局部血液循环障碍.pptVIP

肠梗死 3). 败血性梗死: (septic infarct) 由含有细菌的栓子阻塞血管引起, 可见含有细菌团的栓子在多个器官形成脓肿 梗死对机体的影响及结局 1) 梗死对机体影响与梗死的器官、部 位、梗死的范围面积有关 2) 梗死的结局 1) 溶解、吸收 2) 机化 3) 包裹 4) 钙化 Infarction An infarct is an area of ischemic necrosis within a tissue or an organ, produced by occlusion of either its arterial supply or its veinous drainage. Nearly all infarcts result from thrombotic or embolic occlusion. Infarcts are divided into three types: white infarct (anemic infarct), red infarct (hemorrhagic infarct), and septic infarct. Hemodynamic disorders Survival of cells and tissues is essentially dependent on the oxygen provided in a normal blood supply and, therefore, on delivery of sufficient blood through a patent circulatory system. Dearangements in blood supply cause some of the most commonly encountered disorders in medical practice: congestion, hemorrhage, and the three interrelated conditions— thrombosis, embolism, and infarction. Hemodynamic disorders Not only are these disorders common, but also they are major causes of mortality. Hemorrhage is virtually daily problems in the ER of any large hospital. Thrombosis, embolism, and infarction underlie three most inportant disorders: myocardial infarction, pulmonary embolism, and cerebrovascular accidents (strokes). 毛 脂肪栓塞 (Fat embolism) ? 常见于长骨骨折，脂肪组织严重挫伤入血 → 右心 → 肺 ? 直径＞20μm脂滴栓子 → 肺动脉及 毛细血管栓塞 ? 直径＜20μm脂滴栓子 → 肺泡壁毛 细血管 → 肺静脉 → 左心 → 体循环 → 全身多器官栓塞 肺骨髓栓塞 肺脂肪栓塞 ? 少量脂滴入血 → 被巨噬细胞吞噬吸收或被脂酶分解清除 → 无不良后果 ? 75%的肺栓塞 → 急性右心衰死亡 ? 长骨骨折 → 黄骨髓入血 → 体V,右心 → 肺A、肺内毛细血管 → 肺V → 左心 → 广泛A栓塞(脑A) 气体栓塞(Gas embolism)  ? 空气栓塞(Air embolism)：大量空气入血? 减压病(Depression sickness),又称潜水员病(Divers disease): 在高压环境急速转到低压环境时，原溶解血液内的气体迅速游离形成气泡, 阻塞小血管 羊水栓塞 (Amniotic fluid embolism) ? 分娩过程中罕见的严重合并症(1/50000) 机理:  胎盘早剥, 羊膜破裂 胎儿阻塞产道 宫内压增高 → 羊水被压入子宫壁破 裂V窦内 → 肺及体循环栓塞 病变: 肺小A和毛细血管内有羊水 成份(角化鳞状上皮、胎毛、 胎脂、胎粪、粘液) 后果: 肺动脉栓塞; 过敏性休克; DIC → 母子(女)双亡 其它栓塞: 肿瘤细