局部血液循環(huán)障礙-課件

局部血液循環(huán)障礙-ppt課件1LocalHemodynamicDisorders

局部血液循環(huán)障礙基礎醫(yī)學院病理學系羅庚求LocalHemodynamicDisorders

2局部血液循環(huán)障礙-ppt課件3Contents

循環(huán)血量的異常(充血、缺血)

circulationvolume

血液內出現異常物質

abnormalmaterial血管內成分逸出血管外

emitContents循環(huán)血量的異常(充血、缺血)4HyperemiaAndCongestion

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

HyperemiaAndCongestion5

Hyperemia

Arterialhyperemia/ActivehyperemiaAnactiveprocessresultingfromaugmentedbloodflowduetoarteriolardilation

充血

動脈性充血/主動性充血動脈輸入血量增多Hyperemia6局部血液循環(huán)障礙-ppt課件7原因：血管舒張神經興奮性↑血管收縮神經興奮性↓舒張血管活性物質釋放Causes:excitabilityofvasodilatator↑

excitabilityofvasoconstrictor↓diliveryofrelaxingvasoactivesubstance原因：血管舒張神經興奮性↑Causes:exc8分類：生理性充血病理性充血減壓后充血Classification:physiologicalpathological

Post-decompression分類：生理性充血Classification:9physiological生理性充血physiological生理性充血10hyperemiaofappendix

闌尾充血hyperemiaofappendix11局部血液循環(huán)障礙-ppt課件12pathologicalchangesConsequence病變后果pathologicalchanges13hyperemiahyperemia14

Congestion

Venoushyperemia/PassivehyperemiaApassiveprocessresultingfromimpairedvenousreturnfromatissue

淤血靜脈性充血/被動性充血靜脈血流回流受阻Congestion15局部血液循環(huán)障礙-ppt課件16Reasons:Localcongestion：Externalpressure

ThrombosisSystemiccongestion：Heartfailures原因：局部：靜脈受壓／血栓形成全身：心力衰竭Reasons:17局部血液循環(huán)障礙-ppt課件18FateAtrophy(萎縮）Degeneration（變性）Necrosis（壞死）Edema（水腫）Hemorrhage（出血）Sclerosis（硬化）FateAtrophy(萎縮）19Lungcongestion

Lungbrowninduration

Heartfailurecells

Edema／Hemorrhage

肺淤血

肺褐色硬化心衰細胞水腫／出血Lungcongestion20LungbrownindurationLungbrowninduration21局部血液循環(huán)障礙-ppt課件22局部血液循環(huán)障礙-ppt課件23局部血液循環(huán)障礙-ppt課件24局部血液循環(huán)障礙-ppt課件25heartfailurecellsheartfailurecells26HeartFailurecellsHeartFailurecells27LungcongestionLungcongestion28

Livercongestion

肝淤血

Livercongestion29Fattydegeneration(脂肪變性)Atrophy(萎縮)Centrilobularnecrosis(小葉中央性壞死)Nutmegliver(檳榔肝)Congestivelivercirrhosis淤血性肝硬化Fattydegeneration30NutmegliverNutmegNutmegliverNutmeg31局部血液循環(huán)障礙-ppt課件32NutmegliverNutmegliver33NutmegliverNutmegliver34局部血液循環(huán)障礙-ppt課件35局部血液循環(huán)障礙-ppt課件36局部血液循環(huán)障礙-ppt課件37局部血液循環(huán)障礙-ppt課件38局部血液循環(huán)障礙-ppt課件39CongestivelivercirrhosisCongestivelivercirrhosis40Thrombosis

／ThrombusThrombosisistheprocessofformationofasolidfromthebloodwithinlivingbloodvesselsortheheart,theresultantistermedathrombus.血栓形成/血栓在活體的心臟和血管內，血液發(fā)生凝固或血液中某些有形成分凝集形成固體質塊的過程.Thrombosis／Thrombus41局部血液循環(huán)障礙-ppt課件42Threeprimaryinfluencespredisposetothrombusformation:血栓形成的三個條件:Endothelialinjury(mostimportant)Alonecaninducethrombosis心血管內皮細胞的損傷Stasisorturbulenceofbloodflow血流狀態(tài)的改變(緩慢,渦流)Bloodhypercoagulability血液凝固性增高

