病理学-血液循环系统障碍(中英文)

血液循环系统障碍

HemodynamicDisorders

DepartmentofPathology1《心血运动论》威廉

哈维AnAnatomicalStudyoftheMotionoftheHeartandoftheBloodinAnimals,16282ContainingHeart,artery,VeinGeneralcirculationPulmonarycirculationFunctionsDeliveroxygenandnutrientsCarryawaymetabolicwastes健康的循环系统： ♠正常血容量（Normalbloodvolumn） ♠

血液稳态（Homeostasis）3血液稳态

血管壁完整性vesselwallintegrity

静水压intravascularpressure

胶渗压osmolarity

正常凝血normalhemostasisEdema水肿Hyperemia&congestion

充血和淤血Thrombosis&Embolism

血栓形成和栓塞Infarction梗死Hemorrhage出血Shock休克ThreeMajorCausesofmorbidityandmortality ♦Myocardialinfarction心肌梗死 ♦Pulmonaryembolism肺栓塞 ♦Cerebralvascularaccident脑血管意外，中风4CirculationDisturbanceGeneral(全身性)

Someseveresituationaffectingalloverthebody:

cardiacdysfunction心功能不全

shockLocal（局灶性）Abnormalbloodvolumeandthevelocityofbloodflow:hyperemiaandischemiaAbnormalityofvascularintegrityandpermeability:edemaandhemorrhage

Occlusionofthevessellumen:thrombosis,embolismandinfarction

125WordsandVocabulariescyanosisedemasclerosisheartfailurecellbrownindurationnutmeglivermixedthrombushyalinethrombusorganizationrecanalizationphlebolith&arteriolithcrossedembolismorparadoxicalembolismretrogradeembolismthromboembolismcaissondiseasedecompressionsicknessamnioticfluidembolismsepticinfarct6EDEMA(水肿)组织间隙（interstitialtissuespaces）液体含量增加General&localPathogenesisVascularhydrostaticpressurePlasmacolloidosmoticpressureLymphaticdrainage7EDEMAIncreasedhydrostaticpressure(如心功能不全致心源性水肿，cardiacedema)Reducedplasmaosmoticpressure(nephrotic,hepatic,malnutrientedema,etc.)Lymphaticobstruction(如丝虫病感染—橡皮肿，乳癌扩大根治术后)Sodiumandwaterretention水钠潴留(如急性肾衰)MinimalChangeDiseaseelephantiasisPittingedema8EDEMAMostcommontypesSubcutaneousedemaPulmonaryedemaEdemaofthebrainMorphologyLightMicroscope（LM）:ClearingandseparationoftheextracellularmatrixelementsCellswelling9特殊类型Hydrothorax胸腔积液hydropericardium

心包腔积液hydroperitoneum(ascites)腹腔积液Anasarca

全身性水肿EDEMAClinicalcorrelationfromannoyingtofatalindicatesubtlediseasebenefitorharmful10HYPEREMIA&CONGESTION

充血和淤血局部组织血管内血液含量的增多Arterialhyperemia(hyperemia，充血)局部器官或组织由于动脉血输入量增多而发生的充血anaugmentedbloodflowinducingarteriolarandcapillarydilationVenoushyperemia(congestion，淤血)局部器官或组织由于静脉血液回流受阻，血液淤积于小静脉和毛细血管内accumulationofbloodinsmallveinsandcapillariesresultfromdrainagedifficultyofveins11HYPEREMIA&CONGESTIONHyperemia:activeprocess主动过程;red,raisedtempreture,increasedvolume（红热肿）enhancedfunction功能增强;Congestion:

passiveprocess被动过程;generaloflocal;reddishbluecolor(cyanosis),lowtemperature,increasedvolume,edema（紫冷肿）;decreasedfunction功能低下12机制：

血管舒张神经兴奋性↑

血管收缩神经兴奋性↓类型：

生理性：

如害羞时，运动时，进餐后

病理性：炎性充血，减压后充血

利弊：

－plentysupplyofO2,functionalenhancement,nutritionsubstance

－headache,hemorrhage,stroke

HYPEREMIA13Causes:

全身性:体循环淤血，肺循环淤血

cardiacdysfunction(rightorleft)局灶性:局部静脉受压或阻塞

externalCompression---tumor,bandage occlusionoflumen---thrombosis,embolism thickeningofvenouswall paralysisofneurogenicmodulation---burn,frostbite

CONGESTION14CONGESTIONChroniccongestionRaisedvenouspressure

AnoxiaMetaboliteaccumulationEnlargedinterendothelialgapBasemembranedegeneration

Parenchymal

InterstitialfibrosisAtrophyReticularfibercollapsedIncreasepermeabilityDegenerationCollagenincreasedNecrosisFibroblastproliferationMicroscopicscarring EdemaHemorrhage

