativeatherosclerosis(潰瘍性的動(dòng)脈粥樣硬化)Transmuralmyocardialinfarction(透壁的心肌梗塞)Vasculitis(脈管炎,血管炎)Trauma(創(chuàng)傷,外傷,損傷)Radiation(輻射,放射)Bacterialtoxins(細(xì)菌毒素)心血管內(nèi)皮細(xì)胞的損傷Ulcerativeatherosclerosis(潰瘍性41抗凝ProtectivescreenPGI2,NO,ADP酶ThrombomodulinMembrane-associatedheparin-likemoleculesProteinSt-PA抗凝ProtectivescreenPGI2,NO,ADP42促凝組織因子VonWillebrandfactorPAIs促凝組織因子VonWillebrandfactorPAI43Oncontactwithextracellularmatrix(ECM),plateletsundergothreegeneralreactions:

AdhesionreactionReleasereactionAggregationreaction血小板的活化

粘附反應(yīng)

釋放反應(yīng)

粘集反應(yīng)Oncontactwithextracellular44血流狀態(tài)的改變(緩慢,渦流)Plateletsactivatedbycontactwithendothelium.Slowedflowretardsdilutionofactivatedclottingfactorsandhepaticclearance.Turbulencemayinduceendothelialinjury血流狀態(tài)的改變(緩慢,渦流)45血液凝固性增高:Primary(genetic):Antithrombin(抗凝血酶)IIIdeficiencyProteinCdeficiencyProteinSdeficiencySecondary(acquired):Prolongedbedrest(長(zhǎng)期臥床休息)Myocardialinfarction(心肌梗塞)Tissuedamage(surgery,fractures,burns)Cardiacfailure(心力衰竭).Cancer.Acuteleukemia(急性白血病).DIC.

血液凝固性增高:46ProcessofthrombusformationProcessofthrombusformation47局部血液循環(huán)障礙理論課件48TypesofthrombusPalethrombus

MixedthrombusRedthrombusHyalinethrombus/microthrombus/fibrinousthrombus血栓的類型

白色血栓

混合血栓

紅色血栓

透明血栓/微血栓/纖維素性血栓Typesofthrombus49白色血栓白色血栓50palethrombuspalethrombus51門靜脈內(nèi)血栓形成門靜脈內(nèi)血栓形成52腎靜脈內(nèi)血栓形成腎靜脈內(nèi)血栓形成53局部血液循環(huán)障礙理論課件54左心室附壁血栓左心室附壁血栓55左心房?jī)?nèi)球形附壁血栓左心房?jī)?nèi)球形附壁血栓56局部血液循環(huán)障礙理論課件57mixedthrombusmixedthrombus58局部血液循環(huán)障礙理論課件59局部血液循環(huán)障礙理論課件60紅色血栓紅色血栓61hyalinethrombushyalinethrombus62局部血液循環(huán)障礙理論課件63FateoftheThrombusDissolutionOrganization/recanalizationCalcification/phlebolith/arteriolith血栓的結(jié)局

軟化、溶解、吸收機(jī)化/再通鈣化/靜脈石/動(dòng)脈石FateoftheThrombus64局部血液循環(huán)障礙理論課件65局部血液循環(huán)障礙理論課件66recanalizationrecanalization67局部血液循環(huán)障礙理論課件68影響：“弊大于利”1.阻塞血管2.栓塞

3.心瓣膜變形4.廣泛性出血:DICEffectsofthrombosis：Ischemia(局部缺血)／CongestionEmbolismHeartvalvediseaseDIC影響：“弊大于利”Effectsofthrombosis69

EmbolismEmbolusAnembolusisadetachedintravascularsolid,liquid,orgaseousmassthatiscarriedbythebloodtoasitedistantfromitspointoforigin栓塞栓子在循環(huán)血液中出現(xiàn)的不溶于血液的異常物質(zhì)，隨血流運(yùn)行阻塞血管腔的現(xiàn)象稱為栓塞。Embolism栓塞70Motionalpathwayofembolus:

