血液循环障碍2-徐芳英.pdf

第三章 局部血液循环障碍 徐芳英 xfy@zju.edu.cn 第四节 栓塞 • 在循环血液中出现不溶于血液的异常 物质, 随血液流动, 阻塞远处血管腔的 过程。 • 阻塞血管腔的物质称栓子(embolus) 栓子运行途径 • 正 常 异 常 • 体静脉→肺 交叉性栓塞 门静脉→肝 逆行性栓塞 • 左心、动脉系统 →全身各部位 栓塞的类型和对机体的影响 • 血栓栓塞 • 脂肪栓塞 • 气体栓塞 • 羊水栓塞 • 其他栓塞 血栓栓塞 • 栓塞最常见的原因 • 肺动脉栓塞：95% 以上来自下肢膝以上的 深部静脉 依栓子的大小和数量，后果不同 • 体循环动脉栓塞：80%来自左心 肺栓塞 a large pulmonary thromboembolus. Such thromboemboli typically originate in the leg veins or pelvic veins of persons who are immobilized. Other contributing factors include trauma to the extremities, hypercoagulable states (Trousseauss syndrome in patients with carcinomas; protein C or S deficiency; use of oral contraceptives), heart failure, pregnancy, and older age. Large embolus derived from a lower extremity deep venous thrombosis and now impacted in a pulmonary artery branch. Large saddle embolus from the femoral vein lying astride the main left and right pulmonary arteries. Here is a saddle embolus that bridges across the pulmonary artery from the heart as it divides into right and left main pulmonary arteries. Such a saddle embolus is a cause for sudden death. This thromboembolus displays the typical gross appearance. The surface is somewhat irregular, and there are areas of pale tan to white admixed with dark red areas. The thrombus often has the outlines of the vein in which it formed. The main pulmonary trunk and pulmonary arteries to right and left lungs are seen here opened to reveal a large saddle pulmonary thromboembolus. Such an embolus will kill your patient. This is the microscopic appearance of a pulmonary thromboembolus in a large pulmonary artery. There are interdigitating areas of pal