病理学 英文版11

Ischemia-reperfusionInjuryPathophysiologyDepartment,TongjiMedicalCollege,HUST整理pptConcepts:Ischemia-reperfusion(I-R)injury,oxygen/calcium/pHparadox,calciumoverload,no-flowphenomenonCausesandconditionsofI-RinjuryMechanismsofI-RinjuryMetabolicandfunctionalalterationsPreventionandtreatmentprincipleContents整理pptAggravatedischemicinjuryduringreperfusionReperfusionInjury整理pptIschemiaComponents整理ppt整理ppt0hrReperfusionIschemicInjuryofNeurons1hr2hr整理pptIschemiaTimeInjuryDeathInjuryWindowsReperfusionOxygenparadox,calciumparadox,pHparadox整理pptCausesandConditionsofReperfusionInjuryCausesConditionsRecoverfromcardiacarrestOrgantransplantationLysingthrombiIschemiatimeBranchcirculationOxygenconsumptionTemperature,Na+,pH,Ca2+整理pptCasePresentationA50-year-oldmanwasadmittedtothehospitalwithseverechestpainof5hoursduration.Mentalconfusionandinacutedyspnea.HR:110beats/min,sinusrhythm;BP:75/50mmHg;ECG:STsegmentelevation,V1-V6LVEF:31%ImprovementinbreathBP:100/70mmHgLVEF:38%TemporaryventriculartachycardiaDiuretic,tissueplasminogenactivatorBalloonangioplasty?整理pptMechanismsofReperfusionInjury↑Freeradicals↑Ca2+iNeutrophilactivationandOthers整理pptFreeradicalAnyatomormoleculepossessingunpairedelectronsSuperoxideanion(O2.-)Hydroxylradical(OH.)Nitricoxide(NO.)Peroxynitrite〔ONOO-)(过氧亚硝酸盐〕ˉLipidperoxideradical(LOO.)ˉOxygenfreeradicalsReactiveoxygenspecies(ROS)

OxygenfreeradicalsHydrogenperoxideOthers整理ppt1.Mitochondria2.Activatedinflammatorycells3.Nitricoxide4.IonizingradiationFormationofROS整理pptReperfusion↑Ca2+iROSMechanism1O2整理ppt↑XanthineoxideseReperfusionIschemiaATP↑Ca2+iXanthinedehydrogenase↑HypoxanthinexanthineO2↓Uricacid↑AMPO2O2.-

H2O2EndothelialcellMechanism2整理pptIschemiaReperfusionO2Pro-inflammatorymediators(e.g.cytokines)NOONOO-O2-(Respirationburst)Mechanism3整理pptBiochemicalImpactsofROS整理ppt整理pptCalciumOverloadTheabnormalincreaseofintracellularcalciumwhichcausescellinjury整理pptMechanism1ReperfusionIschemia↓ATPMembranedepolarizationCa2+↑Na+Na/Caexchanger整理ppt↑Ca2+Na+Reperfusion↓H+H+↑Na+IschemiaCa2+Na+Mechanism2↑H+Na/Hexchanger整理pptReperfusionCa2+Na+H+Na+a1NAPLCPIDGPKCIP3SRCa2+Mechanism3整理pptMechanism4ReperfusionMitochondriaERSR↑Ca2+整理ppt整理ppt↑Na+i

GeneactivationNeutrophilactivation

NeutrophilActivationandOthers整理pptNeutrophilactivation

ROSInflammatorymediatorsInjuryofMicro-vesselsNo-reflowphenomenonCellinjuryRoleofNeutrophilReperfusion整理pptStructuralandFunctionalChangesReperfusionarrhythmiaMyocardialstunningHeart:Brain:EdemaCelldeath整理ppt整理pptElectrocardiographicAlterationsAssociatedwiththeThreeZonesofMyocardialInfarction整理pptHeartInjuryIschemia-reperfusioninjuryCalciumoverloadFreeradicalDestroyofcontractileproteinMyocardialstunningCa++K+Na+ArrhythmiaCelldeath整理pptBrainInjury整理ppt整理pptPrinciplesofPreventionandTreatmentControlofreperfusionconditionsRemovaloffreeradicalsUseof