血栓形成与血栓栓塞.doc

血栓形成与血栓栓塞 疾病分类老年病科 概述 血栓栓塞性疾病是包括血栓形成和栓塞，可以发生在血液循环中任何一处心腔、动脉或者静脉。如果血液在某一局部凝固形成血凝块称为血栓形成；形成的血栓脱离原来的位置，并顺血流堵塞其他部位则称为栓塞。Thrombosis and thromboembolic disease classification GeriatricsOverview of thromboembolic disease include thrombosis and embolism, can occur in the blood circulation in the heart of any one chamber, artery or vein.If blood clots form in a local solidification called thrombosis;The formation of thrombus from the original position, and other parts along the blood flow blockage is called embolization.症状体征Symptoms and signs1、静脉血栓形成 最为多见。常见于深静脉、如：髂静脉、股静脉、肠系末静脉及门静脉等，老年人尤常见下肢静脉血栓，其常见原因为手术、外伤、恶性肿瘤、血管炎等。但多数原因不明。血栓类类型多为红细胞血栓肌纤维蛋白血栓。主要表现为：1血栓形成局部肿胀、疼痛2血栓远端血液回流障碍所致的临床异常，如下肢水肿、肿痛、皮肤颜色改变，腹水等。3血栓脱落引起肺梗塞等。1, venous thrombosis is most common.Common in the deep veins, such as: iliac vein, femoral vein, mesenteric vein and portal vein end of the elderly in particular, common deep vein thrombosis, the common reason for surgery, trauma, cancer, vasculitis.However, most of unknown cause.Class type, mostly red blood cell thrombus thrombus thrombus muscle fiber protein.Mainly: 1 thrombosis local swelling, pain 2 distal blood clots clinical disorders caused by abnormal reflux, such as lower extremity edema, swelling, skin color changes, ascites, etc. 3 thrombosis such as pulmonary infarction.2、动脉血栓形成 多见于冠状动脉之脑动脉、肠系膜动脉及肢体动脉等，年龄是冠状动脉粥样硬化心脏病的重要因素，冠心病亦能老年人总常见的心脏病，并直接威胁其生命。脑血管疾病的高患病率，高复发率、高度致残给中老年带来极大痛苦。血栓类型早期多为血小板血栓，随后为纤维蛋白血栓。临床表现有：1发病多较突然，可有局部剧烈疼痛，如心绞痛、头痛、腹痛、肢体剧烈疼痛等2供血部位组织缺血，缺氧所致功能异常，如心力衰竭、心源性休克、心律失常、意识障碍及偏瘫等。3血栓脱落引起脑栓塞、心肌梗死、肾栓塞、脾栓塞等相关症状和体征，4供血组织缺血性坏死所引发的临床表现，如发热等。2, coronary arterial thrombosis more common in the cerebral artery, superior mesenteric artery and other arterial, coronary atherosclerosis, age is an important factor in heart disease, coronary heart disease also common in the elderly general heart disease, and a direct threat to their lives .The high prevalence of cerebrovascular disease, high recurrence rate, a high degree of disability in old age to bring great pain.Type of early, mostly platelet thrombus thrombus, followed by fibrin clots.Clinical manifestations are: 1 more than a sudden onset, may have local pain, such as angina, headache, abdominal pain, limb pain, etc. 2 blood supply to the tissues of ischemia, hypoxia dysfunction, such as heart failure, heart cardiogenic shock, cardiac arrhythmia, disturbance of consciousness and hemiplegia, etc. 3 thrombosis caused by cerebral embolism, myocardial infarction, renal embolization, splenic embolization and other related symptoms and signs, 4 blood supply to tissue ischemia and necrosis caused by clinical manifestations such as fever.3、毛细血管血栓形成 常见于弥散性血管内凝血、雪山性血小板减少性紫癜及溶血性尿毒综合症等。表现往往缺乏特异性，主要为微循环障碍、皮肤黏膜栓塞性坏死、器官功能障碍、出血倾向等。3, capillary thrombosis is common in disseminated intravascular coagulation, Snow thrombocytopenic purpura and hemolytic uremic syndrome.Performance is often a lack of specificity, mainly microcirculation, skin and mucous membranes embolic necrosis, organ dysfunction, bleeding tendencies.疾病病因病理生理Pathophysiology of disease etiology1、血管内皮损伤 血管内膜的完整性、血管内皮细胞的抗血小板聚集及抗凝血活性是保持血流畅通的重要条件。当血管内皮细胞因机械、感染免疫及血管自身病变等因素受损伤时，即可通过下列机制促使血栓形成：1反射性血管收缩等使血流变缓，血液瘀滞，2内皮下组织暴露、vWF释放等导致血小板在血管壁内黏附、聚集及释放反应的发生3TF表达及释放、内皮下基底胶原纤维暴露启动凝血过程，4内皮血小板聚集（前列环素I2等）及抗凝功能（硫酸肝素等）受损，加速凝血过程。1, vascular endothelial damage the integrity of vascular endothelium, vascular endothelial cells, platelet aggregation and anti-clotting activity is an important condition to maintain blood flow.When vascular endothelial cells due to mechanical, infectious and immune factors such as vascular disease by self-injury, can promote thrombosis through the following mechanisms: 1 reflex vasoconstriction so that blood flow slows, blood stasis, 2 within the subcutaneous tissue exposure, vWF release as a result of platelets in the blood vessel wall adhesion, aggregation and release reactions 3TF expression and release, subendothelial collagen exposed basal activation of the clotting process, 4 endothelial platelet aggregation (prostacyclin I2, etc.) and anticoagulant function (heparin sulfate, etc.) damage, speed up the clotting process.2、血小板聚集 血小板在损伤内膜外的黏附、聚集，导致血小板活化及释放反应，通过下列机制参与雪山形成：1血小板聚集直接形成血小板血栓，2释放PF-3参与凝血过程3启动花生四烯酸代谢，TXA2等，收缩血管及血小板凝集，4释放SHT及ADP等，加速血小板的二相聚集5在一定条件下，直接激活F、，启动凝血过程。 