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1、Local Hemodynamic DisordersLocal Hemodynamic Disorders局部血液循环障碍局部血液循环障碍病理学系病理学系彭劲武彭劲武Contentsn n 循环血量的异常循环血量的异常( (充血、缺血充血、缺血) )n n 血液内出现异常物质血液内出现异常物质 ( (血栓、空气、脂滴、羊水等血栓、空气、脂滴、羊水等) )n n 血管内成分逸出血管外血管内成分逸出血管外 （水肿、出血）（水肿、出血）Hyperemia And CongestionHyperemia And Congestion A local increased volume of A loc
2、al 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 due to arteriolar dilation 充血充血 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
3、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 substanceClassification: physiologic congestion pathological congestion congestion after decompressionhy
4、peremia of appendix阑尾充血阑尾充血pathologicalchanges: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 process resulting from impaired venous return from a tissue venous return from a ti
5、ssue 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:Local congestionLocal congestion：External pressureExternal pressureThrombosisThrombosisVenous valvesVenous valvesSystemic congestionSystemic congestion：Heart failuresHeart failures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 chan
6、ges： cyanosis-a blue-red color病变：病变：发绀发绀 Fate Atrophy/Degeneration/Necrosistrophy/Degeneration/NecrosisCongestive 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 Lun
7、g congestion Lung brown Lung brown indurationinduration Heart failure cellsHeart failure cells肺淤血肺淤血 肺褐色硬化肺褐色硬化 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 槟榔肝槟榔肝 淤血性肝硬化淤血性肝硬化Nutmeg liverNutmegNutmegNutmeg liverN
8、utmeg liverCongestive liver cirrhosisThrombosis ThrombusThrombosis is the process 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.Three primar
9、y influences predispose to thrombus formation: Endothelial injury (most important)(most important) Alone can induce thrombosis Alone can induce thrombosis 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抗凝抗凝P
10、rotective 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 general react
11、ions: 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 tox
12、ins(细菌毒素)血流状态的改变血流状态的改变(缓慢缓慢,涡流涡流)Platelets activated by contact with endothelium.Slowed flow retards dilution of activated clotting factors and hepatic clearance.Turbulence may induce endothelial injury血液凝固性增高血液凝固性增高:Primary (genetic):Primary (genetic): AntithrombinAntithrombin( (抗凝血酶) III deficien
13、cy) III deficiency Protein C deficiency Protein C deficiency Protein S deficiency Protein S deficiencySecondary (acquired):Secondary (acquired): Prolonged bed rest ( Prolonged bed rest (长期长期长期长期卧床休息卧床休息) ) Myocardial infarction( Myocardial infarction(心肌梗塞) ) Tissue Tissue damage(surgerydamage(surger
14、y, fractures, burns) , fractures, burns) Cardiac failure( Cardiac failure(心力衰竭). ). Cancer. Acute leukemia( Cancer. Acute leukemia(急性白血病). DIC. ). DIC. Process of thrombus formationTypes of thrombus Pale thrombus Mixed thrombus Red thrombus Hyaline thrombus/ microthrombus/ fibrinous thrombus血栓的类型血栓的
15、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/ phlebolith/ 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reca
16、nalization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: :DICDICEffects of thrombosisEffects of thrombosis：Ischemia(Ischemia(局部缺血) ) CongestionCongestionEmbolismEmbolismHeart valve diseaseHeart valve diseaseDICDIC EmbolismEmbolusEmbolusAn embolus is a detached intravascular An embolus is a detached intravascular solid,liquid,orsolid,liquid,or gaseous mass 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 ori
