血液的组成与功能-副本.ppt

第五章 血液的组成与功能Evaluation only. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血液生理功能： 1.运输功能 2.缓冲功能，维持内环境的稳定 3.调节体温 4.免疫和防御功能 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血细胞比容 血细胞在全血中所占的容积百 分比。 正常值：成年男性 40%50% 成年女性 37%48% 新生儿 55% 第一节 血液的组成、理化特性 一、血液的基本组成和血量 中性粒细胞 红细 胞 血小 板 淋巴 细胞 全血离心后 血 浆 白细胞 和 血小板 红细 胞血细胞 血液由血细胞和血浆两部分组成 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血 液 血 浆 血 细 胞 红细胞 白细胞 血小板: 水：9092 血浆蛋白 溶质： 810 小分子物质 营养物质 激素 代谢产物 有机物 无机盐（电解质） 白蛋白 球蛋白 纤维蛋白原 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血浆蛋白的主要功能： 1.形成血浆的胶体渗透压 2.运输功能 3.免疫作用 4.参与凝血和抗凝血功能 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 二、血液的理化特性 （一)血液的比重 （二）血液的粘滞性 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. (三)血浆渗透压 渗透压：溶液所具有的吸引水分子透过半透膜的能力。 NaClNaCl HH 2 2 OOHH 2 2 OO 半透膜半透膜 渗透压渗透压 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 分类： 晶体渗透压 胶体渗透压 组成 主要为Na+、Cl-、糖 主要为白蛋白 压力 占99.6% 占0.4% 意义 维持细胞内外水分平衡 维持血管内外水分平衡 保持血细胞的正常形态 保持正常循环血量 和功能 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血浆晶体渗透压与胶体渗透压 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 等渗溶液： 以人体血浆的正常渗透压为标准与血浆渗透压相等的溶液 如：0.9% NaCl溶液、 5% 葡萄糖溶液 1.9% 尿素溶液 等张溶液： 能够使悬浮于其中的红胞保持正常的形态和大小的溶液。 如：0.9% NaCl溶液、 5% 葡萄糖溶液 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）血浆酸碱度 （NaHCO3/H2CO3）“碱贮” （Na2HPO4/NaH2PO4） （蛋白质钠盐/蛋白质） 此外， KHb/HHb, KHbO2/HHbO2 pH7.357.45 1.血液中的缓冲物质 2.机体其他器官的酸碱调节(肺、肾) Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一、红细胞 第二节 血细胞形态和功能 (一)红细胞的形态 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）红细胞的生理特性 1.红细胞的可塑变形性 正常红细胞在外力作 用下具有变形的能力。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.红细胞的渗透脆性 红细胞的渗透脆性： 红细胞在低渗溶液中发生膨胀、破裂的特性，称渗透脆性 溶血： 红细胞在低渗溶液中膨胀破裂，血红蛋白释放入溶液中。 临床正常范围:0.350.45%NaCI。 低渗等渗 高渗 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3.红细胞的悬浮稳定性和血沉 红细胞的悬浮稳定性： 正常红细胞能相对稳定地悬浮在血浆中而不易下沉的特性 红细胞沉降率： 抗凝处理的血液垂直静置，RBC在单位时间(1h)内的沉降 距离。 意义: 愈慢，表示悬浮稳定性愈好； 愈快，表示悬浮稳定性愈差。 测定血沉有助于某些疾病的诊断， 也可作为判断病情变化的参考 （三）红细胞的功能 运输O2和CO Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 二、白细胞 (一)白细胞的数量和分类 正常成年人的白细胞数为（4.0-10.0）109/L， 平均为7109/L。 中性粒细胞 50%-70% 颗粒白细胞 嗜酸性粒细胞 0.5-5% 嗜碱性粒细胞 0-1% 单核细胞 3%-8% 无颗粒白细胞 淋巴细胞 0%-40% 白 细 胞 分 类 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. (二)白细胞的生理特性 白细胞渗出(淋巴细胞除外)、趋化性。 (三)白细胞的生理功能 名称 主要功能 中性粒细细胞 吞噬与消化 嗜酸性粒细细胞 抑制过过敏反应应、对对蠕虫的免疫 嗜碱性粒细细胞 参与过过敏反应应、抗凝 淋巴细细胞 T细细胞 细细胞免疫 B细细胞 体液免疫 单单核细细胞 吞噬、免疫 白细细胞分类类及功能 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 三、血小板 （一）血小板的形态和数量 形态：无核。