EmbolusfromleftheartcavityorarterialsystemEmbolusfromrightheartcavityorvenoussystemEmbolusfromportalveinsParadoxicalembolismRetrogradeethrombus栓子運(yùn)行的途徑：動(dòng)脈系統(tǒng)及左心栓子靜脈系統(tǒng)及右心栓子門靜脈系統(tǒng)栓子交叉性栓塞逆行性栓塞Motionalpathwayofembolus:栓子71局部血液循環(huán)障礙理論課件72運(yùn)行途徑運(yùn)行途徑73Thromboembolism

PulmonarythromboembolismSystemicthromboembolism血栓栓塞肺動(dòng)脈栓塞體循環(huán)動(dòng)脈栓塞:下肢.腦.腸.腎Thromboembolism74pulmonaryembolismpulmonaryembolism75肺動(dòng)脈主干及分支血栓栓塞肺動(dòng)脈主干及76

這里是位于通向左肺的肺動(dòng)脈內(nèi)一個(gè)大的肺血栓。這類血栓發(fā)源于不能走動(dòng)的病人的大腿靜脈或骨盆靜脈。

77局部血液循環(huán)障礙理論課件78局部血液循環(huán)障礙理論課件79局部血液循環(huán)障礙理論課件80局部血液循環(huán)障礙理論課件81血栓栓子停留在腦動(dòng)脈，發(fā)源于左心房的一個(gè)附壁血栓。心臟是這種拴子的常見來(lái)源。

血栓栓子停留在腦動(dòng)脈，發(fā)源于左心房的一個(gè)附壁血栓。心臟是這種82Etiology:FracturesoflongbonesSofttissuetrauma(創(chuàng)傷)Burns脂肪栓塞Etiology:脂肪栓塞83Fatembolism

(脂肪栓塞)

Fatembolism(脂肪栓塞)84局部血液循環(huán)障礙理論課件85局部血液循環(huán)障礙理論課件86GasembolismAirembolismDecompression

sickness

Amnioticfluidembolism氣體栓塞

空氣栓塞減壓病Gasembolism87羊水栓塞Incidence:1/50000deliveriesMortalityrate:20-80%Clinicalonset:Suddenseveredyspnea,cyanosis,hypotensiveshock,seisuresandcoma.羊水栓塞Incidence:1/50000delive88角化上皮角化上皮89其他栓塞:膽固醇栓子其他栓塞:膽固醇栓子90癌栓癌栓91局部血液循環(huán)障礙理論課件92局部血液循環(huán)障礙理論課件93InfarctionAninfarctionisanareaofischemicnecrosiscausedbyocclusionofeitherthearterialsupplyorthevenousdrainageinaparticulartissue梗死器官或局部組織由于血管阻塞(動(dòng)脈多見)、血流停止導(dǎo)致缺氧而發(fā)生壞死的過(guò)程，稱為梗死形成，所形成的局部壞死稱為梗死Infarction94Causes

血栓形成:心,腦,肢體動(dòng)脈栓塞:腎,脾,肺,腦動(dòng)脈痙攣血管受壓閉塞Causes血栓形成:心,腦,肢體95Characteristics

Shape:Wedge-shaped(楔形)

Segmental(節(jié)段性)

