病理學(xué)課件 血液循環(huán)障礙-2016 March-liugy

血液循環(huán)系統(tǒng)障礙

HemodynamicDisorders劉國元gyliu@《心血運(yùn)動論》威廉·哈維AnAnatomicalStudyoftheMotionoftheHeartandoftheBloodinAnimals,1628ContainingHeart,artery,VeinGeneralcirculation&PulmonarycirculationFunctionsDeliveroxygenandnutrientsCarryawaymetabolicwastes健康的循環(huán)系統(tǒng)：

正常血容量（Normalbloodvolume）

血液穩(wěn)態(tài)（Homeostasis）血液穩(wěn)態(tài)

Normalhomeostasis

血管壁完整性vesselwallintegrity

靜水壓intravascularpressure

膠滲壓osmolarity

正常凝血normalhemostasisEdema水腫Hyperemia&congestion

充血和淤血Thrombosis&Embolism

血栓形成和栓塞Infarction梗死Hemorrhage出血Shock休克ThreeMajorCausesofmorbidityandmortality

Myocardialinfarction心肌梗死

Pulmonaryembolism肺栓塞

Cerebralvascularaccident腦血管意外，中風(fēng)CirculationDisturbanceGeneral(全身性)Someseveresituationaffectingalloverthebody:cardiacdysfunction心功能不全

shockLocal（局部性）Abnormalbloodvolumeandthevelocityofbloodflow:hyperemia&ischemiaAbnormalityofvascularintegrityandpermeability:edema&hemorrhage

Occlusionofthevessellumen:thrombosis,embolism&infarction

12WordsandVocabulariescyanosisedemasclerosisheartfailurecellbrownindurationnutmeglivermixedthrombushyalinethromusorganizationrecanalizationphlebolith&arteriolithcrossedembolismorparadoxicalembolismretrogradeembolismthromboembolismcaissondiseasedecompressionsicknessamnioticfluidembolismsepticinfarctEDEMA

(水腫)組織間隙(interstitialtissuespaces)液體含量增加General&localPathogenesisVascularhydrostaticpressurePlasmacolloidosmoticpressureLymphaticdrainageEDEMAIncreasedhydrostaticpressure(心功能不全致心源性水腫，cardiacedema)Reducedplasmaosmoticpressure(nephrotic,hepatic,malnutrientedema,etc.)Lymphaticobstruction(絲蟲病感染—橡皮腫，乳癌擴(kuò)大根治術(shù)后)Sodiumandwaterretention水鈉潴留(急性腎衰)MinimalChangeDiseaseelephantiasisPittingedemaEDEMAMostcommontypesSubcutaneousedemaPulmonaryedemaEdemaofthebrainMorphologyLightMicroscope（LM）:ClearingandseparationoftheextracellularmatrixelementsCellswelling特殊類型Hydrothorax胸腔積液hydropericardium心包腔積液hydroperitoneum(ascites)腹腔積液Anasarca全身性水腫EDEMAClinicalcorrelationfromannoyingtofatalindicatesubtlediseasebenefitorharmfulHYPEREMIA&CONGESTION

充血和淤血局部組織血管內(nèi)血液含量的增多Arterialhyperemia(hyperemia，充血)局部器官或組織由于動脈血輸入量增多而發(fā)生的充血

anaugmentedbloodflowinducingarteriolarandcapillarydilationVenoushyperemia(congestion，淤血)局部器官或組織由于靜脈血液回流受阻，血液淤積于小靜脈和毛細(xì)血管內(nèi)accumulationofbloodinsmallveinsandcapillariesresultfromdrainagedifficultyofveinsHyperemia:activeprocess主動過程;red,raisedtemperature,increasedvolume（紅熱腫）enhancedfunction功能增強(qiáng);Congestion:

passiveprocess被動過程;generalorlocal;reddishbluecolor(cyanosis發(fā)紺),lowtemperature,increasedvolume,edema（紫冷腫）decreasedfunction功能低下機(jī)制：

