Xav: Nyob rau hauv ib txwm muaj physiological mob

1. Vim li cas cov ntshav hauv cov hlab ntsha tsis coagulate?

2. Vim li cas cov hlab ntsha puas tsuaj tom qab raug mob los ntshav?

Nrog cov lus nug saum toj no, peb pib kawm hnub no!

Raws li ib txwm muaj lub cev muaj zog, cov ntshav ntws hauv tib neeg cov hlab ntsha thiab yuav tsis ntws tawm sab nraud ntawm cov hlab ntsha kom los ntshav, thiab nws yuav tsis coagulate hauv cov hlab ntsha thiab ua rau thrombosis.Qhov laj thawj tseem ceeb yog tias tib neeg lub cev muaj cov txheej txheem hemostasis zoo thiab ua haujlwm ntawm cov tshuaj tiv thaiv coagulant.Thaum qhov kev ua haujlwm no txawv txav, tib neeg lub cev yuav muaj kev pheej hmoo los ntshav lossis thrombosis.

1. Hemostasis txheej txheem

Peb txhua tus paub tias cov txheej txheem ntawm hemostasis hauv tib neeg lub cev yog thawj qhov kev cog lus ntawm cov hlab ntsha, thiab tom qab ntawd cov adhesion, sib sau ua ke thiab tso tawm ntawm ntau yam procoagulant ntawm platelets los ua cov mos platelet emboli.Cov txheej txheem no hu ua one-stage hemostasis.

Txawm li cas los xij, qhov tseem ceeb tshaj, nws ua rau lub cev coagulation, tsim cov fibrin network, thiab thaum kawg tsim cov thrombus ruaj khov.Cov txheej txheem no hu ua Secondary hemostasis.

2.Coagulation mechanism

Cov ntshav coagulation yog txheej txheem uas coagulation yam tshwm sim nyob rau hauv ib qho kev txiav txim los tsim thrombin, thiab thaum kawg fibrinogen hloov mus ua fibrin.Cov txheej txheem coagulation tuaj yeem muab faib ua peb kauj ruam yooj yim: tsim cov prothrombinase complex, ua kom thrombin thiab tsim cov fibrin.

Cov yam ntxwv ntawm coagulation yog cov npe ntawm cov khoom sib txuas ncaj qha rau hauv cov ntshav coagulation hauv plasma thiab cov ntaub so ntswg.Tam sim no, muaj 12 coagulation yam muaj npe raws li Roman tus lej, uas yog coagulation yam tseem ceeb Ⅰ ~ XⅢ (VI tsis suav tias yog ib qho kev ywj pheej coagulation), tsuas yog Ⅳ Nws yog nyob rau hauv daim ntawv ionic, thiab tus so yog cov proteins.Kev tsim khoom ntawm Ⅱ, Ⅶ, Ⅸ, thiab Ⅹ yuav tsum muaj kev koom tes ntawm VitK.

Raws li cov txheej txheem sib txawv ntawm kev pib thiab coagulation yam cuam tshuam, txoj hauv kev rau kev tsim cov prothrombinase complexes tuaj yeem muab faib ua txoj hauv kev endogenous coagulation thiab exogenous coagulation pathways.

Txoj kev endogenous ntshav coagulation (feem ntau siv APTT test) txhais tau hais tias tag nrho cov yam tseem ceeb ntawm cov ntshav coagulation los ntawm cov ntshav, uas feem ntau yog pib los ntawm kev sib cuag ntawm cov ntshav nrog rau qhov tsis zoo ntawm lub cev txawv teb chaws nto (xws li iav, kaolin, collagen. , thiab lwm yam);Cov txheej txheem coagulation pib los ntawm kev raug cov ntaub so ntswg yog hu ua exogenous coagulation txoj kev (feem ntau siv PT xeem).

Thaum lub cev nyob rau hauv lub xeev pathological, kab mob endotoxin, ntxiv rau C5a, lub cev tsis muaj zog, qog necrosis factor, thiab lwm yam tuaj yeem txhawb nqa vascular endothelial hlwb thiab monocytes los nthuav qhia cov ntaub so ntswg, yog li pib cov txheej txheem coagulation, ua rau 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)

Muaj nuj nqi: Txo qhov tsim ntawm fibrin thiab txo cov qib ua kom muaj ntau yam coagulation.

4.Fibrinolytic mechanism

Thaum cov ntshav coagulates, PLG yog qhib rau hauv PL nyob rau hauv qhov kev txiav txim ntawm t-PA lossis u-PA, uas txhawb fibrin dissolution thiab cov ntaub ntawv fibrin (proto) degradation khoom (FDP), thiab cross-linked fibrin degraded raws li ib yam khoom.Hu ua D-Dimer.Qhov kev ua kom muaj zog ntawm fibrinolytic system feem ntau yog muab faib ua txoj hauv kev ua kom sab hauv, txoj kev ua kom sab nraud thiab txoj kev ua kom sab nraud.

Inner activation pathway: Nws yog txoj hauv kev ntawm PL tsim los ntawm kev sib cais ntawm PLG los ntawm txoj kev endogenous coagulation, uas yog lub hauv paus theoretical ntawm theem nrab fibrinolysis.External activation txoj kev: Nws yog txoj kev uas t-PA tso tawm los ntawm vascular endothelial hlwb cleaves. PLG los tsim PL, uas yog lub hauv paus theoretical ntawm thawj fibrinolysis.Exogenous activation txoj kev: thrombolytic tshuaj xws li SK, UK thiab t-PA uas nkag mus rau tib neeg lub cev los ntawm lub ntiaj teb sab nraud tuaj yeem qhib PLG rau hauv PL, uas yog lub hauv paus theoretical ntawm thrombolytic kev kho mob.

Qhov tseeb, cov txheej txheem koom nrog hauv coagulation, anticoagulation, thiab fibrinolysis systems yog complex, thiab muaj ntau yam kev soj ntsuam kuaj, tab sis qhov peb yuav tsum tau xyuam xim rau ntau tshaj yog lub dynamic tshuav nyiaj li cas ntawm lub tshuab, uas yuav tsis muaj zog los yog heev. qaug zog.