弥散性血管内凝血

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1、1Chapter16.Disseminatedintravascularcoagulation2IntravascularExtravascularNormalcirculationHemostasisliquiditysolidity(coagulation)NormalNormalBloodAbnomalAbnomalsolidity(coagulation)liqidityThromboticdiseaseHemorrhagicdiseaseIntravascularExtravascular3Thefunc

2、tionofcoagulationsystem(Extrinsic,Intrinsicpathwayandplatelet)Thefunctionofanticoagulation(TFPI,PCsystem,ATIIIandfibrinolyticsystem)TheregulationofbalancebyVECThekeyfactorsforbalanceofcoagulation-anticoagulation:4ThechainreactionofbloodcoagulationFXIFXIaFVII/F

3、VIIa-TF-Ca2+(onmembrane)↓↓FIXFIXaTFPI-FXaFVIIIaCa2+-PLprothrombin(FII)PCIFXFxaPL-Ca2+FvaAPC(PS)XIIIthrombinTM-on-VECXIIIaATIIIPCFbnFbnFMFbg(FI)(cross-linked)(soluble)TF=tissuefactor;TFPI=TFpathwayinhibitor;Fbg=fibrinogen;Fbn=fibrin;FM=fibrinmonomer;PC=proteinC

4、;APC=activatedPC;PS=proteinS;PCI=PCinhibitorATIII=antithrombinIII;TM=thrombomodulin;VEC=vascularEC5ThefibrinolysissystemPlasminogen(PLg)(Extra-activatingpathway)(Intra-activatingpathway)tissue-typeplasminogenactivationofclottingsystemactivator(t-PA)XIaurokinas

5、e-typeplasminogenthrombinactivator(u-PA)XIIaXII(Exogenousactivator)urokinase(UK)kallikrein(KK)streptokinase(SK)prekallikrein(PK)Plasmin(Pln)FbgFbnFDP(fibrinogen)(fibrin)(Fbg/Fbndegradationproducts)6InhibitXa,VIIa,TFInhibitplateletaggregationFibrinolysisPreven

6、tfibrinclotformationTraumaAdrenalinThrombinADPNO,PGI2Xa,IIaPlasminPlasminoginActivatorst-PA,u-PAInactivateVa,VIIIaPSThrombinPCAPCTMInhibitXa,IIaATIII+HeparinTFPIAnticoagulantfunctionofendothelialcells7Section1.ConceptandcausesofDIC8Today’sQuestionQuestion1.Wh

7、atisDIC?91.ConceptofDICDisseminatedintravascularcoagulation(DIC)Asyndromethatresultsfromthedisturbanceofkineticbalanceofcoagulationandfibrinolyticprocesses.Characterizedbyextensiveintravascularmicrothrombosisandimpairmentofhemostasia.Itsinitiallinkisactivation

8、ofclottingsysteminthebody10extensivemicrothrombinextensivehemorrhageorgandysfunctionShockaneamiaNormalbalanceofcoagulation-anticoagulationHypocoagulablestateHypercoagulablestateUnb