门脉高压病理生生理及其麻醉处理.pptVIP

门脉高压的病理生理 及麻醉处理 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 关于门静脉 静脉提供肝脏总血流量的%及 氧量的6% Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 胃肠道 肠系膜上静脉 脾静脉 门静脉 胰腺 十窦→肝静脉一→下腔静脉 肝动脉 25%6 窦前性 窦后性 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 勹静脉高压概念 正常门静脉压为1.27-2.35kpa(13-24 cmH20),平均压力为18cmH20(比下腔静 脉压高45mHg),若超过25cm0, 则称为门脉高压。 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 门静脉高压症病因 ■血流量增加(少见) ■血流阻力增加(常见) 1.内本身疾病(常见) 2.脾静脉或门静脉阻塞(罕见) 3肝静脉流出受阻(罕见) Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 门脉高压肝脏病因 ·坏死性肝炎、肝硬变 窦性、窦后性梗阻。 血吸虫肝硬变; 窦前性阻塞。 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 病理 1.脾肿大、脾亢:脾窦充血,纤维组织增生;脾髓细胞再 生,全血减少 2.交通支扩张:重要的是胃底、食管下段交通支; 3.腹水:压力高,肝功能减退,白蛋白合成障碍;胶体渗 透压下降;肾上腺皮质和醛固酮的作用;钠水潴留 肝性脑病:常可继发肝昏迷,血氨200ug/dl诱发因素 有一低血压、高蛋白饮食、胃肠道出血、感染、药物影 响等,应予防治 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L ■脾亢时脾滤血亢进,大量血细胞(红细胞 白细胞、血小板)阻留在脾内并被破坏 吞噬 早期以白细胞、血小板减少为主 晚期白细胞、红细胞、血小板减少(三系 减少) Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L 脾亢凝血障碍原因 ■蛋白合成不足凝血因子合成减 维生素K吸收障碍—依赖维生素K的凝血 因子前体不能活化 肝素酶合成降低,肝素灭活能力下降,血 中肝素浓度上升 骨髓合成下降,血小板下降 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 di