Tib neeg lub cev yog qhov ua tau zoo heev thiab muaj txiaj ntsig zoo nrog ntau lub tswv yim ntawm kev tswj tus kheej. Nyob rau sab saum toj ntawm cov kab ke no rightfully zaum hemostasis, ib qho piv txwv zoo kawg nkaus ntawm kev ua kom zoo zoo rau kev khaws cov ntshav. Hemostasis muaj nws tus kheej txoj cai, kev cai thiab kev zam uas koj yuav tsum to taub: nws tsis yog hais txog kev noj qab haus huv, lub xeev ntawm hemostasis yog ib qho teeb meem ntawm lub neej thiab kev tuag ntawm ib tug neeg.
High flight logistics
Lub cev tib neeg tuaj yeem muab piv rau qhov chaw muaj kev lag luam niaj hnub no (raws li lub tuam txhab high-tech tshiab tam sim no hu ua). Cov hlab ntsha yog txoj kev loj, txoj kev, txoj kev tsav tsheb thiab kev tuag. Zoo, ntshav ua raws li lub luag haujlwm ntawm tus neeg ua haujlwm logistics dav dav.
Kev xa cov pa oxygen thiab tag nrho cov as-ham raws sijhawm thiab raws nraim li qhov xav tauchaw nyob rau txhua lub cev ntawm tib neeg lub cev - qhov tseem ceeb tshaj plaws "logistic" ua haujlwm ntawm cov ntshav. Txhawm rau ua qhov no, cov ntshav yuav tsum ruaj khov hauv cov kua dej. Qhov no tsis yog tib qho kev ntsuas rau ib txwm ua haujlwm cov ntshav. Qhov thib ob, tsis muaj qhov tseem ceeb tsawg yog qhov kev khaws cia ntawm cov ntshav ncig. Qhov no tshwm sim nrog kev pab los ntawm ib qho kev nthuav mechanism rau kev tsim cov ntshav txhaws - kev tiv thaiv los ntawm cov ntshav poob hauv kev ua txhaum ntawm kev ncaj ncees ntawm cov hlab ntsha. Cov kev cai ntawm cov ntshav sib xws nyob ntawm lub xeev ntawm lub cev hu ua hemostasis. Nws suav nrog ntau yam thiab cov txheej txheem uas txiav txim siab tam sim no ntawm tib neeg kev noj qab haus huv thiab kev kwv yees kev kho mob rau yav tom ntej.
Kev sib sau ntawm qhov sib txawv: ntshav coagulation thiab anticoagulation systems
Dynamic tshuav nyiaj li cas ntawm cov haujlwm sib txawv yog qhov tseem ceeb tshaj plaws ntawm hemostasis. Qhov no yog ib qho kev xav tau rau cov hlab ntsha thiab cov ntshav, ua kom tiav ntawm qhov yuav tsum tau saib xyuas hauv txhua tus neeg yam tsis tau poob. Feem ntau, cov ntshav xav tau cov kua - qhov no, kev thauj mus los ntawm cov khoom los ntawm cov ntaub so ntswg tshwm sim yam tsis muaj kev cuam tshuam. Yog hais tias, txawm li cas los xij, muaj qhov tawg ntawm cov ntaub so ntswg, thiab tus neeg pib los ntshav, cov ntshav hloov mus ua jelly hauv daim ntawv ntawm cov ntshav txhaws - lub qhov txhab yog "sau", kev tiv thaiv raug teeb tsa, txhua yam nyob rau hauv kev txiav txim. Nyob rau hauv lub neej yav tom ntej, qhov "kev kub ntxhov" thrombus tsis xav tau, nws yaj, cov ntshav rov ua kua, kev thauj mus los tau rov qab los, thiab lub cev rov ua dua.
Qhov kev ua haujlwm ntawm hemostasis tseem ceeb dua rau kev noj qab haus huv - lub luag haujlwm rau lub xeev ua kua (ntshav anticoagulation system) lossistsim kev tiv thaiv thrombi (clotting system)? Thaum xub thawj siab ib muag, nws zoo nkaus li tias ib txwm ua haujlwm thawj zaug yeej dhau qhov thib ob: cov ntshav ntws xav tau yam tsis muaj kev cuam tshuam, tsis tas yuav muaj thrombosis. Qhov tseeb, ntshav txhaws yog ib feem ntawm cov txheej txheem ntau yam uas cov txheej txheem anticoagulant ua raws li kev tswj hwm ntawm cov ntshav txhaws. Nws yog lub sijhawm los pib nthuav qhia cov txheej txheem ntawm hemostasis.