Irregular(不規(guī)則形)color:Redandwhiteinfarcts

Characteristics96ClassificationAnemicinfarcts/WhiteinfarctsHemorrhagicinfarcts/RedinfarctsSepticinfarcts分類貧血性梗死/白色梗死:心,腎,脾出血性梗死/紅色梗死:肺、腸敗血性梗死Classification97局部血液循環(huán)障礙理論課件98RenalinfarctRenalinfarct99局部血液循環(huán)障礙理論課件100SpleeninfarctSpleeninfarct101局部血液循環(huán)障礙理論課件102Lung

infarctLunginfarct103局部血液循環(huán)障礙理論課件104梗死區(qū)梗死區(qū)105局部血液循環(huán)障礙理論課件106腸梗死正常腸Intestineinfarct腸梗死正常腸Intestineinfarct107局部血液循環(huán)障礙理論課件108細(xì)菌栓子細(xì)菌栓子109THANKS提問(wèn)THANKS提問(wèn)110一、名詞解釋：Congestion/HeartfailurecellsBrownindurationoflung/NutmegliverThrombosis/MixedthrombusHyalinethrombus/RecanalizationCrossedembolism/RetrogradeembolismAmnioticfluidembolism/InfarctionAnemicinfarcts/HemorrhagicinfartsDecompressionsickness一、名詞解釋：111二、問(wèn)答題：1、慢性肝淤血時(shí)，肝切面為什么會(huì)出現(xiàn)檳榔狀花紋？2、栓子是如何運(yùn)行的？3、羊水栓塞的病理特征是什么？4、靜脈淤血、血栓形成、栓塞及梗死之間有何聯(lián)系？二、問(wèn)答題：112局部血液循環(huán)障礙理論課件113LocalHemodynamicDisorders

局部血液循環(huán)障礙病理學(xué)系彭勁武LocalHemodynamicDisorders

114Contents循環(huán)血量的異常(充血、缺血)血液內(nèi)出現(xiàn)異常物質(zhì)(血栓、空氣、脂滴、羊水等)血管內(nèi)成分逸出血管外（水腫、出血）Contents循環(huán)血量的異常(充血、缺血)115HyperemiaAndCongestion

Alocalincreasedvolumeofbloodinaparticulartissue充血和淤血局部組織血管內(nèi)血液含量增多

HyperemiaAndCongestion116

Hyperemia

Arterialhyperemia/ActivehyperemiaAnactiveprocessresultingfromaugmentedbloodflowduetoarteriolardilation

動(dòng)脈性充血

主動(dòng)性充血/動(dòng)脈性充血?jiǎng)用}輸入血量增多Hyperemia117局部血液循環(huán)障礙理論課件118局部血液循環(huán)障礙理論課件119原因：血管舒張神經(jīng)興奮性↑

血管收縮神經(jīng)興奮性↓舒張血管活性物質(zhì)釋放分類：生理性充血

病理性充血減壓后充血Causes:excitabilityofvasodilatator↑

excitabilityofvasoconstrictor↓diliveryofrelaxingvasoactivesubstanceClassification:physiologiccongestionpathologicalcongestioncongestionafterdecompression原因：血管舒張神經(jīng)興奮性↑Causes:exc120hyperemiaofappendix

闌尾充血hyperemiaofappendix121pathologicalchanges:Consequence:病變：后果：pathologicalchanges:122hyperemiahyperemia123

Congestion

Venoushyperemia/PassivehyperemiaApassiveprocessresultingfromimpairedvenousreturnfromatissue

淤血靜脈性充血/被動(dòng)性充血靜脈血流回流受阻Congestion124局部血液循環(huán)障礙理論課件125Reasons:

Localcongestion：Externalpressure／

Thrombosis／Venousvalves

Systemiccongestion：Heartfailures原因：局部：靜脈受壓／靜脈腔阻塞全身：心力衰竭Reasons:126局部血液循環(huán)障礙理論課件127

Pathologicalchanges：

cyanosis---ablue-redcolor病變：發(fā)紺

Pathologicalchanges：128

FateAtrophy/Degeneration/NecrosisCongestiveedemaCongestivehemorrhageCongestivesclerosis萎縮/變性/壞死淤血性水腫淤血性出血淤血性硬化Fate129LungcongestionLungcongestion130局部血液循環(huán)障礙理論課件131Lungcongestion

