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Aa标,bb文,Cc文,Dd文,*,Pathology,Thrombosis,Thrombosis,1,Contents,Concept,Requirement,and mechanism,Process and appearance,Results and effects,ContentsConcept,2,Definition of thrombosis and thrombus,Thrombosis is the formation of a solid mass of blood constituents within the vascular system during life,thrombosis,thrombus,Definition of thrombosis and t,3,Requirement,and mechanism,为什么血液流动日夜川流不息？,动态平衡,抗凝血,凝 血,Requirement and mechanism为什么血液,4,维持平衡的因素,Endothelial integrity,内膜完整,Normal blood stream,正常的血流状态,Normal blood coagulation ability,正常的凝血功能状态,维持平衡的因素Endothelial integrity,5,维持平衡的因素,内膜的完整,血液,内皮细胞,内皮下,维持平衡的因素内膜的完整血液内皮细胞内皮下,6,维持平衡的因素,内膜的完整,内皮细胞,抗凝,屏障,合成抗凝物质及分解促凝物质,前列环素 NO ADP酶抑血小板,凝血酶调节蛋白 蛋白S灭活V ,硫酸乙酰肝素灭活a a a,纤溶酶原活化因子纤溶,维持平衡的因素内膜的完整 抗凝,7,维持平衡的因素,内膜的完整,内皮细胞,促凝,合成促凝物质,组织因子,vWF,纤溶酶原活化因子的抑制因子,仅在内皮细胞受损时释放,维持平衡的因素内膜的完整 促凝仅在内皮细胞受损时释放,8,维持平衡的因素,内膜的完整,内皮细胞,内皮下结缔组织被封闭,暴露胶原,活化血小板,凝血酶,ADP,血栓素,A,2,活化凝血因子,血细胞和纤维蛋白原粘着,纤维连接蛋白,促凝,正常时被封闭,维持平衡的因素内膜的完整暴露胶原促凝正常时被封闭,9,维持平衡的因素,血流状态,保持轴流和边流,血流速度正常,无涡流、无异常流向,维持平衡的因素血流状态,10,维持平衡的因素,血液性质,内外源性凝血系统,抗凝系统功能,血小板数量和功能,维持平衡的因素血液性质,11,破坏动态平衡，促进凝血优势的条件,心血管内膜损伤 胶原暴露,心血管内膜损伤,内皮细胞促凝,因子释放,胶原暴露,血小板粘附,启动内外源,凝血过程,破坏动态平衡，促进凝血优势的条件心血管内膜损伤 胶原暴露,12,破坏动态平衡，促进凝血优势的条件,血流变慢、出现异常流向,致使血小板靠边,凝血物质局部浓度增高,缺氧内皮细胞受损,破坏动态平衡，促进凝血优势的条件血流变慢、出现异常流向,13,破坏动态平衡，促进凝血优势的条件,血液凝固性增加（高凝状态）,血液粘稠度增高,血小板数目 粘性,凝血因子增多或被激活,破坏动态平衡，促进凝血优势的条件血液凝固性增加（高凝状态）,14,破坏动态平衡，促进凝血优势的条件,妊娠产后,高脂饮食,手术后,吸烟,血小板,胰腺癌 胃癌,乳腺癌 肺癌,凝血因子,组织因子,促凝血因子A,脱水,Hypercoagulability,血液浓缩,血液粘稠度,破坏动态平衡，促进凝血优势的条件妊娠产后手术后血小板胰腺癌,15,破坏动态平衡，促进凝血优势的条件,注意,各条件经常同时存在,都从血小板粘附于内膜下暴露的胶原开始,关键是内膜损伤和血小板粘集,形成过程、血栓形态、组成、大小取决于部位和该处的血流速度,破坏动态平衡，促进凝血优势的条件注意,16,Virchows triad,predisposing situations for thrombus formation,Endothelial injury,Stasis or turbulence of blood flow,Blood hypercoagulability,Virchows triad, predisposing,17,THROMBOSIS,ENDOTHELIAL INJURY,ABNORMAL,BLOOD FLOW,HYPERCOAGULABILITY,THROMBOSISENDOTHELIAL INJURYAB,18,Process & appearance,Role of platelets,Process of thrombosis,Appearance of thrombus,Process & appearanceRole of pl,19,Role of platelets,第一步 粘附,血小板粘附,胶原暴露,血小板活化,激活凝血酶,Role of platelets第一步 粘附血小板粘附胶原,20,Role of platelets,第一步 粘附,第二步 释放反应 粘性变态,血小板收缩,脱颗粒,纤维蛋白原-,纤维连接蛋白,PF,4,PDGF,ADP,Ca,2+,血管胺,血栓素A,2,PF,3,凝血酶原,凝血酶,a, a,a,a, Ca,2+,凝血酶原酶,Role of platelets第一步 粘附血小板收缩纤维,21,Role of platelets,第一步 粘附,第二步 释放反应 粘性变态,第三步 粘集,凝血酶,ADP,血栓素,血小板粘集,可逆 不可逆,Role of platelets第一步 粘附凝血酶ADP血,22,Role of platelets,Role of platelets,23,血栓形成ppt课件,24,Process of thrombosis,Platelet adhesion to damaged vessel walls,Thrombus formation,Process of thrombosisPlatelet,25,Appearance of thrombus,Pale thrombus,Red thrombus,Mixed thrombus,Hyaline thrombus,Appearance of thrombusPale thr,26,Appearance of thrombus,Pale Mixed Red,性质,血小板粘集 血液凝固,常见部位,形成过程,大体,镜下,心室 动脉,血小板粘集,灰白粗硬,波纹,紧连管壁,静脉,继发凝血,暗红,软/干燥,易脱落,红色血栓与死后血凝块有何区别？,Appearance of thrombus,27,血栓形成ppt课件,28,血栓形成ppt课件,29,血栓形成ppt课件,30,Appearance of thrombus,静脉内延续性血栓,头 白色血栓,体 混合血栓,尾 红色血栓,球形血栓 层状血栓,Appearance of thrombus静脉内延续性血栓,31,血栓形成ppt课件,32,Appearance of thrombus,Pale thrombus,Red thrombus,Mixed thrombus,Hyaline thrombus,Appearance of thrombusPale thr,33,Results,Softening,liquefying,resorption Shedding,Organization, recanalization,Calcification,ResultsSoftening, liquefying,34,血栓形成ppt课件,35,Effects,Advantageous,Hazardous,Emphraxis,Embolism,Disfiguration of cardiac valve,DIC,disseminated intravascular coagulation,EffectsAdvantageous,36,血栓闭塞性,脉管炎,血栓闭塞性,37,血栓形成ppt课件,38,
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