Kufunga: Pasi pezvakajairika physiological mamiriro

1. Sei ropa ririkuyerera mutsinga risingabatanidzi?

2. Sei tsinga yeropa yakakuvadzwa mushure mekushungurudzika inogona kumira kubuda ropa?

Nemibvunzo iri pamusoro, tinotanga kosi yanhasi!

Pasi pezvakajairwa zvemuviri mamiriro, ropa rinoyerera mutsinga dzeropa remunhu uye harizopfachukira kunze kwetsinga dzeropa kukonzeresa kubuda ropa, uye harizobatanidze mutsinga uye kukonzera thrombosis.Chikonzero chikuru ndechekuti muviri wemunhu une yakaoma uye yakakwana hemostasis uye anticoagulant mabasa.Kana basa iri risina kujairika, muviri wemunhu unenge uri panjodzi yekubuda ropa kana thrombosis.

1.Hemostasis process

Isu tose tinoziva kuti muitiro wehemostasis mumuviri wemunhu ndiko kutanga kukanganiswa kwetsinga, uyezve kunamatira, kuunganidza uye kusunungurwa kwezvinhu zvakasiyana-siyana zveprocoagulant zveplatelet kuti zvigadzire nyoro platelet emboli.Iyi nzira inonzi one-stage hemostasis.

Nekudaro, zvinonyanya kukosha, inomutsa iyo coagulation system, inoumba fibrin network, uye pakupedzisira inoumba yakagadzikana thrombus.Iyi nzira inonzi yechipiri hemostasis.

2.Coagulation mechanism

Ropa coagulation inzira iyo coagulation zvinhu zvinogadziriswa mune imwe kurongeka kuti ibudise thrombin, uye pakupedzisira fibrinogen inoshandurwa kuita fibrin.Iyo coagulation process inogona kukamurwa kuita matanho matatu ekutanga: kuumbwa kweprothrombinase yakaoma, activation yethrombin uye kugadzirwa kwefibrin.

Coagulation zvinhu ndiro zita remubatanidzwa rezvinhu zvinosanganisirwa muropa coagulation muplasma uye tishu.Parizvino, kune gumi nemaviri coagulation zvinhu zvakatumidzwa maererano nenhamba dzechiRoma, zvinoti coagulation zvinhu Ⅰ~XⅢ (VI haichaonekwi seyakazvimirira coagulation zvinhu), kunze kwe Ⅳ Iyo iri muionic fomu, uye mamwe mapuroteni.Kugadzirwa kwe Ⅱ, Ⅶ, Ⅸ, uye Ⅹ kunoda kutora chikamu kweVitK.

Zvinoenderana nemaitiro akasiyana ekutanga uye coagulation zvinhu zvinosanganisirwa, nzira dzekugadzira prothrombinase complexes dzinogona kukamurwa kuita endogenous coagulation nzira uye exogenous coagulation nzira.

Iyo endogenous blood coagulation pathway (inowanzo shandiswa APTT bvunzo) zvinoreva kuti zvese zvinosanganisirwa muropa coagulation zvinobva muropa, iro rinowanzotangwa nekusangana kweropa nechaji isina kunaka yemuviri wekunze (segirazi, kaolin, collagen. , nezvimwewo);Iyo coagulation process yakatangwa nekuratidzwa kune tishu chinhu inonzi exogenous coagulation nzira (inowanzo shandiswa PT bvunzo).

Kana muviri uri mumamiriro ekurwara, bhakitiriya endotoxin, inobatanidza C5a, immune complexes, tumor necrosis factor, nezvimwewo inogona kukurudzira vascular endothelial masero uye monocytes kuratidza tissue factor, zvichiita kuti iite coagulation process, zvichiita kuti diffuse intravascular coagulation (DIC).

3.Anticoagulation mechanism

a.Antithrombin system (AT, HC-Ⅱ)

b.Protein C system (PC, PS, TM)

c.Tissue factor pathway inhibitor (TFPI)

Basa: Deredza kuumbwa kwefibrin uye kuderedza activation level yezvinhu zvakasiyana-siyana coagulation.

4.Fibrinolytic mechanism

Kana ropa rakabatana, PLG inoshandiswa mu PL pasi pekuita kwe t-PA kana u-PA, iyo inokurudzira fibrin kuparara uye inoumba fibrin (proto) degradation products (FDP), uye fibrin-yakabatana yakasvibiswa sechimwe chigadzirwa.Inonzi D-Dimer.Kushandiswa kwefibrinolytic system inonyanya kukamurwa kuva mukati mekuita nzira, nzira yekunze yekushanda uye nzira yekunze.

Inner activation pathway: Ndiyo nzira yePL yakaumbwa nekuputika kwePLG ne endogenous coagulation nzira, iyo ndiyo nheyo yezvinyorwa zvechipiri fibrinolysis.External activation pathway: Ndiyo nzira iyo t-PA yakabudiswa kubva kune vascular endothelial cells inocheka. PLG kuumba PL, iyo ndiyo nheyo yezvinyorwa zvekutanga fibrinolysis.Exogenous activation pathway: thrombolytic zvinodhaka zvakadai seSK, UK uye t-PA inopinda mumuviri womunhu kubva kunze kwenyika inogona kushandura PLG muPL, iyo ndiyo nheyo yezvinyorwa zve thrombolytic therapy.

Muchokwadi, nzira dzakabatanidzwa mukugadzirisa, anticoagulation, uye fibrinolysis masisitimu akaomarara, uye kune akawanda ane hukama bvunzo dzemurabhoritari, asi chatinoda kunyanya kutarisisa ndiko kusimba kwesimba pakati pemasisitimu, ayo asingakwanise kusimba zvakanyanya kana zvakare. weak.