血管舒張神經(jīng)興奮性↑

血管收縮神經(jīng)興奮性↓類型：

生理性：

如害羞時，運(yùn)動時，進(jìn)餐后

病理性：炎性充血，減壓后充血

利弊：

－plentysupplyofO2,functionalenhancement,nutritionsubstance

－h(huán)eadache,hemorrhage,stroke

HYPEREMIA充血Pathologicchanges

Gross—Floridincolor

－Raisedtemperature

－Enlargedvolumeoforganortissue

LM－DilationofarterioleandcapillarystuffingwithRBCCauses:

全身性:體循環(huán)淤血，肺循環(huán)淤血

cardiacdysfunction(rightorleft)局灶性:局部靜脈受壓或阻塞

externalcompression---tumor,bandage occlusionoflumen---thrombosis,embolism thickeningofvenouswall paralysisofneurogenicmodulation---burn,frostbite

CONGESTION淤血CONGESTIONChroniccongestionraisedvenouspressure

AnoxiaMetaboliteaccumulationEnlargedinterendothelialgapBasemembranedegeneration

Parenchymal

InterstitialfibrosisAtrophyReticularfibercollapsedIncreasedpermeabilityDegenerationCollagenincreasedNecrosisFibroblastproliferationMicroscopicscarring

Edema&Hemorrhage

CongestivesclerosisCONGESTION

淤血

靜脈壓升高

缺氧及代謝產(chǎn)物堆積

毛細(xì)血管內(nèi)皮間隙增寬

基底膜變性

實(shí)質(zhì)細(xì)胞萎縮、變性和壞死間質(zhì)纖維組織增生

血管通透性增加

淤血性水腫

淤血性出血

淤血性硬化Morphology大體鏡下小血管內(nèi)富含紅細(xì)胞

CONGESTION肺急性肺淤血acutepulmonarycongestionGross:肺飽滿腫脹，胸膜光亮，切面流出泡沫狀紅色水腫液體(edematousfluid)

LM:肺泡壁毛細(xì)血管高度擴(kuò)張充血——串珠樣、玫瑰樣肺泡腔“虛實(shí)不一”，充滿嗜酸性水腫液臨床病理聯(lián)系

氣促、發(fā)紺、粉紅色泡沫痰

foamypinkysputum慢性肺淤血chronicpulmonarycongestion多由風(fēng)濕性心瓣膜病伴心功能不全引起Gross:質(zhì)地較硬，棕褐色，散在分布有棕色小點(diǎn)

——褐色硬化(BrownInduration)LM:肺泡壁(septa)增厚纖維化心衰細(xì)胞(heartfailurecells)

——吞噬紅細(xì)胞并將血紅蛋白分解形成棕黃色的含鐵血黃素（hemosiderin）的巨噬細(xì)胞

—hemosiderin-ladenmacrophage臨床病理聯(lián)系：

咳嗽，咳鐵銹色痰，呼吸困難肝急性肝淤血acutehepaticcongestion大體：肝臟體積增大，呈暗紅色鏡下：

小葉中央靜脈和肝竇(sinusoid)擴(kuò)張，充滿紅細(xì)胞

嚴(yán)重時可有小葉中央肝細(xì)胞萎縮、壞死

慢性肝淤血chronichepaticcongestion檳榔肝NutmegLiver

Gross：肝小葉中央?yún)^(qū)因嚴(yán)重淤血而呈暗紅色，肝小葉周邊部肝組織因脂肪變性而呈黃色，紅(淤血區(qū))黃(肝脂肪變區(qū))相間，狀似檳榔切面。LM：肝小葉中央?yún)^(qū)淤血乃至出血，肝細(xì)胞萎縮，甚至壞死、崩解消失，肝小葉周邊部肝細(xì)胞脂肪變性。長期嚴(yán)重的肝淤血

纖維組織增生，肝臟表面細(xì)小顆粒狀“豬皮”