Thaum xav tau ntshav txhaws: tiv thaiv ntshav poob
Cov ntshav ntim ntawm tus neeg laus yog kwv yees li tsib litres. Qhov ntim no yuav tsum tau khaws cia hauv txhua qhov xwm txheej. Txhawm rau tiv thaiv qhov ntim no, muaj cov kab mob thrombogenesis, tab sis tsis yog xwb. Nws yuav yog ib qho yuam kev uas xav tias kev tiv thaiv kev poob ntshav tsuas yog lub coagulation system. Qhov no kuj tseem yuav suav nrog kev tawg ntawm thrombus thaum nws ua tiav nws txoj haujlwm thiab tsis xav tau. Hemostasis yog ib qho kev ua haujlwm sib koom ua ke.
Ob lub txheej txheem ntawm cov ntshav txhaws
- Vascular-platelet mechanism: kev tsim ntawm thrombus pib thiab ua haujlwm raws li lub hauv paus ntsiab lus domino - cov no yog cov txheej txheem ua ntu zus, qhov twg yav dhau los pib qhov tom ntej. Cov cim tseem ceeb thiab cov thawj coj ntawm cov txheej txheem no yog cov qe ntshav me (platelets) thiab cov hlab ntsha me me (feem ntau capillaries). Kev tiv thaiv yog ua raws li tag nrho cov kev cai ntawm kev tsim kho: lub nkoj nqaim ntawm qhov chaw ntawm kev puas tsuaj, platelets o thiab hloov lawv cov duab thiaj li yuav pib lo rau ntawm phab ntsa ntawm lub nkoj (adhesion) thiab lo ua ke (ua ke). Ib qho xoob thawj thrombus, lossis platelet hemostatic ntsaws, cov ntaub ntawv.
- Coagulation clotting mechanism tshwm sim hauv kev raug mobcov hlab ntsha loj yog cov txheej txheem biochemical enzymatic. Ntawm nws cov tub ntxhais, qhov no yog kev hloov pauv ntawm fibrinogen (ib qho dej-soluble protein) rau hauv fibrin (ib qho protein tsis txaus), uas cov thrombus thib ob muaj - ntshav txhaws. Fibrin plays lub luag hauj lwm ntawm ib tug tuab reinforcing mesh rau cov qe ntshav uas tau poob rau hauv nws.
Hypocoagulation syndrome: ib zaj dab neeg muaj koob muaj npe
Txhua tus tau hnov txog cov ntshav coagulation tsis zoo nyob rau hauv daim ntawv ntawm hemophilia - cov neeg mob twb nto moo heev. Yav dhau los, nws tau pom tias yog kab mob ntawm cov ntshav muaj koob muaj npe nrog cov neeg pluag Tsarevich Alexei, zoo li hauv zaj dab neeg. Hemophilia niaj hnub no yog ib hom kab mob dawb huv uas muaj cov noob caj noob ces nyob rau ntawm poj niam X chromosome. Cov poj niam raug mob hemophilia, thiab cov txiv neej raug kev txom nyem los ntawm nws. Ua tsaug rau British poj huab tais Victoria thiab nws cov xeeb leej xeeb ntxwv, cov tswv cuab ntawm European vaj ntxwv tsev (rau tus poj niam thiab kaum ib tus txiv neej nyob rau hauv tag nrho), lub ntiaj teb no muaj ib tug tu siab thiab txhim khu kev qha piv txwv ntawm kev kis tus kab mob tshwm sim los ntawm keeb kwm.
Tam sim no hais txog cov txheej txheem tshwj xeeb. Hauv hemophilia, cov synthesis ntawm platelets thiab lwm yam khoom ntawm kallikrein-kinin system yog impaired. Nrog rau cov noob hloov pauv ntawm yam VIII, lawv hais txog hemophilia A. Nrog rau kev tsis sib haum xeeb hauv qhov xwm txheej IX, hemophilia B. Lub xub ntiag ntawm hemophilia C nyob ntawm yam XI. Tag nrho cov kev xaiv saum toj no yog hais txog cov kab mob ntawm thawj theem ntawm cov ntshav txhaws. - nquag prothrombinase tsis tsim, uas ua rau lub sijhawm tseem ceeb ntawm cov ntshav txhaws.