Threeprimaryinfluencespredi43▲心血管內皮細胞的損傷▲心血管內皮細胞的損傷44抗凝ProtectivescreenPGI2,NO,ADP酶ThrombomodulinMembrane-associatedheparin-likemoleculesProteinSt-PA抗凝ProtectivescreenPGI2,NO,ADP45促凝組織因子VonWillebrandfactorPAIs促凝組織因子VonWillebrandfactorPAI46Oncontactwithextracellularmatrix(ECM),plateletsundergothreegeneralreactions:

(血小板的活化)Adhesionreaction(粘附反應)Releasereaction(釋放反應)Aggregationreaction(粘集反應)Oncontactwithextracellular47局部血液循環(huán)障礙-ppt課件48局部血液循環(huán)障礙-ppt課件49局部血液循環(huán)障礙-ppt課件50Ulcerativeatherosclerosis(潰瘍性的動脈粥樣硬化)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(細菌毒素)EndothelialinjuryUlcerativeatherosclerosis(潰瘍性51

Stasisorturbulenceofbloodflow

（血流狀態(tài)的改變）Plateletsactivatedbycontactwithendothelium.（血小板與內皮接觸后激活）Slowedflowretardsdilutionofactivatedbloodcoagulationfactor

．（凝血因子濃度升高）Turbulencemayinduceendothelialinjury（渦流導致內皮損傷）Stasisorturbulenceofbl52Hypercoagulablestates

（高凝狀態(tài)）Primary(genetic):（原發(fā)性）AntithrombinIIIdeficiency（抗凝血酶III缺陷）ProteinCdeficiency（蛋白Ｃ缺陷）ProteinSdeficiency

（蛋白Ｃ缺陷）Hypercoagulablestates

（高凝狀態(tài)）53HypercoagulablestatesSecondary(acquired):Highrisk:Prolongedbedrestorimmobilization.（不動）Myocardialinfarction(心肌梗死）

Tissuedamage(surgery,fractures,burns)Cardiacfailure(心衰）Acuteleukemia（急性白血?。〥IC.CancerAtrialfibrillation（房顫）Cardiomyopathy（心肌?。〩ypercoagulablestatesSecondar54HypercoagulablestatesSecondary(acquired):

Lowrisk:Nephroticsyndrome（腎病綜合征）

Hyperlipidemia（高脂血癥）Oralcontraceptives.（口服避孕藥）Sicklecellanemia（鐮刀細胞貧血）Smoking（吸煙）Thrombocytosis（血小板增多）HypercoagulablestatesSecondar55ProcessofthrombusformationProcessofthrombusformation56局部血液循環(huán)障礙-ppt課件57局部血液循環(huán)障礙-ppt課件58局部血液循環(huán)障礙-ppt課件59局部血液循環(huán)障礙-ppt課件60Typesofthrombus（血栓的類型）Palethrombus（白色血栓）Redthrombus（紅色血栓）Mixedthrombus（混合血栓）Hyalinethrombus/microthrombus/fibrinousthrombus

（透明血栓/微血栓/纖維素性血栓）Typesofthrombus61局部血液循環(huán)障礙-ppt課件62Downloadedfrom:Robbins&CotranPathologicBasisofDisease(on28August200509:34AM)?2005ElsevierDownloadedfrom:Robbins&Cot63Downloadedfrom:Robbins&CotranPathologicBasisofDisease(on28August200509:34AM)?2005ElsevierDownloadedfrom:Robbins&Cot64mixedthrombusmixedthrombus65mixedthrombusmixedthrombus66局部血液循環(huán)障礙-ppt課件67局部血液循環(huán)障礙-ppt課件68palethrombuspalethrombus69局部血液循環(huán)障礙-ppt課件70hyalinethrombushyalinethrombus71局部血液循環(huán)障礙-ppt課件72FateoftheThrombus（血栓的結局）Dissolution（軟化、溶解、吸收）Organization/recanalization

（機化/再通）Calcification/phlebolith/arteriolith

（鈣化/靜脈石/動脈石）FateoftheThrombus73局部血液循環(huán)障礙-ppt課件74局部血液循環(huán)障礙-ppt課件75局部血液循環(huán)障礙-ppt課件76recanalizationrecanalization77局部血液循環(huán)障礙-ppt課件78局部血液循環(huán)障礙-ppt課件79

Effectsofthrombosis

（影響：“弊大于利”）Ischemia(阻塞血管局部缺血)Embolism（栓塞）Heartvalvedisease（心瓣膜變形）DIC（廣泛性出血）Effectsofthrom80