“淤血性肝硬化”（心源性肝纖維化）hepaticfibrosis(cardiaccirrhosis).nutmegliver

Centrilobularnecrosis慢性肝淤血Spleencongestion

Cause:livercirrhosis,cardiacfailurePathologicchange:

tobacconodulesGandy-Gammanodules

含鐵小結(jié)/煙草小結(jié)

Hemorrhage（出血）Causes血管破裂(破裂性出血）Trauma Pepticulcer,aneurism,atherosclerosis出血傾向(漏出性出血）Enlargedinterendothelialgap(basementmembraneinjury).Theintegrityofthevesselsremainsintact

Injurytovascularwall:severeinfection,anoxia,toxinsChangeinnumberandqualityofplateletsuremia,leukemia,idiopathic

Disturbanceofcoagulationmechanismcongenitaldisease,DIC,deficiencyofVit.KHemorrhage瘀點(diǎn)petechiae紫癜purpuras瘀斑ecchymoses血腫hematoma胸腔積血hemothorax心包腔積血hemopericardium腹腔積血hemoperitoneum關(guān)節(jié)腔積血hemoarthrosis臨床意義取決于出血的類型、出血量、出血速度和出血部位嚴(yán)重后果：

HemorrhagicshockStroke

NormalhemostasisMaintainbloodinafluid,clot-freestateLocalizedhemostaticplug止血栓血栓形成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)塊的過程稱為血栓形成(thrombosis)；所形成的固體質(zhì)塊稱為血栓(thrombus)。Hemostasis&thrombosis

（止血和血栓形成）凝血系統(tǒng)纖維蛋白溶解系統(tǒng)（抗凝血系統(tǒng)）Vasoconstriction血管攣縮Primaryhemostasis一期（初步）止血Hemostasis

止血過程Secondaryhemostasis二期止血antithromboticcounter-regulation抗血栓形成反向調(diào)節(jié)

Dependenton—Thevascularwall—Platelets—ThecoagulationcascadeHemostasisandthrombosis三個參與止血的主要成分

血管壁

血小板

凝血級聯(lián)反應(yīng)凝血途徑CoagulationPathway內(nèi)源性凝血途徑；外源性凝血途徑凝血因子Ⅰ~ⅩⅢ,Ca2+，血小板磷脂F(xiàn)Ⅲ：組織因子；FⅡ：凝血酶原；FⅠ：纖維蛋白原“a”代表水解激活后狀態(tài)

Coagulationcascade凝血級聯(lián)反應(yīng)

Fibrinolyticsystem抗凝特性Antithrombotic（內(nèi)皮完整時）屏障抗血小板antiplatelet抗凝anticoagulant纖溶fibrinolytic促凝特性Prothrombotic（內(nèi)皮受損時）輔助血小板黏附激活外源性凝血途徑抑制纖維蛋白溶解

Endothelium血管內(nèi)皮細(xì)胞

黏附反應(yīng)AdhesiontoECMvWF釋放反應(yīng)

(releasereaction/secretion)Ca++,ADP,TXA2黏集反應(yīng)(aggregation)凝血級聯(lián)反應(yīng)

Platelets血小板ThrombosisPathogenesis心血管內(nèi)皮細(xì)胞損傷血流狀態(tài)異常血液凝固性增加

魏爾嘯三角VirchowTriangle1心血管內(nèi)皮細(xì)胞的損傷血栓形成的主要影響因素對心臟和動脈內(nèi)血栓的形成尤為重要心肌梗死、心瓣膜炎嚴(yán)重動脈粥樣硬化時有潰瘍形成的斑塊創(chuàng)傷/炎癥性血管損傷損傷因素創(chuàng)傷、缺氧、化學(xué)物質(zhì)、感染、免疫反應(yīng)…高膽固醇血癥、高血壓、高胱氨酸尿、放射線…2血流緩慢、渦流形成靜脈系血栓形成的主要原因血流緩慢——