Kev cuam tshuam hauv theem ob ntawm cov ntshav coagulation - tsis ua tiav ntawm thrombin tsim(txo qis hauv kev sib txuas ntawm prothrombin thiab lwm yam khoom siv). Qhov thib peb theem ua rau muaj kev nce ntxiv hauv cov txheej txheem "solving" tseem ceeb - fibrinolysis.
Lo lus platelet
Platelets yog cov qe ntshav tseem ceeb tshaj plaws thiab nthuav dav nrog cov tsos mob tsis zoo: tsis xwm yeem, hloov pauv, tsis muaj xim. Tsis muaj nucleus, lawv tsis nyob ntev - tsuas yog 10 hnub. Lawv muaj lub luag haujlwm rau coagulation thiab anticoagulation systems ntawm cov ntshav. Platelets muaj cov haujlwm tseem ceeb tshaj plaws:
- Angiotrophic - txhawb microvascular tsis kam.
- Adhesive-aggregation - muaj peev xwm ua ke nrog ib leeg thiab lo rau ntawm phab ntsa ntawm lub nkoj ntawm qhov chaw puas.
Hauv kev kuaj ntshav, lawv tus lej yog qhov tseem ceeb ntawm kev saib xyuas tshwj xeeb. Cov platelet suav yuav tsum nyob twj ywm qhov muaj zog tshaj plaws nyob rau hauv tib neeg lub cev nyob rau hauv txhua yam mob, tsis muaj ntxiv thiab tsis tsawg. Vim tias thrombocytopenia (tus lej hauv qab no) yog qhov tsis muaj cov ntshav txhaws, qhov tsis muaj cov hlab ntsha spasm thiab, vim li ntawd, cov ntshav txhaws qeeb. Thrombocytopathy yog ib qho kev hloov pauv hauv lub cell nws tus kheej - cov qauv, biochemical. Cov kev hloov pauv no tseem ua rau muaj kev cuam tshuam cov platelet ua haujlwm.
Anticoagulation normal
Cov txheej txheem ntawm cov ntshav coagulation suav nrog kev ua haujlwm ntawm ib pab pawg tshwj xeeb inhibitors. Cov proteins no tsis muaj dab tsi ntau tshaj li cov ntshav anticoagulant. Physiology nyob rau hauv lub dynamic tshuav nyiaj li cas ntawm cov txheej txheem tawm tsam. Physiological anticoagulants yog lub ntsiabthrombosis fighters. Cov protein tshwj xeeb no tau muab faib ua peb pawg nrog cov npe uas hais rau lawv tus kheej:
- Antithrombotic daim hlau.
- Antithrombins.
YAntifibrins.
Proteins ntawm thawj ob pawg ua haujlwm inhibitory: lawv inhibit adhesion thiab aggregation ntawm platelets, qeeb tsim cov fibrin los ntawm fibrinogen, thiab lwm yam Proteins ntawm peb pab pawg neeg yog tshwj xeeb, lawv ua ib tug txawv kiag li txoj hauj lwm - Lawv rhuav tshem cov fibrin uas twb tau tsim lawm (txhim kho mesh ntawm cov ntshav txhaws) mus rau cov khoom hu ua fibrin degradation - PDF.
yav tom ntej, lub thrombus, twb tsis muaj zog fiber ntau threads, shrinks (tus txheej txheem hu ua retraction) thiab dissolves, uas yog, nws xaus nws lub neej luv luv nrog ua tiav lysis. Kev sib cais ntawm fibrin filaments nrog rau kev sib cais tom qab ntawm ib qho thrombus yog ib qho txheej txheem tseem ceeb uas nyob rau hauv ntau qhov chaw fibrin splitting nrog kev puas tsuaj ntawm ib tug twb tsim thrombus thiab inhibition ntawm thrombus tsim tau piav raws li cov txheej txheem cais: fibrinolytic thiab anticoagulant ntshav systems. Yog li, nws yuav yog qhov tsim nyog los lees txais thiab txais peb lub luag haujlwm ntawm hemostasis. Cov no suav nrog cov coagulation, anticoagulation, thiab fibrinolytic systems ntawm cov ntshav.