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 数量：100300109/L (1030万/mm3)。 5万/mm3 ：血小板减少性紫癜 100万/mm3：血栓性疾病 （二）血小板的生理特性 1.粘附 2.聚集 3.释放 4.收缩 5.吸附 （三）血小板的生理功能 1. 保持毛细血管内皮细胞的完整性 2.促进凝血 3.参与止血 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 四、红细胞的生成与调节 （一）造血过程及调节 红骨髓、脾和淋巴结 （二）红细胞的生成与破坏 1.红细胞的生成所需的原料： 蛋白质 铁、叶酸、 维生素B12、内因子， Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 2.红细胞生成的调节： 爆式促进激活物：刺激早期红系组细胞增殖 促红细胞生成素：促进晚期红系组细胞增殖 雄激素、 甲状腺激素、生长激素、糖皮质激素促 进红细胞生成。 雌激素抑制红细胞生成 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 3.红细胞的破坏 RBC寿命120天左右 临床上可用切脾治疗以减轻贫血。 破坏场所 血管内占10% 主要在血管外（脾、肝） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第三节 凝血、抗凝血和纤维蛋白溶解系统 一、生理止血的基本过程 分三个时相： 1.血管收缩 2.血小板血栓形成 3.血液凝固使血栓进一步巩固 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血管受损 血管收缩 胶原、微纤维 血小板粘附 血小板分泌 凝血酶 （ADP、TXA2、PAF、IP3 ） 限制血流 血小板聚集成止血栓 纤维蛋白形成 生理性止血过程 血管期 细胞期 血浆期 初步止血 加固止血 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 二、血液凝固 血液由流动的液体状态变成不流动的凝胶状 血块的过程称为凝血。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （一）凝血因子 1. 是Ca2+ 2. 、需要维生素K 3. 、是酶原，需要激活 4. 是组织因子 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）凝血过程 分为三个基本步骤： 凝血酶原激活物形成 凝血酶原 凝血酶 纤维蛋白原 纤维蛋白 血清与血 浆的区别 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 血友病 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. (1) 内源性凝血途径:正反馈 负电荷促进凝血：胶原纤维、玻璃、棉纱、金属、粘土 正电荷抑制凝血：细胞色素C、溶菌酶 (2) 外源性/组织因子凝血途径 有来自血液外释放的组织因子的参与的凝血途径。 凝血酶原激活物的形成 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. (三）血液凝固过程的调节 1.血管内皮的抗凝作用 2.纤维蛋白的吸附、血流的稀释、单核巨噬细胞的吞噬 3.生理性抗凝物质 1)抗凝血酶 (AT) 2)肝素 3)蛋白质C系统 4)组织因子抑制物(负反馈） Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 三、纤维蛋白溶解系统 意义:使血液经常保持液态,血流通畅,防血栓形成。 纤溶的基本过程包括： 纤溶酶原的激活 纤维蛋白的降解 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 第四节 血 型 与 输 血 一、血型 血型：指的是红细胞膜上特异性抗原的类型。 红细胞凝集：若不同血型的血液混合，会出现红细 胞彼此聚集在一起，成为一簇簇的细 胞团，这种现象称为红细胞凝集反应。 血型的分类:目前已知人类的RBC除ABO血型系统外, 还有Rh等25个血型系统。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. 一、ABO血型系统 (一)抗原与分型 凝集原:指红细胞膜上 的抗原物质。 凝集素:指血清中能与 凝集原对应的特异抗 体。 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. ABO血型系统中的凝集原和凝集素 血型 凝集原 凝集素 A : A1 A+A1 抗 B A2 A 抗B+抗A1 B B 抗 A AB: A1B A+A1+B 无 A2B A+B 抗A1 O 无 抗A+抗B Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （二）ABO血型系统抗体的特性 天然抗体：不能通过胎盘 免疫抗体：可以通过胎盘 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （三）ABO血型的遗传 A B 属于显性基因 O属于隐性基因 基因型表现现型 OOO AA、AOA BB、BOB ABAB Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd. （四）血型的检测 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile .Created with Aspose.Slides for .NET 3.5 Client Profi