Congestivesclerosis15CONGESTION慢性淤血

静脉压升高

缺氧及代谢产物堆积

毛细血管内皮细胞间隙增宽

基底膜变性

实质细胞萎缩、变性和坏死间质纤维组织增生毛细血管通透性增加

淤血性水肿

淤血性出血

淤血性硬化16Morphology大体镜下小血管内富含红细胞

CONGESTION17CONGESTION肺急性肺淤血acutepulmonarycongestion大体:肺饱满肿胀，胸膜光泽，色泽暗红，切面流出泡沫状红色血性液体

（edematousfluid）

镜下:肺泡壁毛细血管高度扩张充血——串珠样，玫瑰样肺泡腔“虚实不一”，充满嗜酸性水肿液

临床表现：

咳嗽，喀粉红色泡沫痰（foamypinkysputum）18CONGESTION肺慢性肺淤血chronicpulmonarycongestion大体:质地较硬，棕褐色，散在分布有棕色小点——褐色硬化(BrownInduration)镜下:肺泡壁(septa)增厚纤维化心衰细胞(heartfailurecells)

，——吞噬红细胞并将其中的血红蛋白分解形成棕黄色的含铁血黄素（hemosiderin）的巨噬细胞

—hemosiderin-ladenmacrophages

临床表现：

咳嗽，喀铁锈色痰，呼吸困难19CONGESTION肝

急性肝淤血acutehepaticcongestion大体：肝脏体积增大，呈暗红色镜下：

小叶中央静脉和肝窦(sinusoid)扩张，充满红细胞严重时可有小叶中央肝细胞萎缩、坏死

20CONGESTION肝慢性肝淤血chronichepaticcongestion

槟榔肝NutmegLiver大体：肝小叶中央区因严重淤血而呈暗红色，肝小叶周边部肝组织因脂肪变性而呈黄色，红(淤血区)黄(肝脂肪变区)相间，状似槟榔切面。镜下：肝小叶中央区淤血乃至出血，肝细胞萎缩，甚至坏死、崩解消失，肝小叶周边部肝细胞脂肪变性。长期严重的肝淤血

hepaticfibrosis(cardiaccirrhosis)

21Hemorrhage（出血）Causes血管破裂Trauma Pepticulcer,aneurism,atherosclerosis

出血倾向 Enlargedinterendothelialgap(basementmembraneinjury). TheintergrityofthevesselsremainsintactInjurytovascularwall:severeinfection,anoxia,toxinsChangeinnumberandqualityofplatelets

uremia,leukemia,idiopathicDisturbanceofcoagulationmechanism

congenitaldisease,DIC,deficiencyofVit.K22hemorrhage瘀点petechiae紫癜purpuras瘀斑ecchymoses血肿hematoma胸腔积血hemothorax心包腔积血hemopericardium腹腔积血hemoperitoneum关节腔积血hemoarthrosis临床意义取决于出血的类型、出血量、出血速度和出血部位严重后果：

HemorrhagicshockStroke

23NormalhemostasisMaintainbloodinafluid,clot-freestateLocalizedhemostaticplug血栓形成在活体的心脏和血管内，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称为血栓形成(thrombosis)；所形成的固体质块称为血栓(thrombus)。Hemostasis&thrombosis

（止血和血栓形成）24Hemostasis三个参与止血的主要成分

血管壁

血小板

凝血级联反应止血过程

血管挛缩vasoconstriction

一期（初步）止血primaryhemostasis

二期止血secondaryhemostasis

抗血栓形成反向调节

antithromboticcounter-regulation

25凝血途径CoagulationPathway内源性凝血途径；外源性凝血途径凝血因子Ⅰ~ⅩⅢ,Ca2+，血小板磷脂FⅢ：组织因子；FⅡ：凝血酶原；FⅠ：纤维蛋白原“a”代表水解激活后状态Hemostasis26Hemostasis&thrombosis血管内皮细胞抗凝特性Antithrombotic（内皮完整时）抗血小板antiplatelet抗凝anticoagulant纤溶fibrinolytic促凝特性Prothrombotic（内皮受损时）辅助血小板黏附激活外源性凝血途径抑制纤维蛋白溶解27Hemostasis&thrombosis血小板黏附反应(adhesion)释放反应

(releasereaction/secretion)黏集反应(aggregation)凝血级联反应28thrombosisPathogenesis心血管内皮细胞损伤血流状态异常血液凝固性增加

魏尔啸三角VirchowTriangle29thrombosisMorphology动脉血栓originatefrominjurysites静脉血栓(phlebothrombus)originatefromthesitesofstasis bothextendtotheheartZahn线，灰白色与暗褐色相间的条纹状结构

paleplateletandfibrinlayers darkerythrocyte-richlayers30thrombosisLinesofZahn31thrombosisLM:plateletstrabeculae+neutrophil fibrin+redcells32thrombosisTypes

MuralthrombusOcclusivethrombusGlobularthrombusVegetation细菌性血栓

肿瘤性血栓

PalethrombusMixedthrombusRedthrombusHyalinethrombus33

白色血栓PaleThrombus血小板&