局部血液循环障碍理论课件.ppt

1、Hyperemia And CongestionHyperemia And Congestion A local increased volume of A local increased volume of blood in a particular tissue blood in a particular tissue充血和淤血充血和淤血局部组织血管内血液含量增多局部组织血管内血液含量增多 Hyperemia Arterial hyperemia/Active hyperemia An active process resulting from augmented blood flow d

2、ue to arteriolar dilation 动脉性充血动脉性充血 主动性充血主动性充血/动脉性充血动脉性充血 动脉输入血量增多动脉输入血量增多原因：原因：血管舒张神经兴奋性血管舒张神经兴奋性 血管收缩神经兴奋性血管收缩神经兴奋性 舒张血管活性物质释放舒张血管活性物质释放 分类：分类：生理性充血生理性充血 病理性充血病理性充血 减压后充血减压后充血Causes:excitability of vasodilatator excitability of vasoconstrictor dilivery of relaxing vasoactive substanceClassificati

3、on:physiologic congestion pathological congestion congestion after decompressionhyperemia of appendix阑尾充血阑尾充血pathological changes:Consequence:病变：病变：后果：后果：hyperemia Congestion Venous hyperemia/Passive Venous hyperemia/Passive hyperemiahyperemia A passive process resulting from impaired A passive proc

4、ess resulting from impaired venous return from a tissue venous return from a tissue 淤血淤血 静脉性充血静脉性充血/被动性充血被动性充血 静脉血流回流受阻静脉血流回流受阻Reasons:原因：原因：局部：局部：静脉受压静脉腔阻塞静脉受压静脉腔阻塞全身：心力衰竭全身：心力衰竭 Pathological changes：cyanosis-a blue-red color病变：病变：发绀发绀 Fate Atrophy/Degeneration/Necrosistrophy/Degeneration/NecrosisC

5、ongestive edemaCongestive edemaCongestive hemorrhageCongestive hemorrhageCongestive sclerosisCongestive sclerosis萎缩萎缩/变性变性/坏死坏死淤血性水肿淤血性水肿淤血性出血淤血性出血淤血性硬化淤血性硬化Lung congestion Lung congestion Lung congestion Lung brown Lung brown indurationinduration Heart failure cellsHeart failure cells肺淤血肺淤血 肺褐色硬化（慢

6、性肺淤血）肺褐色硬化（慢性肺淤血）心衰细胞心衰细胞Lung brown indurationheart failure cellsHeart Failure cells Liver congestion Nutmeg liver Congestive liver cirrhosis 肝淤血肝淤血 槟榔肝（慢性肝淤血）槟榔肝（慢性肝淤血）淤血性肝硬化淤血性肝硬化Nutmeg liverNutmegNutmegNutmeg liverNutmeg liverCongestive liver cirrhosisThrombosis ThrombusThrombosis is the process

7、of formation of a solid from the blood within living blood vessels or the heart,the resultant is termed a thrombus.血栓形成血栓形成/血栓血栓在在活体活体的心脏和血管内，血液发生凝固或血液的心脏和血管内，血液发生凝固或血液中某些有形成分凝集形成固体质块的过程中某些有形成分凝集形成固体质块的过程.mixed thrombus红色血栓Three primary influences predispose to thrombus formation:Endothelial injury

8、Stasis or turbulence of blood flow Blood hypercoagulability血栓形成的三个条件血栓形成的三个条件:心血管内皮细胞的损伤心血管内皮细胞的损伤 血流状态的改变血流状态的改变(缓慢缓慢,涡流涡流)血液凝固性增高血液凝固性增高Ulcerative atherosclerosis(溃疡性的动脉粥样硬化)Transmural myocardial infarction (透壁的心肌梗塞)Vasculitis(脉管炎,血管炎)Trauma(创伤,外伤,损伤)Radiation(辐射,放射)Bacterial toxins(细菌毒素)心血管内皮细胞的损

9、伤心血管内皮细胞的损伤抗凝抗凝Protective screenPGI2,NO,ADP酶酶ThrombomodulinMembrane-associated heparin-like moleculesProtein St-PA促凝促凝组织因子组织因子Von Willebrand factorPAIsOn contact with extracellular On contact with extracellular matrix(ECMmatrix(ECM),platelets undergo),platelets undergo three general reactions:three

10、general reactions:Adhesion reaction Adhesion reaction Release reaction Release reaction Aggregation reaction Aggregation reaction血小板的活化血小板的活化 粘附反应粘附反应 释放反应释放反应 粘集反应粘集反应血流状态的改变血流状态的改变(缓慢缓慢,涡流涡流)血液凝固性增高血液凝固性增高:抗凝血酶卧床休息卧床休息心肌梗塞心力衰竭急性白血病Process of thrombus formationTypes of thrombus Pale thrombus Mixed