Embolism（栓塞）Embolus（栓子）Anembolusisadetachedintravascularsolid,liquid,orgaseousmassthatiscarriedbythebloodtoasitedistantfromitspointoforigin。(在循環(huán)血液中出現的不溶于血液的異常物質，隨血流運行阻塞血管腔的現象稱為栓塞。)Embolism（栓塞）81Motionalpathwayofembolus

（栓子的運行途徑）

Embolusfromrightheartcavityorvenoussystem（右心或靜脈系統）

Embolusfromleftheartcavityorarterialsystem（左心或動脈系統）Embolusfromportalveins（門靜脈）Paradoxical/Crossedembolism（反常栓塞，交叉栓塞）

Retrogradeembolism（逆行栓塞）MotionalpathwayofembolusEm82局部血液循環(huán)障礙-ppt課件83Thromboembolism（血栓栓塞）

Pulmonarythromboembolism（肺動脈栓塞）Systemicthromboembolism（體循環(huán)動脈栓塞）

Thromboembolism84Pulmonaryembolism（肺動脈栓塞）1.Largeemboli(5%):

（大栓子）Instantaneousdeath(>60%).

（猝死）PulmonaryembolismInstantaneou85pulmonaryembolismpulmonaryembolism86

這里是位于通向左肺的肺動脈內一個大的肺栓。這類血栓發(fā)源于不能走動的病人的大腿靜脈或骨盆靜脈。

87局部血液循環(huán)障礙-ppt課件88Largeembolusderivedfromalowerextremitydeepvenousthrombosisandnowimpactedinapulmonaryarterybranch.Largeembolusderivedfromal892.Smallemboli(60-80%):

（小栓子）Infarctions（梗死）2.Smallemboli(60-80%):

90局部血液循環(huán)障礙-ppt課件91Systemicembolism

（體循環(huán)栓塞）

I.

80-85%fromheart

（心臟）Ⅱ

.

Debrisfromulcerativeatheromata,

（動脈粥樣硬化潰瘍）orinaneurysms

(動脈瘤)Systemicembolism

（體循環(huán)栓塞）I.92局部血液循環(huán)障礙-ppt課件93局部血液循環(huán)障礙-ppt課件94局部血液循環(huán)障礙-ppt課件95血栓栓子停留在腦動脈，發(fā)源于左心房的一個附壁血栓。心臟是這種拴子的常見來源。

血栓栓子停留在腦動脈，發(fā)源于左心房的一個附壁血栓。心臟是這種96Etiology:FracturesoflongbonesSofttissuetraumaBurnsFatembolismEtiology:Fatembolism97Fatembolism

(脂肪栓塞)

Fatembolism(脂肪栓塞)98Fig5-17Fig5-1799Fatembolismclinicalmanifestation（臨床表現）Pulmonaryinsufficiency（肺功能不全）Neurologicsymptoms（神經癥狀）Fatembolismclinicalmanifesta100Gasembolism（氣體栓塞）

Airembolism（空氣栓塞）

Decompression

sickness（減壓?。〨asembolism101Etiology（病因）Intravenoustherapeuticprocedures（靜脈輸液）Obstetricprocedures(分娩和流產)Chestwallinjury（氣胸）Decompressionsickness

(nitrogen)（減壓病）AirembolismEtiology（病因）Airembolism102局部血液循環(huán)障礙-ppt課件103圖a為鎖骨下靜脈栓塞。圖b為上腔靜脈和左心室氣體栓塞。圖c為肺動脈干氣栓。

圖a為鎖骨下靜脈栓塞。104局部血液循環(huán)障礙-ppt課件105局部血液循環(huán)障礙-ppt課件106局部血液循環(huán)障礙-ppt課件107GasembolismClinicaleffect:>100cc

（臨床反應）Caissondisease/diver’sdisease（沉箱病/潛水員?。㎝ultiplefociofischemicnecrosisinskeletalsystemandbends（骨關節(jié)缺血性多灶性壞死）GasembolismClinicaleffect:>108AMNIOTICFLUIDEMBOLISM

（羊水栓塞）Incidence:1/50000（發(fā)病率）Mortalityrate:80%（致死率）Clinicalonset:（臨床）Suddenseveredyspnea（呼吸困難）Cyanosis（發(fā)紺）hypotensiveshock（休克）Coma（昏迷）AMNIOTICFLUIDEMBOLISM

（羊水栓塞）109角化上皮角化上皮110Embolizationofthepulmonarymicrocirculationoftheparticulatedebrisinamnioticfluid.

（肺的微循環(huán)栓塞）Releaseofvasoconstrictoragents,e.g.,PGreducingpulmonarybloodflow.