心力衰竭、手術(shù)后及久臥床者渦流形成——動脈粥樣硬化潰瘍性斑塊 動脈瘤 風(fēng)濕性心瓣膜病二尖瓣狹窄ThemajorfactorinthedevelopmentofvenousthrombiIncidenceofthrombosisV:A=4:1Veinsofupperlimb:lowerlimb=1:33血液凝固性增強(qiáng)凝血系統(tǒng)纖維蛋白溶解系統(tǒng)遺傳性高凝狀態(tài)第Ⅴ因子基因突變、抗凝血酶Ⅲ以及C蛋白、S蛋白先天性缺乏…

繼發(fā)性高凝狀態(tài)嚴(yán)重創(chuàng)傷、手術(shù)或產(chǎn)后大面積燒傷、晚期腫瘤、腎病綜合癥…endothelialintegrity—singlemostimportantfactorindependentorcombinedimportantinheart/arterialthrombosismajorfactorinvenousthrombosis

HypercoagulableStatesPrimary(Genetic)Common

MutationinfactorVgene(factorVLeiden)

Mutationinprothrombingene

MutationinmethyltetrahydrofolategeneRare

AntithrombinIIIdeficiency

ProteinCdeficiency

ProteinSdeficiencyVeryrare

FibrinolysisdefectsSecondary(Acquired)Highriskforthrombosis

Prolongedbedrestorimmobilization

Myocardialinfarction

Atrialfibrillation

Tissuedamage(surgery,fracture,burns)

Cancer

Prostheticcardiacvalves

Disseminatedintravascularcoagulation

Heparin-inducedthrombocytopenia

Antiphospholipidantibodysyndrome(lupusanticoagulantsyndrome)Lowerriskforthrombosis

Cardiomyopathy

Nephroticsyndrome

Hyperestrogenicstates(pregnancy)

Oralcontraceptiveuse

Sicklecellanemia

SmokingThrombosisMorphology動脈血栓originatefrominjurysites靜脈血栓

(phlebothrombus)originatefromthesitesofstasis bothextendtotheheart血栓形成2個階段——血小板的沉積與凝集 血液的凝固

內(nèi)皮損傷---血小板小丘、小梁---白細(xì)胞粘附---纖維蛋白網(wǎng)架---紅細(xì)胞---阻塞管腔---紅色血栓血栓頭（白色血栓）混合血栓（血栓體）血栓尾（紅色血栓）1.血栓頭（白色血栓）與血管壁緊密粘著,血小板+少量纖維蛋白構(gòu)成2.混合血栓（血栓體）Zahn線，灰白色與暗褐色相間的條紋狀結(jié)構(gòu)

paleplateletandfibrinlayers darkerythrocyte-richlayers

3.血栓尾（紅色血栓）RBC血栓的結(jié)構(gòu)LinesofZahnThrombosisLM:plateletstrabeculae+neutrophil fibrin+redcellsThrombosisTypes

MuralthrombusOcclusivethrombusGlobularthrombusVegetation細(xì)菌性血栓

腫瘤性血栓

PalethrombusMixedthrombusRedthrombusHyalinethrombus血栓的部位血栓的結(jié)構(gòu)血栓的內(nèi)容

白色血栓PaleThrombus血小板&纖維蛋白靜脈性/延續(xù)性血栓頭部

多見于心瓣膜、心腔或主動脈eg.贅生物vegetation：發(fā)生在心瓣膜上的附壁血栓Thrombosis

混合血栓Mixedthrombus

血小板小梁（trabaculaes）和富紅細(xì)胞區(qū)域交替存在靜脈性/延續(xù)性血栓體部eg.附壁血栓muralthrombus：黏附于心臟房室和血管（如動脈瘤）內(nèi)膜面的的混合血栓附壁血栓muralthrombus球形血栓globularthrombus