Lungbrowninduration

Heartfailurecells肺淤血肺褐色硬化（慢性肺淤血）心衰細(xì)胞Lungcongestion132LungbrownindurationLungbrowninduration133局部血液循環(huán)障礙理論課件134局部血液循環(huán)障礙理論課件135局部血液循環(huán)障礙理論課件136局部血液循環(huán)障礙理論課件137heartfailurecellsheartfailurecells138HeartFailurecellsHeartFailurecells139Livercongestion

Nutmegliver

Congestivelivercirrhosis肝淤血檳榔肝（慢性肝淤血）淤血性肝硬化Livercongestion140NutmegliverNutmegNutmegliverNutmeg141NutmegliverNutmegliver142NutmegliverNutmegliver143局部血液循環(huán)障礙理論課件144局部血液循環(huán)障礙理論課件145局部血液循環(huán)障礙理論課件146局部血液循環(huán)障礙理論課件147CongestivelivercirrhosisCongestivelivercirrhosis148Thrombosis／ThrombusThrombosisistheprocessofformationofasolidfromthebloodwithinlivingbloodvesselsortheheart,theresultantistermedathrombus.血栓形成/血栓在活體的心臟和血管內(nèi)，血液發(fā)生凝固或血液中某些有形成分凝集形成固體質(zhì)塊的過(guò)程.Thrombosis／Thrombus149mixedthrombusmixedthrombus150紅色血栓紅色血栓151Threeprimaryinfluencespredisposetothrombusformation:Endothelialinjury(mostimportant)AlonecaninducethrombosisStasisorturbulenceofbloodflowBloodhypercoagulability血栓形成的三個(gè)條件:心血管內(nèi)皮細(xì)胞的損傷血流狀態(tài)的改變(緩慢,渦流)血液凝固性增高Threeprimaryinfluencespredi152Ulcerativeatherosclerosis(潰瘍性的動(dòng)脈粥樣硬化)Transmuralmyocardialinfarction(透壁的心肌梗塞)Vasculitis(脈管炎,血管炎)Trauma(創(chuàng)傷,外傷,損傷)Radiation(輻射,放射)Bacterialtoxins(細(xì)菌毒素)心血管內(nèi)皮細(xì)胞的損傷Ulcerativeatherosclerosis(潰瘍性153抗凝ProtectivescreenPGI2,NO,ADP酶ThrombomodulinMembrane-associatedheparin-likemoleculesProteinSt-PA抗凝ProtectivescreenPGI2,NO,ADP154促凝組織因子VonWillebrandfactorPAIs促凝組織因子VonWillebrandfactorPAI155Oncontactwithextracellularmatrix(ECM),plateletsundergothreegeneralreactions:

AdhesionreactionReleasereactionAggregationreaction血小板的活化

粘附反應(yīng)

釋放反應(yīng)

粘集反應(yīng)Oncontactwithextracellular156血流狀態(tài)的改變(緩慢,渦流)Plateletsactivatedbycontactwithendothelium.Slowedflowretardsdilutionofactivatedclottingfactorsandhepaticclearance.Turbulencemayinduceendothelialinjury血流狀態(tài)的改變(緩慢,渦流)157血液凝固性增高:Primary(genetic):Antithrombin(抗凝血酶)IIIdeficiencyProteinCdeficiencyProteinSdeficiencySecondary(acquired):Prolongedbedrest(長(zhǎng)期臥床休息)Myocardialinfarction(心肌梗塞)Tissuedamage(surgery,fractures,burns)Cardiacfailure(心力衰竭).Cancer.Acuteleukemia(急性白血病).DIC.