(縮血管物質）IntercurrenceofDICShock(休克）Embolizationofthepulmonary111其他栓塞:膽固醇栓子其他栓塞:膽固醇栓子112局部血液循環(huán)障礙-ppt課件113癌栓癌栓114局部血液循環(huán)障礙-ppt課件115局部血液循環(huán)障礙-ppt課件116Infarction（梗死）Aninfarctionisanareaofischemicnecrosiscausedbyocclusionofeitherthearterialsupplyorthevenousdrainageinaparticulartissue。（器官或局部組織由于血管阻塞，動脈多見、血流停止導致缺氧而發(fā)生的壞死。）Infarction117Thrombosis（血栓形成）Embolism（栓塞）Twistingofthevessels

（血管痙攣）Extrinsiccompression（外源性壓迫）Etiology（病原學）Thrombosis（血栓形成）Etiology118Factorsthatinfluencedevelopmentofaninfarct

（影響梗死的因素）

Natureofthevascularsupply

（血管類型）Vulnerabilitytohypoxia

（對缺血的敏感性）Factorsthatinfluence119INFARCTION

（梗死）Morphologyofinfarct

（形態(tài)學）Shape:Wedge-shapedIrregularSegmentaltexturecolor

:RedandwhiteinfarctsINFARCTION

（梗死）Morphologyofi120Classification（分類）

Anemicinfarcts/Whiteinfarcts（貧血性梗死/白色梗死）:心,腎,脾Hemorrhagicinfarcts/Redinfarcts（出血性梗死/紅色梗死）:肺、腸Septicinfarcts（敗血性梗死）Classification121Tissuespreviouslycongested（淤血）Loosetissues

(組織疏松）Hemorrhagicinfarcts/Redinfarct

（出血性梗死）TissuespreviouslycongestedHe122局部血液循環(huán)障礙-ppt課件123局部血液循環(huán)障礙-ppt課件124局部血液循環(huán)障礙-ppt課件125局部血液循環(huán)障礙-ppt課件126局部血液循環(huán)障礙-ppt課件127SpleeninfarctSpleeninfarct128局部血液循環(huán)障礙-ppt課件129局部血液循環(huán)障礙-ppt課件130局部血液循環(huán)障礙-ppt課件131Lung

infarctLunginfarct132局部血液循環(huán)障礙-ppt課件133局部血液循環(huán)障礙-ppt課件134梗死區(qū)梗死區(qū)135局部血液循環(huán)障礙-ppt課件136腸梗死正常腸Intestineinfarct腸梗死正常腸Intestineinfarct137局部血液循環(huán)障礙-ppt課件138局部血液循環(huán)障礙-ppt課件139局部血液循環(huán)障礙-ppt課件140

ClinicalEffects決定于梗死的器官、梗死灶的大小和部位、以及有無細菌感染ClinicalEffects141Hemorrhage

（出血）Hemorrhage

（出血）142局部血液循環(huán)障礙-ppt課件143局部血液循環(huán)障礙-ppt課件144局部血液循環(huán)障礙-ppt課件145局部血液循環(huán)障礙-ppt課件146局部血液循環(huán)障礙-ppt課件147局部血液循環(huán)障礙-ppt課件148局部血液循環(huán)障礙-ppt課件149局部血液循環(huán)障礙-ppt課件150一、名詞解釋：

congestion

HeartfailurecellsBrownindurationoflung

Nutmegliver

Thrombosis

Decompressionsickness一、名詞解釋：151二、問答題：1、慢性肝淤血時，肝切面為什么會出現檳榔狀花紋？2、栓子是如何運行的？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系？二、問答題：152Casediscussion

Caseabstract.Female,30-year-old,farmer.Chiefcomplaint.Intermittentpalpitation(心悸）

andshortbreathefor1years;lowerextrem-itiesedemaandoligouriafor1month.CasediscussionCaseabstract.153Currentmedicalhistory.Sincelastyear,shefeltpalpitationandshortbreathafterlaboring,andthesesymptomswererelievedwhenrelaxation.Shecaughtacold,andpresentedfever,worsenpalpitationandshortbreathonemonthbefore.Currentmedicalhistory.Since154Simultaneously,Lowerextremitiesedema,oligouria,andright-upperabdominalturgor(膨?。゜eganandappetitedecreased,Especiallyshewasunabletoliehorizontally.ShewasadmittedtohospitalbecausetheGeneralmedicaltreatmentwasineffectivetoher.

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