3、凝血过程启动 在血液凝固性增高的条件下，因血管内皮损伤，血小板活化及其他因素致凝血过程启动，促进血栓形成：1凝血酶激活，形成纤维蛋白血栓，2凝血过程中形成的凝血酶，反馈性加速凝血过程，3凝血酶等激活纤容酶原，启动纤溶过程，4凝血酶引导不可逆性血小板聚集及释放反应等。2, platelet aggregation of platelets in the damaged outer membrane adhesion, aggregation, leading to platelet activation and release reaction, the formation of mountains through the following mechanisms involved: 1 direct the formation of platelet aggregation platelet thrombus, 2 release of PF-3 involved in blood clotting process starts 3 arachidonic acid metabolism, TXA2, etc., constricts blood vessels and platelet aggregation, 4 SHT and ADP release, etc., to accelerate the second phase of platelet aggregation 5 under certain conditions, direct activation of F , , activation of the clotting process.3, the clotting process starts in the blood coagulation conditions, due to vascular endothelial injury, platelet activation and other factors that cause clotting process begins and promote thrombosis: 1 thrombin activation, the formation of fibrin clots, 2 formed during the coagulation thrombin, feedback to accelerate the clotting process, 3 zymogen of thrombin and other activated fiber content, start the fibrinolytic process, 4 thrombin guide irreversible platelet aggregation and release reactions.4、抗凝活性减低 人体生理性抗凝活性降低是血栓形成的重要条件，引起人体抗凝活性减低的直接的原因是抗凝功能酶类活性如纤溶酶等溶解血栓的酶类活性降低了。5、纤溶系统活性降低 临床常见者有：1纤溶酶原结构及功能异常，如异常纤溶酶原血症等，2纤溶酶原激活剂（PA）释放障碍，3纤溶酶活化剂抑制物（PAI）过多，这些因素导致人体对纤维蛋白清除能力下降，有利于血栓形成及扩大。4, reducing the bodys physiological anticoagulant activity reduced anticoagulant activity is an important condition for the formation of blood clots, causing the body to reduce the direct anticoagulant activity due to anticoagulant activity of functional enzymes such as thrombolytic enzymes plasmin activity reducing .5, fibrinolytic activity was reduced by a common clinical: 1 plasminogen structure and function abnormalities, such as hyperlipidemia and other abnormal plasminogen, 2 plasminogen activator (PA) release barriers, 3 fiber melting activity of inhibitor (PAI) too much, these factors lead to the bodys reduced ability to clear fibrin, is conducive to thrombosis and expand.6、血流异常 各种原因引起的全身或局部血流淤滞、缓慢及循环障碍是血栓形成的重要因素，如高纤维蛋白原血症、高脂血症、脱水、红细胞增多所致的高黏度综合症等，它可通过以下机制促进血栓形成：1红细胞聚集成团，形成红色血栓2促进血小板与内皮的黏附及聚集、释放反应3损伤血管内皮，启动凝血过程。6, a variety of causes abnormal blood flow or systemic blood flow stasis, slow and circulatory disturbance is an important factor in thrombosis, such as high fibrinogen, hyperinsulinemia, hyperlipidemia, dehydration, polycythemia caused by high viscosity syndrome, which can promote thrombosis through the following mechanisms: 1 red blood cells gathered into a group, the formation of red thrombus 2 to promote platelet and endothelial adhesion and aggregation, release reaction 3 damage vascular endothelium, activation of the clotting process.诊断检查Diagnostic tests需要注意的是，很多老年人外表健康但存在生理性血栓前状态。血液流变学检测（医院有，数据为25项），各种血栓形成及血栓栓塞性疾病的症状、体征的医院检查项目：血液流变学检测，血栓检测仪，如血管造影、血管超声多普勒、CT、MRI（核磁共振）、凝学象、凝学激活分子标志物等方面的检测，血管造影及影像学方面的检查。本店做的是血象检测，也是一种很科学的检查方式，通过总放大几十万倍，可大致地看到。Note that many apparently healthy elderly people but there are physiological prothrombotic state.Hemorheology (hospitals, data 25), a variety of thrombosis and thromboembolic disease symptoms, signs of the hospital project: hemorheology, thrombosis detector, such as angiography, vascular ultrasound more Doppler, CT, MRI (magnetic resonance), coagulation study, as, molecular markers of coagulation activation study other aspects of testing, angiography and imaging aspects of the inspection.Our blood test is done, but also a very scientific way of checking, the total magnification by dozens of times, can be broadly seen . . .治疗方案 目的在于改善血栓前状态或高凝状态，防止血栓扩大及新血栓形成，溶解血栓，重建血流通道，恢复相关组织、器官供血及功能。Treatment programs aimed at improving the prothrombotic state or a hypercoagulable state and prevent the expansion and new thrombosis, blood clots, dissolve the clot, blood flow channel reconstruction, recovery-related tissues, organs, blood supply and function.1、治疗基础疾病 如防治动脉硬化、控制糖尿病等。1, treatment of underlying diseases such as atherosclerosis prevention and control diabetes.2、一般治疗 卧床休息，抬高静脉血栓形成的患肢。2, the general treatment of bed rest, elevation of venous thrombosis limb.3、对症治疗 包括止痛、纠正器官功能衰竭等。3, symptomatic treatment including pain relief, to correct organ failure.4、血栓药物4-thrombosis