紅色血栓RedThrombus紅細(xì)胞靜脈性/延續(xù)性血栓尾部

透明血栓(微血栓)Hyalinethrombus(microthrombus)纖維蛋白與彌散性血管內(nèi)凝血(DIC)有關(guān)毛細(xì)血管內(nèi)腫瘤性血栓tumorthrombus細(xì)菌性血栓bacterialthrombusThrombosis閉塞性血栓(血管管腔完全阻塞)occlusivethrombus球形血栓globularthrombusThrombosisThrombosisDifferencebetweenthrombusandpostmortemclot

Thrombus

Postmortumclots干drywetandgelatinous“chickenfat”supernatant糙roughsurfacesmoothsurface硬hardsoft脆fragilegelatinous層LinesofZahnhomogenous緊firmlyattachednoattachment裂slitduetocontraction,fragmentation,generateembolusnoslit血栓死后血凝塊Thrombosis轉(zhuǎn)歸與結(jié)局

延伸與阻塞Propagationandobstruction溶解與吸收Dissolutionandabsorption形成栓塞Embolization機(jī)化與再通Organizationandrecanalization鈣化Calcification

靜脈石或動脈石Phlebolith&arteriolithOrganization(機(jī)化)Recanalization(再通)臨床聯(lián)系靜脈血栓形成

(phlebothrombosis)Varicosities靜脈曲張DVT(DeepVeinThrombosis),trauma,surgery,postpartum產(chǎn)后心臟與動脈血栓形成(Cardiacandarterialthrombosis)muralthrombus(MI,AS)rheumaticheartdisease,valvediseaseEmbolizeperipherally,brain,kidney,spleen,etc毛細(xì)血管血栓形成彌散性血管內(nèi)凝血

(Disseminatedintravascularcoagulation，DIC)

通常見于許多嚴(yán)重疾病

嚴(yán)重細(xì)菌或病毒感染，過敏性疾病，缺氧，創(chuàng)傷，休克，惡性腫瘤等血液凝固系統(tǒng)被激活

微血栓廣泛形成，累及各種器官

Platelets+Fibrin

(lung,brain,kidney,liver,GItract,adrenalgland,etc.)

凝血物質(zhì)大量消耗，纖溶系統(tǒng)被激活

臨床表現(xiàn)：出血傾向，多器官功能衰竭（multiorgandysfunction，MOD）

consumptioncoagulopathy/defibrinationsyndrome

消耗性凝血病/去纖維蛋白綜合征血栓對機(jī)體的影響

利——止血，有助于創(chuàng)口愈合， 局限感染區(qū)域，防止感染擴(kuò)散 弊——血管阻塞和栓塞 多種因素影響其后果（部位、大小、形成速度、釋放脫落以及側(cè)支循環(huán)等）局部缺血----變性、壞死靜脈血栓----組織淤血、水腫栓塞---組織缺血、梗死贅生物機(jī)化---心瓣膜變形彌散性血管內(nèi)凝血----后果嚴(yán)重Embolism

（栓塞）Occlusionofcardiovascularsystembysomeinsolublemass.

ThemassistermedasEMBOLUS

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)。阻塞血管腔的異常物質(zhì)稱為栓子(embolus)。

Thromboembolism99%solid,liquid,gaseousmassfat,air,amnioticfluid,tumorfragments,bitsofbonemarrow,etc.Embolism栓子的運(yùn)行途徑

動脈栓塞——leadtosystemicembolism靜脈栓塞——leadtopulmonaryembolism門靜脈栓塞——leadtohepaticembolism交叉性栓塞（反常性栓塞）Paradoxicalembolism,crossedembolism

Embolifromveinsofthegeneralcirculationpassthroughanatrialorventricularseptaldefect,enteringarteriesofthegeneralcirculation.逆行性栓塞Retrogradeemboli動脈栓塞栓子來源

80%—Intracardiacmuralthrombi

2/3—Leftventricularwallinfarcts

1/3—Dilatedleftatria

20%—Ulceratedatheroscleroticplaques

Aorticaneurysms,valvularvegetation

栓塞部位 下肢(75%)腦(10%)