Thaum cov ntshav txhaws muaj teeb meem: pathological thrombosis
Tsis txhob cuam tshuam thrombosis nrog ntshav txhaws. Cov tom kawg tuaj yeem yog cov txheej txheem ywj pheej txawm tias sab nraum lub cev. Thrombosis - maj mam tsim cov ntshav txhaws nrog tsim ntawm fibrin thiab ua txhaum caintshav ncig. Muaj ntau qhov laj thawj rau qhov tshwm sim ntawm thrombosis: qog, kab mob, kab mob ntawm cov hlab plawv, thiab lwm yam. Tab sis rau txhua yam ua tau, cov xwm txheej tseem ceeb rau kev yug me nyuam ntawm pathological ntshav txhaws nyob ntawm kev hloov pauv hauv cov ntshav anticoagulant hauv daim ntawv:
- hypercoagulation (tsis muaj cov tshuaj tiv thaiv coagulant);
- nce ntshav viscosity;
- kev puas tsuaj rau phab ntsa ntawm lub nkoj (tam sim adhesion - adhesion ntawm platelets);
- slow blood flow.
Vaj huam sib luag thiab thrombosis
Thrombosis yog ib qho mob hnyav heev thiab mob hnyav. Nws los hauv cov ntawv hauv qab no:
- Venous lossis arterial.
- mob lossis mob ntev.
Atherothrombosis.
Atherothrombosis tuaj yeem hu ua kev puas tsuaj ntawm vascular tiag. Cov no yog lub plawv nres ntawm cov kabmob thiab cov hlab ntsha ntawm lub hlwb vim yog cov hlab ntsha los ntawm cov hlab ntsha sclerotic. Kev phom sij loj yog qhov kev pheej hmoo ntawm cov hlab ntsha tawg nrog cov hlab ntsha ntawm lub ntsws lossis lub plawv, uas ua rau tuag sai sai.
Nyob rau hauv kev kho mob ntawm xws li pathologies, lub hom phiaj yog tib yam - txo qis, uas yog, kev tswj cov ntshav coagulation kom zoo. Nyob rau hauv tas li ntawd, cov tshuaj anticoagulant yog siv, ib yam ntawm cov khoom siv anticoagulant system. Txawm li cas los xij, cov ntshav txhaws ntau dhau thiab cov ntshav txhaws tau raug kho nrog cov txheej txheem rov qab.
Anticoagulation hauv pathologies
Lub luag haujlwm ntawm cov tshuaj tiv thaiv kab mob ntawm cov ntshav yog qhov nyuajoverestimate. Ua ntej tshaj plaws, qhov no yog kev ua haujlwm ntawm fibrinolysis - kev sib cais ntawm fibrin clot los tswj cov kua hauv cov ntshav thiab cov lumen dawb ntawm cov hlab ntsha. Lub ntsiab tivthaiv yog fibrinolysin (plasmin), uas rhuav tshem fibrin threads thiab hloov mus rau hauv FDP (fibrin degradation khoom) nrog rau compression thiab dissolution ntawm lub thrombus.
Anti-coagulant ntshav system hauv luv
Qhov kev ua tau zoo ntawm hemostasis nyob ntawm qhov sib cuam tshuam, qhov kev txiav txim ntawm qhov yuav tsum tau txiav txim siab ua ke:
- Txoj kev mob ntawm phab ntsa ntawm cov hlab ntsha.
- Muaj pes tsawg tus platelets thiab lawv cov txiaj ntsig zoo.
- Lub xeev ntawm cov plasma enzymes, tshwj xeeb tshaj yog cov fibrinolytic.
Yog tias peb tham txog qhov tseem ceeb thiab kev ua haujlwm tseem ceeb rau tib neeg kev noj qab haus huv thiab lub neej, tom qab ntawd ntawm cov xwm txheej no muaj cov thawj coj tsis sib haum xeeb: biochemistry ntawm cov hlab ntshav anticoagulant yog tus qauv rau kev kho mob ntau yam kab mob loj, suav nrog tsim ntawm pathological ntshav txhaws. Qhov kev txiav txim ntawm cov tshuaj niaj hnub no yog ua raws li cov qauv no. Lub physiology ntawm anticoagulant ntshav system yog xws li hais tias nws lags qab lub coagulation system thiab depletes sai: anticoagulants tau noj sai dua li lawv tsim. Yog li, txoj hauv kev tseem ceeb ntawm kev kho mob thrombosis yog los them rau qhov tsis muaj cov tshuaj tiv thaiv kab mob.
