醫(yī)學(xué)生理學(xué)課件(血液)

血液（Blood)第一節(jié)概述（Introduction)第二節(jié)血漿（Plasma)第三節(jié)血細(xì)胞（Bloodcells)第四節(jié)生理止血（Hamostasis)第五節(jié)血型（Bloodgroup)第六節(jié)造血和血細(xì)胞的破壞（HematopoiesisandHematoclasis)Introduction血液血漿：血細(xì)胞電解質(zhì)（electrocytes)、營養(yǎng)成分(nutrients)、氣體(gases)、代謝產(chǎn)物(wasteproducts)、蛋白質(zhì)（proteins)、水分（water)。RedbloodcellsWhitebloodcellsPlatelets一、血液的基本組成二、血液的功能1、運(yùn)輸作用（Transportation)4、緩沖作用5、傳遞信息3、生理止血(hemostasis)2、防御功能（defense)Plasma一、Components

andfunctionsofplasma1.Electrolyte:血漿晶體滲透壓2.Protein(1)albumin:形成血漿膠體滲透壓及物質(zhì)轉(zhuǎn)運(yùn)(2)globulin：1、2、、globulin,物質(zhì)轉(zhuǎn)運(yùn)及特異性免疫(3)fibrinogen：血液凝固二、physicochemicalpropertiesofplasma1.Plasma的比重和粘滯性比重：2.PlasmaosmoticpressurePlasmaosmoticpressure(313mOsm)Plasmacrystalosmoticpressure(311.5mOsm)Plasmacolloidosmoticpressure(1.5mOsm)粘滯性：1.025-1.0301.6-2.4H2OH2OPlasmacrystalosmoticpressure

細(xì)胞內(nèi)外的水分交換而維持細(xì)胞的正常形態(tài)和功能::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::血管內(nèi)外的水分交換

Plasmacolloidosmoticpressure三、plasmapHpH7.35-7.45血細(xì)胞（Bloodcell)一、RedbloodcellMale:(4.5-5.5)×1012/LFemale:(3.8-4.6)×1012/L(2.0-3.0)×106Hb/RBC每一個(gè)Hb分子可結(jié)合4個(gè)O2分子PhysiologicalpropertiesofRBC1、滲透脆性（fragility)2.PlasticdeformationofRBC3.Erythrocytesedimentationrate4.Rouleauxformationoferythrocyte5、紅細(xì)胞比容（Hematocritvalue）Male:40-50%female:37-48%0.9%NaCl0.7%NaCl0.5%NaCl0.4%NaCl0.3%NaCl0.9%NaClisotonicsolution(physiologicalsaline)hemolysisSuspensionstabilityESR:male3mm,female

10mm二、whitebloodcellWhitebloodcellsPolymorphonuclearneutrophilsPolymorphonucleareosinophilsPolymorphonuclearbasophilsmonocyteslymphocytes4000-10000/mm350-70%2-5%0.5-1%3-8%20-30%Monocytes,Neutrophils(phagocytosis)NonspecificimmunitylymphocytesTcellsBcellsCellularimmunitySmallsensetizedlymphocytesantibobyHumoralimmunityeosinophilsParasiticidalactionbasophilsSecretionofheparin三、platelet（100-300）×109/Lhemostasis生理止血（Hemostasis)生理止血：正常人血管受損傷后，有blood從血管流出來，數(shù)分鐘后自行停止。包括：localvasoconstriction(局部小血管收縮）,formationofplateletplug(血小板栓子的形成）,bloodcoagulation(血液凝固）,fibrinolysisandpreventionofcoagulation(纖維蛋白溶解和抗凝）一、LocalvasoconstrictionresponseTransientlydelayorstopbleeding(暫時(shí)延緩或停止blood的流動(dòng))Numerousinfluencesmaycausevasoconstriction:1.Excitationofsympatheticnerve:2.Releaseof5-HT,TXA2,ETetc.二、FormationofplateletplugAdhesionandaggregation內(nèi)皮細(xì)胞（vWfactor)ReceptorsonplateletsPlateletadhesionAggregation(ADP,NEand5-HT)ReleaseofADP,ATP,5-HT,K+,plateletfactor3,TXA&lysosomalenzymeContractilefunction三、Bloodcoagulation1.Coagulationfactor1)用羅馬字I-XIII表示，共12種和PK,HMWK,PL等;2）thefactorIViscalcium,PLisalipid,whileothersareproteins;3)vitaminKisinvolvedinthecombinationoffactorII,IIV,IX,X;4)factorIIIisatissuethromboplastin.2.Coagulationstages1)formationofprothrombin-convertingenzyme(凝血酶原激活物的形成).2)conversionofprothrombintothrombin(凝血酶的形成).3)conversionoffibrinogentofibrin(纖維蛋白的形成).3.Pathways:1)intrinsicpathway:由activationoffactorXII所啟動(dòng)的凝血途徑,whichiscompletelyfinishedbythecoagulationfactorsinplasma.2)extrinsicpathway:由activationoffactorIII所啟動(dòng)的凝血途徑。XIIXIIacollagenHMWKXIXIaCa++IXIXaVIIIaCa++PLIIIIaIIaXIIIFibrinpolymerXXaIIIVIIaCa++PLVa,Ca++,PLPKKallikreinPlasminogenplasmin(纖溶酶原)(纖溶酶)Activator(纖溶酶原激活物)Fibrin(纖維蛋白)Fibrindegradationproducts(纖維蛋白降解產(chǎn)物)4.Fibrinolysis(纖維蛋白溶解)inhibitor5.Preventionofcoagulation1)AntithrombinIII:-globulin,與thrombin結(jié)合thrombin的失活(inactivation)Antithrombin-heperincomplexEffectofAntithrombinCoagulationfactorIXa,Xa,XIa,XIIa的失活2)Heparin:Antithrombin-heparincomplexEffectofantithrombin3)ProteinC:Vit.Kdependentplasmaprotein,(1)在proteinS的幫助下,使factorVa,VIIIa失活(2)