腎、脾、腸靜脈栓塞栓子來源 右心和體循環(huán)靜脈的栓子

95%—Deeplegvein栓塞部位 肺動脈主干、分支門靜脈栓塞栓子來源——門靜脈系的栓子栓塞部位——門靜脈各級分支異常性/交叉性栓塞（paradoxical/crossedembolism）靜脈系栓子房室間隔缺損動脈系逆行性栓塞(retrogradeembolism)大靜脈栓子小靜脈右心、下腔靜脈肝、腎、股靜脈胸、腰、盆腔靜脈椎靜脈系脊髓、腦Embolism

Canyouanswerthesequestions:Wheredotheycomefrom?Wheredotheylodge?Whatarethefeaturesoftheirimpairment?血栓栓塞Thromboembolism99%

—Pulmonary—Arterial非血栓栓塞Non-thromboticembolism

脂肪栓塞Fatembolism

氣體栓塞Gasembolism

羊水栓塞Amnioticfluidembolism

Incidence:20-25/100,000hospitalizedpatientsSource:>95%fromDVTabovetheknee肺動脈栓塞PulmonaryThromboembolism后果:取決于血栓的大小、數(shù)量以及患者有無心肺疾患

絕大多數(shù)栓子（60%-80%）較小，臨床上亦無癥狀Fewsmallemboli—Clinicalsilent(60-80%)NumerousSmallEmboli（>60%肺循環(huán)量)—PulmonaryhypertensionwithrightventricularfailureMediumSizeEmboli—出血，通常無梗死

—梗死？(withinsufficientcollateralcirculation)Largeemboli（saddleembolus騎跨在左右肺動脈主干)

猝死>60%circulationobstructed肺動脈栓塞引起死亡機(jī)制：

肺循環(huán)機(jī)械性阻塞

N反射支氣管A、肺A痙攣5-HT冠狀A(yù)、肺A、

支氣管A痙攣

肺循環(huán)衰竭、心肌缺血Embolism來源:80%來自心內(nèi)附壁血栓; MI,aorticaneurysms,ulceratedASplaques,vegetations栓塞部位: lowerextremities(75%),brain(10%),intestines,kidney,spleen結(jié)局:INFARCTION體循環(huán)動脈血栓栓塞

SystemicThromboembolismFatEmbolism脂肪栓塞releasedfromthebonemarrowandsofttissueduetosevereinjury由于嚴(yán)重創(chuàng)傷從骨髓和軟組織釋放Longbonefracture長骨骨折

softtissuetraumaorburns軟組織挫傷或燒傷

squeezeofthefattychangedliver脂肪肝擠壓Mainlyoccursinthelungand

thebrain大多數(shù)無癥狀，僅10%嚴(yán)重骨骼損傷有臨床表現(xiàn)FatEmbolism后果取決于脂滴的大小以及數(shù)量

ф>20μm,引起肺栓塞

ф<20

μm,

引起腦栓塞和其他器官栓塞

特殊染色顯示脂滴蘇丹III染色鋨酸染色FattyEmbolusintheVascularLumenPathogenesis損傷機(jī)制

阻塞&游離脂肪酸的損傷毒性

——內(nèi)皮受損，血小板黏附和黏集反應(yīng)，啟動凝血途徑Symptom癥狀

tachypnea,dyspnea,tachycardia呼吸急促、困難，心動過速；

irritability,restlessness,deliriumorcoma易激惹，煩躁，譫妄，昏迷；

anemiaandthrombocytopenia貧血，血小板減少

diffusepetechialrash廣泛瘀點(diǎn)性皮疹(占20-50%)FatEmbolismGASEmbolism

氣體栓塞來源:airorN2bubblesExogenic：輸液transfusion

頸部或胸部手術(shù)或創(chuàng)傷

人工氣胸、氣腹

Endogenic:decompressionsickness減壓病caissondisease沉箱病結(jié)局：

少量氣體可被吸收

大量氣體可占據(jù)心臟，因心臟博動產(chǎn)生血?dú)馀?，阻斷血流，并?dǎo)致死亡

造成心腦等多器官氣體栓塞癥狀：

疼痛,猝死治療:

高壓艙治療RecompressionGASEmbolismAmnioticFluidEmbolism羊水栓塞

Lowincidence低發(fā)病率(1/40,000)

HighMotality高致死率

(70%~80%)Source：Sinusoidswhichplacentaattached

胎盤附著處血竇

Torncervicalvessels撕裂的宮頸管ComponentsofAmnioticFluid:squamousepithelialcells,lanugohair,fat,fetalfeces,mucinandTXA2鱗狀上皮,胎毛,胎脂,胎糞,黏蛋白及血栓緊張素等SquamouscellsandKeratinizationsubstances癥狀:

突發(fā)嚴(yán)重呼吸困難

紫紺

休克死因:

多發(fā)性栓塞;

肺栓塞;

反射性血管痙攣;

過敏性休克AllergicShock;DICAlcianBluePASstainingAmnioticFluidEmbolismINFARCTION

（梗死形成）

器官或局部組織由于血流中斷導(dǎo)致的缺血性壞死，稱為梗死(infarction)。梗死多由于動脈阻塞引起，但靜脈回流中斷，使局部血流停滯組織缺氧，也可引起梗死。發(fā)生壞死的病變區(qū)域稱梗死灶。TheformationofalocalizedareaofischemicnecrosiswithinatissueororganduetoimpairedarterialsupplyorthevenousdrainageThenecrosisareaiscalled“infarct”.

Anextremelyimportantcauseofclinicalillness:

myocardiacinfarction，MI心肌梗死 cerebralinfarction腦梗死原因動脈阻塞或靜脈回流不暢

Occlusionofarterialsupplyorvenousdrainage

Thrombosis,embolism,athermanousplaques,externalcompression功能性細(xì)動脈痙攣

Functionalspasmofarteriole類型Whiteinfarcts(anemicinfarcts)白色梗死（貧血性梗死）Redinfarcts(hemorrhagicinfarcts)紅色梗死(出血性梗死)Septicinfarcts敗血性梗死INFARCTIONINFARCTIONFactorsthatinfluencedevelopmentofaninfarct影響梗死形成和發(fā)展的要素NatureofthevascularsupplyRateofdevelopmentofocclusionVulnerabilitytohypoxiaOxygencontentofbloodanemicinfarct貧血性梗死WhiteinfarctionArterialocclusion動脈阻塞Solid,compactorgans質(zhì)實(shí)組織或臟器Fewcollateralcirculation缺乏側(cè)支循環(huán)spleen,kidney,heart,brain,etc.Morphology

GrossDullpale,dry,wedge-shapednecroticlesion,withahemorrhagiczonesurrounding灰白，干燥，大致呈楔形，尖端指向門部，底部緊鄰包膜；病灶周圍可見充血出血帶。新鮮時病灶腫脹，略隆起于臟器表面，漿膜外可見絮狀纖維蛋白性滲出；陳舊時病灶收縮，質(zhì)實(shí)。LM Ischemiccoagulativenecrosis（kidney）NecroticcoreInflammatoryandgranulationtissue.HyperemicandhemorrhagiczoneMostundergoorganizationandscarringintheend.SpleenInfarctionCardiacInfarctionBrainInfarction(liquefiednecrosis)出血性梗死hemorrhagicinfarctRedinfarction?Arterialocclusion動脈阻塞?Venousocclusion靜脈阻塞/淤滯（如卵巢扭轉(zhuǎn)、大腦深靜脈血栓形成）?Loosetissue組織疏松,有利于血液積聚于梗死區(qū)?Dualcirculations:lung,smallintestine

雙重血供previouslycongestedre-establishedbloodflowtoasiteofpreviousarterialocclusionandnecrosis先前有動脈閉塞或組織壞死部位有血液再灌流Hemorrhagicinfar