创伤的病理生理PPT.ppt

1、Section III Pathophysiology of trauma 创伤的病理生理,heat 热,redness 红,swelling 肿,pain 痛,loss of function 功能丧失,1.Inflammation 炎症,Inflammatory cells 炎性细胞 Inflammatory cytokines 炎性因子,capillary毛细血管,Inflammation after trauma 创伤后炎症,Systemic Inflammatory Response Syndrome (SIRS) 全身炎症反应综合征 Compensatory Anti-inflam

2、matory Response Syndrome (CARS) 代偿性抗炎症反应综合征 Trauma and bacteria can cause inflammation 创伤和细菌可引起炎症 This process involve many cells and cytokine 这个过程涉及到许多细胞及细胞因子,inflammation staging 炎症分段,杀灭细菌和毒素 去除坏死细胞 促进组织愈合,促炎和抗炎平衡，炎性稍占上风,Injury 损伤,Bodys response 身体反应,SIRS,CARS,Uncontrolled systemic inflammatory re

3、sponse syndrome 失控的全身炎症反应综合征,besides 此外,sufficient 充分,Death 死亡,uns. 不充分,Under control 得到控制,Clinical presentations of SIRS 全身炎症反应综合征的临床表现,Body temperature （体温） 38 Heart rate （心率）90/min Breathe （呼吸） Blood cell count （血细胞计数）12109/L,20/min,Types of inflammatory mediators 炎性介质的类型,Cytokines 细胞因子,Tumor nec

4、rosis factor (TNF) 肿瘤坏死因子 Interleukin 白介素 Interferon (ITF) 干扰素 Growth factor-(TGF-) 生长因子- ,Activation of inflammatory cells 炎症细胞的激活 (Macrophage) （巨噬细胞）,多器官功能障碍综合征周荣斌,促 炎 介 质 过 度 产 生,原始病因 感 染 损 伤,抗 炎 介 质 过 度 产 生,全 身 反 应 全身炎症反应综合征 （SIRS） 代偿性炎症反应综合征（CARS） 混合性抗炎反应综合征（MARS）,平 衡 SIRS、 CARS,细胞调亡 SIRS过度,免疫功

5、能障碍 CARS过度,MODS SIRS过度,休 克 SIRS过度,局部促炎介质,局部抗炎介质,SIRS临床发病过程,神经内分泌系统变化,2.全身反应 systemic response,代谢变化,3. Wound healing 创伤的愈合,Wound healing is composed of several steps 创伤的愈合分为几个阶段 regeneration 再生 granulation 肉芽组织 angiogenesis 血管生成 epithelialization 形成上皮 The process is mediated by a variety of growth fa

6、ctors. 各种生长因子参与 Primary healing and secondary healing 一期愈合、二期愈合,What is Tissue Repair? 组织修复,The process to replace injured or dead cells and to repair tissues after inflammation. 炎症后，取代受伤或死亡细胞、修复组织的过程 Types of T.R 组织修复的类型 complete T.R 完全愈合 incomplete T.R 不完全愈合,What is Regeneration ? 再生,The process o

7、f the replacement of injured cells by cells of the same type. 损伤细胞被周围同种细胞更换的过程,What is granulation? 肉芽组织,During the course of healing, fibroplasia is developed in the wound by fibroblasts. 在伤口愈合的过程中，纤维母细胞转化形成纤维组织增生 It includes : small blood vessels （小血管） fibroblasts （纤维母细胞） inflammatory cells （炎性细胞）

8、,What is angiogenesis? 血管生成,Angiogenesis is necessary feature of repair and started from preexisting venules, it becomes visible about 4 days after injury. 血管再生是修复的重要特征，在损伤后4天左右时，由先前存在的小静脉开始,Preexisting venules,What is epithelialization? 上皮形成,Epithelial cells is stimulated by a variety of growth fac

9、tors, such as TGF-1,and anchor on the first unepithelialized place. 上皮细胞受到多种生长因子的刺激作用（例如TGF-1）后，集聚于早期非上皮化的部位,The process of repair 修复的过程,coagulation and inflammation 凝聚、炎症 Matrix deposition and granulation 基质沉淀、肉芽组织 Angiogenesis 血管再生 Epithelialization 上皮形成 Collagen maturation 胶原蛋白成熟 Wound contractio

10、n 伤口收缩,Types of wound healing 伤口愈合的类型,Primary healing 一期愈合 small, clean and less tissue damage. 伤口小，清洁，较少组织损伤 by stitching, mild inflammatory reaction. 通过缝合，轻度炎症反应 epidermal regeneration, a small amount of granulation tissue, few scars. 表皮再生，少量肉芽组织，几乎无瘢痕,Primary healing 一期愈合,Types of wound healing 伤

11、口愈合的类型,Secondary healing 二期愈合 Large wound 伤口范围大 Necrotic tissue and inflection 组织坏死、变形 Granulation tissue filled the wound 肉芽组织填充伤口 Big scars 瘢痕大,Nutrition 营养水平 Metabolic status 代谢状态 Circulatory status 循环状态 Hormones 激素水平,Systemic factors 全身因素,Local factors 局部因素,Infection 感染 Wound defect 伤口缺损 Foreign

12、 bodies 异物 Size, location, and type of wound 伤口大小、位置、类型,plication of trauma 创伤并发症,感染 休克 脂肪栓塞综合症 应激性溃疡 凝血功能障碍 器官功能障碍,A,25,Section IV Trauma diagnosis 创伤的诊断,A,26,Relationship between systemic and local 系统与局部的关系,Systemic diagnosis（系统诊断）： Five vital signs/Glasgow scale/CRAMS 五项生命体征/ Glasgow昏迷评分法/CRAMS评分

13、 brain/viscus/chest/lung 脑/内脏/胸/肺 Local diagnosis（局部诊断）： Wound types/scope/depth 伤口的类型、范围、深度 Infection/non-infection 是否感染 Bleeding/fracture 出血、骨折 Systemic diagnosis be the most important 系统诊断尤为重要,A,27,Respiration 呼吸 respiratory rate:25/15/min, cyanosis. 呼吸频率 25 / 15次/分，发绀 Blood pressure and pulse ra

14、te 血压、脉率 pulse rate 100/min, blood pressure 100/min，血压90mmHg Consciousness and pupils motion 意识、瞳孔 Glasgow scale and CRAMS Glasgow昏迷评分法/CRAMS评分,General physical examination (Five vital signs) 一般体格检查（五项生命体征）,A,28,Local wound inspection principles 局部伤口检查的原则,wound size, depth and shape 伤口大小、深度、形状 wound

15、 contamination 伤口污染情况 wound traits 伤口特性 blood vessel damage and bleeding 血管损伤及出血情况 foreign bodies in the wound . 伤口中异物情况 whether involve deep viscus injury or not 是否涉及腹部深层脏器损伤,A,29,Experimental puncture 诊断性穿刺 abdominocentesis 腹腔穿刺 thoracentesis 胸腔穿刺 Exploratory surgery 探查术 Adjunctive check 辅助检查 imaging: CT MRI X-ray 成像：CT、MRI、X线,Blunt trauma examination (close wound check) 闭合性创伤检查,A,30,Abdominocentesis 腹腔穿刺术,A,31,Thoracentesis 胸腔穿刺术,inj