醫(yī)學(xué)生理學(xué)(血液)課件

1、血液（Blood)第一節(jié) 概述（Introduction)第二節(jié) 血漿（Plasma) 第三節(jié) 血細(xì)胞（Blood cells)第四節(jié) 生理止血（Hamostasis)第五節(jié) 血型（Blood group)第六節(jié) 造血和血細(xì)胞的破壞（Hematopoiesis and Hematoclasis)Introduction 血液血漿：血細(xì)胞電解質(zhì)（electrocytes)、營養(yǎng)成分(nutrients)、氣體(gases)、代謝產(chǎn)物(waste products)、蛋白質(zhì)（proteins)、水分（water)。Red blood cellsWhite blood cellsPlatelets一

2、、血液的基本組成二、血液的功能1、運(yùn)輸作用（Transportation)4、緩沖作用5、傳遞信息3、生理止血 (hemostasis)2、防御功能（defense)Plasma一、Components and functions of plasma1. Electrolyte:血漿晶體滲透壓2. Protein(1) albumin: 形成血漿膠體滲透壓及物質(zhì)轉(zhuǎn)運(yùn)(2) globulin：1、2、 globulin,物質(zhì)轉(zhuǎn)運(yùn)及特異性免疫(3) fibrinogen：血液凝固二、physicochemical properties of plasma1. Plasma 的比重和粘滯性比重：2.

3、Plasma osmotic pressurePlasma osmotic pressure (313 mOsm)Plasma crystal osmotic pressure (311.5 mOsm)Plasma colloid osmotic pressure ( 1.5 mOsm)粘滯性：1.025-1.0301.6-2.4:血管內(nèi)外的水分交換 Plasma colloid osmotic pressure三、plasma pHpH 7.35-7.45血細(xì)胞（Blood cell)一、Red blood cellMale: (4.5-5.5)1012/L Female:( 3.8-4.6

4、)1012/L(2.0-3.0)106 Hb/RBC每一個(gè)Hb分子可結(jié)合4個(gè)O2分子0.9%NaCl0.7%NaCl0.5%NaCl0.4%NaCl0.3%NaCl0.9% NaCl isotonic solution (physiological saline)hemolysisSuspension stabilityESR: male 3mm, female 10mm二、white blood cellWhite blood cellsPolymorphonuclear neutrophils Polymorphonuclear eosinophilsPolymorphonuclear b

5、asophilsmonocyteslymphocytes4000-10000/mm350-70%2-5%0.5-1%3-8%20-30%三、platelet（100-300）109/ Lhemostasis生理止血（Hemostasis)生理止血：正常人血管受損傷后，有blood從血管流出來，數(shù)分鐘后自行停止。包括：local vasoconstriction(局部小血管收縮）,formation of platelet plug(血小板栓子的形成）, blood coagulation(血液凝固）, fibrinolysis and prevention of coagulation(纖維蛋

6、白溶解和抗凝）二、Formation of platelet plugAdhesion and aggregation內(nèi)皮細(xì)胞（vW factor)Receptors on plateletsPlatelet adhesionAggregation(ADP,NE and 5-HT)Release of ADP, ATP, 5-HT, K+, platelet factor 3,TXA & lysosomal enzymeContractile function三、Blood coagulation1. Coagulation factor1)用羅馬字 I-XIII表示，共12種和PK,HMWK

7、, PL等 ; 2）the factor IV is calcium,PL is a lipid,while others are proteins; 3)vitamin K is involved in the combination of factor II, IIV, IX, X; 4) factor III is a tissue thromboplastin.2. Coagulation stages1)formation of prothrombin-converting enzyme(凝血酶原激活物的形成).2)conversion of prothrombin to throm

8、bin(凝血酶的形成).3)conversion of fibrinogen to fibrin(纖維蛋白的形成).3. Pathways:1) intrinsic pathway:由activation of factor XII 所啟動(dòng)的凝血途徑, which is completely finished by the coagulation factors in plasma.2) extrinsic pathway: 由activation of factor III 所啟動(dòng)的凝血途徑。Plasminogen plasmin(纖溶酶原) (纖溶酶)Activator(纖溶酶原激活物)F

9、ibrin(纖維蛋白)Fibrin degradation products (纖維蛋白降解產(chǎn)物)4. Fibrinolysis(纖維蛋白溶解)inhibitor5. Prevention of coagulation1)Antithrombin III: -globulin, 與thrombin結(jié)合 thrombin的失活(inactivation)Antithrombin-heperin complexEffect of AntithrombinCoagulation factor IXa, Xa, XIa, XIIa的失活4)2 巨球蛋白:與coagulation factor 結(jié)合而防

10、止它們的激活 Blood group1. ABO blood group system2. Rh blood group system一、ABO blood group system and Rh blood group system二、Blood transfusion and cross matchingRh blood group systemRhesus monkey的red blood cellrabbitSerum (antibody)80-99%人類的red blood cellagglutination出現(xiàn)agglutination的blood group: Rh positive不出現(xiàn)agglutination的blood group: Rh negative1. Antigen of Rh blood group syst