Kuganiza: Pansi pa mikhalidwe yabwinobwino ya thupi

1. N’chifukwa chiyani magazi omwe akuyenda m’mitsempha ya magazi sagwirana?

2. N’chifukwa chiyani mtsempha wamagazi wowonongeka pambuyo pa ngozi ungasiye kutuluka magazi?

Ndi mafunso omwe ali pamwambapa, tikuyamba maphunziro a lero!

Mu mkhalidwe wabwinobwino wa thupi, magazi amayenderera m'mitsempha yamagazi ya anthu ndipo sadzasefukira kunja kwa mitsempha yamagazi kuti ayambe kutuluka magazi, komanso sadzaundana m'mitsempha yamagazi ndikuyambitsa thrombosis. Chifukwa chachikulu ndichakuti thupi la munthu limakhala ndi ntchito zovuta komanso zangwiro zochotsa magazi m'thupi komanso zoletsa magazi kuundana. Ngati ntchito imeneyi si yachilendo, thupi la munthu lidzakhala pachiwopsezo cha kutuluka magazi kapena thrombosis.

1. Njira yochotsera magazi m'thupi

Tonsefe tikudziwa kuti njira yochotsera magazi m'thupi la munthu choyamba ndi kufupika kwa mitsempha yamagazi, kenako kumamatirana, kusonkhana ndi kutulutsidwa kwa zinthu zosiyanasiyana za procoagulant za ma platelet kuti apange emboli yofewa ya ma platelet. Njira imeneyi imatchedwa hemostasis ya gawo limodzi.

Komabe, chofunika kwambiri n'chakuti imayambitsa njira yolumikizirana kwa magazi, imapanga netiweki ya fibrin, ndipo pamapeto pake imapanga thrombus yokhazikika. Njira imeneyi imatchedwa secondary hemostasis.

2. Njira yolumikizira magazi

Kugawanika kwa magazi ndi njira imene zinthu zogawanika zimayatsidwa mwadongosolo linalake kuti zipange thrombin, ndipo pamapeto pake fibrinogen imasinthidwa kukhala fibrin. Njira yogawanika ingagawidwe m'magawo atatu oyambira: kupanga prothrombinase complex, kuyambitsa thrombin ndi kupanga fibrin.

Zinthu zophatikizana ndi mayina a zinthu zomwe zimakhudzidwa mwachindunji ndi kugawanika kwa magazi m'magazi ndi minofu. Pakadali pano, pali zinthu 12 zophatikizana zomwe zimatchulidwa malinga ndi manambala achiroma, zomwe ndi zinthu zophatikizana Ⅰ~XⅢ (VI siikuonedwanso ngati zinthu zodziyimira payokha zogawanika), kupatula Ⅳ Ili mu mawonekedwe a ionic, ndipo zina zonse ndi mapuloteni. Kupanga Ⅱ, Ⅶ, Ⅸ, ndi Ⅹ kumafuna kutenga nawo mbali kwa VitK.

Malinga ndi njira zosiyanasiyana zoyambira ndi zolumikizirana zomwe zimagwiritsidwa ntchito, njira zopangira ma prothrombinase complexes zitha kugawidwa m'njira zolumikizirana zamkati ndi njira zolumikizirana zakunja.

Njira yolumikizira magazi m'thupi (yomwe imagwiritsidwa ntchito kwambiri poyesa magazi a APTT) imatanthauza kuti zinthu zonse zomwe zimakhudzidwa ndi kugawanika kwa magazi zimachokera m'magazi, zomwe nthawi zambiri zimayambitsidwa ndi kukhudzana kwa magazi ndi pamwamba pa thupi lakunja lomwe lili ndi mphamvu yoipa (monga galasi, kaolin, collagen, ndi zina zotero). Njira yolumikizira magazi yomwe imayambitsidwa ndi kukhudzana ndi chinthu cha minofu imatchedwa njira yolumikizira magazi m'thupi (yomwe imagwiritsidwa ntchito kwambiri poyesa magazi a PT).

Thupi likadwala, endotoxin ya bakiteriya, C5a yowonjezera, ma immunocomplexes, chotupa cha necrosis factor, ndi zina zotero zimatha kuyambitsa maselo a endothelial a mitsempha yamagazi ndi ma monocytes kuti awonetse minofu, motero kuyambitsa njira yolumikizirana, zomwe zimayambitsa kufalikira kwa magazi m'mitsempha (DIC).

3. Njira yoletsa magazi kuundana

a. Dongosolo la antithrombin (AT, HC-Ⅱ)

b. Dongosolo la mapuloteni C (PC, PS, TM)

c. Choletsa njira ya zinthu za m'thupi (TFPI)

Ntchito: Kuchepetsa kupangika kwa fibrin ndikuchepetsa kuchuluka kwa zinthu zosiyanasiyana zotsekeka kwa magazi.

4. Njira ya Fibrinolytic

Magazi akamaundana, PLG imayatsidwa mu PL motsogozedwa ndi t-PA kapena u-PA, zomwe zimapangitsa kuti fibrin isungunuke ndikupanga zinthu zowononga fibrin (proto) (FDP), ndipo fibrin yolumikizidwa imawonongeka ngati chinthu china. Yotchedwa D-Dimer. Kuyatsa kwa dongosolo la fibrinolytic kumagawidwa makamaka m'njira yoyatsira mkati, njira yoyatsira kunja ndi njira yoyatsira kunja.

Njira yoyambitsa mkati: Ndi njira ya PL yomwe imapangidwa ndi kugawanika kwa PLG ndi njira yolumikizirana ya endogenous, yomwe ndi maziko a chiphunzitso cha fibrinolysis yachiwiri. Njira yoyambitsa kunja: Ndi njira yomwe t-PA yotulutsidwa kuchokera ku maselo a endothelial a mitsempha imagawanika PLG kuti ipange PL, yomwe ndi maziko a chiphunzitso cha fibrinolysis yoyamba. Njira yoyambitsa kunja: mankhwala oyambitsa thrombolytic monga SK, UK ndi t-PA omwe amalowa m'thupi la munthu kuchokera kunja amatha kuyambitsa PLG kukhala PL, yomwe ndi maziko a chiphunzitso cha chithandizo cha thrombolytic.

Ndipotu, njira zomwe zimagwiritsidwa ntchito mu machitidwe otsekereza magazi, oletsa magazi kuundana, ndi fibrinolysis ndi zovuta, ndipo pali mayeso ambiri okhudzana ndi labotale, koma chomwe tiyenera kuyang'anitsitsa kwambiri ndi kulumikizana kwamphamvu pakati pa machitidwe, omwe sangakhale amphamvu kwambiri kapena ofooka kwambiri.