病理學ppt課件-局部血液循環障礙1LocalHemodynamicDisorders

局部血液循環障礙病理學系彭勁武LocalHemodynamicDisorders

2Contents循環血量的異常(充血、缺血)血液內出現異常物質(血栓、空氣、脂滴、羊水等)血管內成分逸出血管外（水腫、出血）Contents循環血量的異常(充血、缺血)3病理學ppt課件-局部血液循環障礙4HyperemiaAndCongestion

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

HyperemiaAndCongestion5

Hyperemia

Arterialhyperemia/ActivehyperemiaAnactiveprocessresultingfromaugmentedbloodflowduetoarteriolardilation

充血主動性充血/動脈性充血動脈輸入血量增多Hyperemia6病理學ppt課件-局部血液循環障礙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/被動性充血靜脈血流回流受阻Congestion12Reasons:

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:13病理學ppt課件-局部血液循環障礙14

Pathologicalchanges：

cyanosis---ablue-redcolor病變：發紺

Pathologicalchanges：15

FateAtrophy/Degeneration/NecrosisCongestiveedemaCongestivehemorrhageCongestivesclerosis萎縮/變性/壞死淤血性水腫淤血性出血淤血性硬化Fate16LungcongestionLungcongestion17病理學ppt課件-局部血液循環障礙18Lungcongestion

Lungbrowninduration

Heartfailurecells肺淤血肺褐色硬化心衰細胞Lungcongestion19LungbrownindurationLungbrowninduration20病理學ppt課件-局部血液循環障礙21病理學ppt課件-局部血液循環障礙22病理學ppt課件-局部血液循環障礙23病理學ppt課件-局部血液循環障礙24heartfailurecellsheartfailurecells25HeartFailurecellsHeartFailurecells26Livercongestion

Nutmegliver

Congestivelivercirrhosis肝淤血檳榔肝淤血性肝硬化Livercongestion27NutmegliverNutmegNutmegliverNutmeg28NutmegliverNutmegliver29NutmegliverNutmegliver30病理學ppt課件-局部血液循環障礙31病理學ppt課件-局部血液循環障礙32病理學ppt課件-局部血液循環障礙33病理學ppt課件-局部血液循環障礙34CongestivelivercirrhosisCongestivelivercirrhosis35Thrombosis／ThrombusThrombosisistheprocessofformationofasolidfromthebloodwithinlivingbloodvesselsortheheart,theresultantistermedathrombus.血栓形成/血栓在活體的心臟和血管內，血液發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／Thrombus36Threeprimaryinfluencespredisposetothrombusformation:Endothelialinjury(mostimportant)AlonecaninducethrombosisStasisorturbulenceofbloodflowBloodhypercoagulability血栓形成的三個條件:心血管內皮細胞的損傷血流狀態的改變(緩慢,渦流)血液凝固性增高Threeprimaryinfluencespredi37抗凝ProtectivescreenPGI2,NO,ADP酶ThrombomodulinMembrane-associatedheparin-likemoleculesProteinSt-PA抗凝ProtectivescreenPGI2,NO,ADP38促凝組織因子VonWillebrandfactorPAIs促凝組織因子VonWillebrandfactorPAI39Oncontactwithextracellularmatrix(ECM),plateletsundergothreegeneralreactions:

AdhesionreactionReleasereactionAggregationreaction血小板的活化

粘附反應

釋放反應

粘集反應Oncontactwithextracellular40病理學ppt課件-局部血液循環障礙41病理學ppt課件-局部血液循環障礙42病理學ppt課件-局部血液循環障礙43Ulcerativeatherosclerosis(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(創傷,外傷,損傷)Radiation(輻射,放射)Bacterialtoxins(細菌毒素)Ulcerativeatherosclerosis(潰瘍性44血流狀態的改變(緩慢,渦流)Plateletsactivatedbycontactwithendothelium.Slowedflowretardsdilutionofactivatedclottingfactorsandhepaticclearance.Turbulencemayinduceendothelialinjury血流狀態的改變(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病理學ppt課件-局部血液循環障礙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門靜脈內血栓形成門靜脈內血栓形成52腎靜脈內血栓形成腎靜脈內血栓形成53病理學ppt課件-局部血液循環障礙54左心室附壁血栓左心室附壁血栓55左心房內球形附壁血栓左心房內球形附壁血栓56病理學ppt課件-局部血液循環障礙57mixedthrombusmixedthrombus58病理學ppt課件-局部血液循環障礙59病理學ppt課件-局部血液循環障礙60紅色血栓紅色血栓61hyalinethrombushyalinethrombus62病理學ppt課件-局部血液循環障礙63FateoftheThrombusDissolutionOrganization/recanalizationCalcification/phlebolith/arteriolith血栓的結局

軟化、溶解、吸收機化/再通鈣化/靜脈石/動脈石FateoftheThrombus64病理學ppt課件-局部血液循環障礙65病理學ppt課件-局部血液循環障礙66recanalizationrecanalization67病理學ppt課件-局部血液循環障礙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70Motionalpathwayofembolus:

EmbolusfromleftheartcavityorarterialsystemEmbolusfromrightheartcavityorvenoussystemEmbolusfromportalveinsParadoxicalembolismRetrogradeethrombus栓子運行的途徑：動脈系統及左心栓子靜脈系統及右心栓子門靜脈系統栓子交叉性栓塞逆行性栓塞Motionalpathwayofembolus:栓子71病理學ppt課件-局部血液循環障礙72運行途徑運行途徑73病理學ppt課件-局部血液循環障礙74Thromboembolism

PulmonarythromboembolismSystemicthromboembolism血栓栓塞肺動脈栓塞體循環動脈栓塞:下肢.腦.腸.腎Thromboembolism75pulmonaryembolismpulmonaryembolism76肺動脈主干及分支血栓栓塞肺動脈主干及77

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

78病理學ppt課件-局部血液循環障礙79病理學ppt課件-局部血液循環障礙80病理學ppt課件-局部血液循環障礙81血栓栓子停留在腦動脈，發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，發源于左心房的一個附壁血栓。心臟是這種82Etiology:FracturesoflongbonesSofttissuetrauma(創傷)Burns脂肪栓塞Etiology:脂肪栓塞83Fatembolism

(脂肪栓塞)

Fatembolism(脂肪栓塞)84病理學ppt課件-局部血液循環障礙85病理學ppt課件-局部血液循環障礙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病理學ppt課件-局部血液循環障礙92病理學ppt課件-局部血液循環障礙93InfarctionAninfarctionisanareaofischemicnecrosiscausedbyocclusionofeitherthearterialsupplyorthevenousdrainageinaparticulartissue梗死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生壞死的過程，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,肢體動脈栓塞:腎,脾,肺,腦動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(節段性)

Irregular(不規則形)color:Redandwhiteinfarcts

Characteristics96ClassificationAnemicinfarcts/WhiteinfarctsHemorrhagicinfarcts/Redinfarc