11、thrombus Red thrombus Hyaline thrombus/microthrombus/fibrinous thrombus血栓的类型血栓的类型 白色血栓白色血栓 混合血栓混合血栓 红色血栓红色血栓 透明血栓透明血栓/微血栓微血栓/纤维素性血栓纤维素性血栓白色血栓pale thrombus门静脉内血栓形成肾静脉内血栓形成左心室附壁血栓左心房内球形附壁血栓mixed thrombus红色血栓hyaline thrombusFate of the Thrombus Dissolution Organization/recanalization Calcification/phle

12、bolith/arteriolith血栓的结局血栓的结局 软化软化、溶解、吸收溶解、吸收 机化机化/再通再通 钙化钙化/静脉石静脉石/动脉石动脉石recanalization影响：“弊大于利”1.1.阻塞血管阻塞血管 2.2.栓塞栓塞 3.3.心瓣膜变形心瓣膜变形4.4.广泛性出血广泛性出血:DICDIC局部缺血 EmbolismEmbolusEmbolusAn embolus is a detached intravascular An embolus is a detached intravascular solid,liquid,orsolid,liquid,or gaseous mas

13、s that is gaseous mass that is carried by the blood to a site distant carried by the blood to a site distant from its point of originfrom its point of origin栓栓 塞塞栓子栓子在循环血液中出现的不溶于血液的异常物质，在循环血液中出现的不溶于血液的异常物质，随血流运行阻塞血管腔的现象称为栓塞。随血流运行阻塞血管腔的现象称为栓塞。栓子运行的途径：栓子运行的途径：动脉系统及左心栓子动脉系统及左心栓子静脉系统及右心栓子静脉系统及右心栓子门静脉系统栓

14、子门静脉系统栓子交叉性栓塞交叉性栓塞逆行性栓塞逆行性栓塞运行途径运行途径Thromboembolism Pulmonary thromboembolism Systemic thromboembolism血栓栓塞血栓栓塞 肺动脉栓塞肺动脉栓塞 体循环动脉栓塞体循环动脉栓塞:下肢下肢.脑脑.肠肠.肾肾 pulmonary embolism肺动脉主干及分支血栓栓塞 这里是位于通向这里是位于通向左肺的肺动脉内左肺的肺动脉内一个大的肺血栓。一个大的肺血栓。这类血栓发源于这类血栓发源于不能走动的病人不能走动的病人的大腿静脉或骨的大腿静脉或骨盆静脉。盆静脉。血栓栓子停留在脑动脉，发源于左心房的一个附壁血栓

15、。心脏是这种拴子的常见来源。创伤脂肪栓塞脂肪栓塞Fat embolism(脂肪栓塞脂肪栓塞)Gas embolism Air embolism Decompression sickness Amniotic fluid embolism气体栓塞气体栓塞 空气栓塞空气栓塞 减减 压压 病病角化上皮其他栓塞其他栓塞:胆固醇栓子胆固醇栓子癌栓癌栓InfarctionInfarctionAn infarction is an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous

16、 drainage in a particular tissue梗死器官或局部组织由于血管阻塞器官或局部组织由于血管阻塞(动脉多见动脉多见)、血流停止导致缺氧而发生坏死的过程，称血流停止导致缺氧而发生坏死的过程，称为梗死形成，所形成的局部坏死称为梗死为梗死形成，所形成的局部坏死称为梗死Causes 血栓形成血栓形成:心心,脑脑,肢体肢体 动脉栓塞动脉栓塞:肾肾,脾脾,肺肺,脑脑 动脉痉挛动脉痉挛 血管受压闭塞血管受压闭塞Characteristics 楔形不规则形 color Classification Anemic infarcts/White infarcts Hemorrhagic i

17、nfarcts/Red infarcts Septic infarcts分类分类 贫血性梗死贫血性梗死/白色梗死白色梗死:心心,肾肾,脾脾 出血性梗死出血性梗死/红色梗死红色梗死:肺、肠肺、肠 败血性梗死败血性梗死Renal infarctSpleen infarctLung infarct梗死区梗死区肠梗死肠梗死正常肠正常肠Intestine infarct细菌栓子一、名词解释：一、名词解释：Congestion /Heart failure cellsBrown induration of lung /Nutmeg liver Thrombosis /Mixed thrombus Hyal

18、ine thrombus /RecanalizationCrossed embolism /Retrograde embolismAmniotic fluid embolism /Infarction Anemic infarcts /Hemorrhagic infartsDecompression sickness 二、问答题：二、问答题：1、慢性肝淤血时，肝切面为什么会出慢性肝淤血时，肝切面为什么会出 现槟榔状花纹？现槟榔状花纹？2、栓子是如何运行的？、栓子是如何运行的？3、羊水栓塞的病理特征是什么？、羊水栓塞的病理特征是什么？4、静脉淤血、血栓形成、栓塞及梗死、静脉淤血、血栓形成、栓塞及梗死之间有何联系？之间有何联系？