血液凝固性增高:158ProcessofthrombusformationProcessofthrombusformation159局部血液循環(huán)障礙理論課件160TypesofthrombusPalethrombus

MixedthrombusRedthrombusHyalinethrombus/microthrombus/fibrinousthrombus血栓的類型

白色血栓

混合血栓

紅色血栓

透明血栓/微血栓/纖維素性血栓Typesofthrombus161白色血栓白色血栓162palethrombuspalethrombus163門靜脈內(nèi)血栓形成門靜脈內(nèi)血栓形成164腎靜脈內(nèi)血栓形成腎靜脈內(nèi)血栓形成165局部血液循環(huán)障礙理論課件166左心室附壁血栓左心室附壁血栓167左心房?jī)?nèi)球形附壁血栓左心房?jī)?nèi)球形附壁血栓168局部血液循環(huán)障礙理論課件169mixedthrombusmixedthrombus170局部血液循環(huán)障礙理論課件171局部血液循環(huán)障礙理論課件172紅色血栓紅色血栓173hyalinethrombushyalinethrombus174局部血液循環(huán)障礙理論課件175FateoftheThrombusDissolutionOrganization/recanalizationCalcification/phlebolith/arteriolith血栓的結(jié)局

軟化、溶解、吸收機(jī)化/再通鈣化/靜脈石/動(dòng)脈石FateoftheThrombus176局部血液循環(huán)障礙理論課件177局部血液循環(huán)障礙理論課件178recanalizationrecanalization179局部血液循環(huán)障礙理論課件180影響：“弊大于利”1.阻塞血管2.栓塞

3.心瓣膜變形4.廣泛性出血:DICEffectsofthrombosis：Ischemia(局部缺血)／CongestionEmbolismHeartvalvediseaseDIC影響：“弊大于利”Effectsofthrombosis181

EmbolismEmbolusAnembolusisadetachedintravascularsolid,liquid,orgaseousmassthatiscarriedbythebloodtoasitedistantfromitspointoforigin栓塞栓子在循環(huán)血液中出現(xiàn)的不溶于血液的異常物質(zhì)，隨血流運(yùn)行阻塞血管腔的現(xiàn)象稱為栓塞。Embolism栓塞182Motionalpathwayofembolus:

EmbolusfromleftheartcavityorarterialsystemEmbolusfromrightheartcavityorvenoussystemEmbolusfromportalveinsParadoxicalembolismRetrogradeethrombus栓子運(yùn)行的途徑：動(dòng)脈系統(tǒng)及左心栓子靜脈系統(tǒng)及右心栓子門靜脈系統(tǒng)栓子交叉性栓塞逆行性栓塞Motionalpathwayofembolus:栓子183局部血液循環(huán)障礙理論課件184運(yùn)行途徑運(yùn)行途徑185Thromboembolism

PulmonarythromboembolismSystemicthromboembolism血栓栓塞肺動(dòng)脈栓塞體循環(huán)動(dòng)脈栓塞:下肢.腦.腸.腎Thromboembolism186pulmonaryembolismpulmonaryembolism187肺動(dòng)脈主干及分支血栓栓塞肺動(dòng)脈主干及188

這里是位于通向左肺的肺動(dòng)脈內(nèi)一個(gè)大的肺血栓。這類血栓發(fā)源于不能走動(dòng)的病人的大腿靜脈或骨盆靜脈。

189局部血液循環(huán)障礙理論課件190局部血液循環(huán)障礙理論課件191局部血液循環(huán)障礙理論課件192局部血液循環(huán)障礙理論課件193血栓栓子停留在腦動(dòng)脈，發(fā)源于左心房的一個(gè)附壁血栓。心臟是這種拴子的常見來(lái)源。

血栓栓子停留在腦動(dòng)脈，發(fā)源于左心房的一個(gè)附壁血栓。心臟是這種194Etiology:FracturesoflongbonesSofttissuetrauma(創(chuàng)傷)Burns脂肪栓塞Etiology:脂肪栓塞195Fatembolism

(脂肪栓塞)

Fatembolism(脂肪栓塞)196局部血液循環(huán)障礙理論課件197局部血液循環(huán)障礙理論課件198GasembolismAirembolismDecompression

sickness

Amnioticfluidembolism氣體栓塞