生理学课件血液1kong.pptVIP

* This scanning electron photomicrograph shows the actual clot formation. The fibrin mesh of cross-linked fibrin monomers can be seen as a white stringlike substance trapping red blood cells in a fresh clot.The red cells are not sticking together; they are being held together by fibrin. Much the same process occurs early in clot development, when platelet aggregates are held together by fibrinogen, which stabilizes the first hemostatic plug. Colman RW, Hirsh J, Marder VJ, Salzman EW. Overview of hemostasis. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and thrombosis, 3rd ed. Philadelphia: J.B. Lippincott, 1994 pp 6,13,14. 华法林临床上用于预防包括房颤、静脉血栓、冠状动脉病、某些矫形手术以及先天性或获得性血栓的形成，是唯一被批准用于长期抗血栓治疗的药物。但因其治疗窗窄、起效慢、需较频繁的血液监测来调整剂量以及与多种食物（包括酒精）或药物间存在相互作用而使其在临床应用中受到限制。 * Multiple pathways are responsible for platelet activation. Platelets adhere to damaged blood vessels via cell surface adhesion molecules and their membrane receptors such as glycoprotein Ib/IX (GP Ib/IX), the ligand for von Willebrand factor (VWF), which in turn can activated platelets and cause conformational changes. Further, other activators including thrombin, adrenaline, ADP, and collagen can also activate platelets. When activation occurs, the glycoprotein IIb/IIIa membrane receptor (GP IIb/IIIa) is exposed. This receptor forms bridges using fibrinogen resulting in aggregation. Platelet activation also exposes a phospholipid surface (meeting place) upon which coagulation proteins carry out their reactions. The sequential activation of these coagulation factors ultimately leads to the formation of fibrin, which is a critical component in stabilizing the hemostatic plug. Thrombin when generated, plays a pivotal role in hemostasis, via both fibrin conversion and platelet activation. * 三、输血的原则 交叉配血试验 红细胞 供血者 血 清 受血者 血 清 次侧 主侧 红细胞 * 配血结果 结果判定 临床 主侧 次侧 (＋) (＋) 不合 绝对禁止输入 (＋) (－) (－) (＋) 基本相合 慎重输入 (－) (－) 相合 可以输入 结果判定 * 2.输血的原则 ●根本原则： (主要考虑供血者的红细胞不被受血者 血清所凝集) ——避免输血过程中出现红细胞