Te Whakaaro: I raro i ngā āhuatanga ā-tinana noa

1. He aha te take kāore e pupū ai te toto e rere ana i roto i ngā uaua toto?

2. He aha i taea ai e te uaua toto kua pakaru i muri i te whara te aukati i te toto?

Me ngā pātai i runga ake nei, ka tīmata tā tātou akoranga o te rā nei!

I raro i ngā āhuatanga ā-tinana noa, ka rere te toto i roto i ngā oko toto o te tangata, ā, e kore e puea ake i waho o ngā oko toto hei whakaputa toto, e kore hoki e totohu i roto i ngā oko toto hei whakaputa totohu. Ko te take matua he uaua, he tino pai hoki ngā mahi hemostasis me ngā mahi anticoagulant a te tinana tangata. Ina he rerekē tēnei mahi, ka tūpono te tinana tangata ki te totohu, ki te totohu rānei.

1. Tukanga hemostasis

E mōhio ana tātou katoa ko te tukanga o te hemostasis i roto i te tinana tangata ko te whakaheke i ngā oko toto, kātahi ko te piri, te whakakotahi me te tuku i ngā matū whakapūpū o ngā pereti toto hei hanga i ngā emboli pereti toto ngohengohe. Ka kiia tēnei tukanga he hemostasis wāhanga kotahi.

Heoi, ko te mea nui ake, ka whakahohe i te pūnaha toto totoka, ka hanga he whatunga fibrin, ā, ka mutu ka hanga he thrombus pumau. Ka kiia tēnei tukanga he hemostasis tuarua.

2. Tikanga totoka

Ko te toto toto he tukanga e whakahohehia ai ngā āhuatanga toto toto i roto i tētahi raupapa hei whakaputa i te thrombin, ā, hei whakamutunga, ka hurihia te fibrinogen hei fibrin. Ka taea te wehewehe i te tukanga toto toto ki ngā taahiraa matua e toru: te hanganga o te matatini prothrombinase, te whakahohenga o te thrombin me te hanga fibrin.

Ko ngā āhuatanga toto totoka te ingoa whānui o ngā matū e whai wāhi tika ana ki te toto totoka i roto i te toto totoka me ngā kiko. I tēnei wā, e 12 ngā āhuatanga totoka kua whakaingoatia kia rite ki ngā tau Rōmana, arā, ko ngā āhuatanga totoka Ⅰ~XⅢ (kāore te VI e kiia he āhuatanga totoka motuhake), engari ko te Ⅳ kei roto i te āhua ionic, ā, ko ngā toenga he pūmua. Ko te hanga o te Ⅱ, Ⅶ, Ⅸ, me te Ⅹ me whai wāhi mai a VitK.

E ai ki ngā tikanga rerekē o te tīmatanga me ngā āhuatanga taupatupatu e whai wāhi ana, ka taea te wehewehe i ngā ara mō te whakaputa i ngā matatini prothrombinase ki ngā ara taupatupatu taketake me ngā ara taupatupatu o waho.

Ko te ara toto toto ā-roto (te whakamātautau APTT e whakamahia whānuitia ana) ko te tikanga ko ngā āhuatanga katoa e uru ana ki te toto toto i ahu mai i te toto, e tīmata ana i te nuinga o te wā mā te pa atu o te toto ki te mata o te tinana ke (pērā i te karāhe, te kaolin, te collagen, me ētahi atu); ko te tukanga toto toto i tīmatahia mā te pānga ki te āhuatanga kiko ka kiia ko te ara toto toto ā-waho (te whakamātautau PT e whakamahia whānuitia ana).

Ina kei roto te tinana i te āhua mate, ka taea e te endotoxin huakita, te tāpiringa C5a, ngā matatini ārai mate, te tumor necrosis factor, me ētahi atu te whakaoho i ngā pūtau endothelial vascular me ngā monocyte ki te whakaatu i te tissue factor, ā, ka tīmata te tukanga toto toto, ka puta te diffuse intravascular coagulation (DIC).

3. Tikanga ārai toto

a. Pūnaha ārai-thrombin (AT, HC-Ⅱ)

b. Pūnaha Pūmua C (PC, PS, TM)

c. Te aukati i te ara o ngā āhuatanga kiko (TFPI)

Mahi: Whakaitihia te hanganga o te fibrin me te whakaiti i te taumata whakahohenga o ngā momo matū toto totoka.

4. Tikanga fibrinolytic

Ina totohu te toto, ka whakahohehia te PLG ki roto i te PL i raro i te mahi a te t-PA, te u-PA rānei, e whakatairanga ana i te whakarewatanga o te fibrin, ka hanga i ngā hua pirau fibrin (proto) (FDP), ā, ka pakaruhia te fibrin honohono-whiti hei hua motuhake. E kiia ana ko te D-Dimer. Ko te whakahohenga o te pūnaha fibrinolytic e wehea ana ki te ara whakahohenga ā-roto, te ara whakahohenga o waho me te ara whakahohenga o waho.

Ara whakahohenga ā-roto: Ko te ara o te PL i hangaia e te wehenga o te PLG e te ara toto toto ā-roto, koinei te pūtake ariā o te fibrinolysis tuarua. Ara whakahohenga ā-waho: Ko te ara e pakaru ai te PLG e te t-PA i tukuna mai i ngā pūtau endothelial vascular hei hanga i te PL, koinei te pūtake ariā o te fibrinolysis tuatahi. Ara whakahohenga ā-waho: ko ngā rongoā thrombolytic pēnei i te SK, UK me te t-PA e uru ana ki te tinana tangata mai i te ao o waho ka taea te whakahohe i te PLG ki roto i te PL, koinei te pūtake ariā o te rongoā thrombolytic.

Ina hoki, he uaua ngā tikanga e pā ana ki ngā pūnaha toto totoka, te ārai totoka, me te fibrinolysis, ā, he maha ngā whakamātautau taiwhanga e pā ana, engari ko te mea me aro nui atu tātou ko te taurite hihiri i waenga i ngā pūnaha, e kore e taea te kaha rawa, te ngoikore rawa rānei.