创伤的病理生理培训课件.ppt
创伤的病理生理,创伤的病理生理,1.Inflammation炎症,Inflammatory cells炎性细胞 Inflammatory cytokines炎性因子,2,创伤的病理生理,1.InflammationInflammatory cel,capillary毛细血管,3,创伤的病理生理,sitmulateplasmacytokineprotein,Inflammation after trauma创伤后炎症,Systemic Inflammatory Response Syndrome(SIRS)全身炎症反应综合征 Compensatory Anti-inflammatory Response Syndrome(CARS)代偿性抗炎症反应综合征 Trauma and bacteria can cause inflammation 创伤和细菌可引起炎症 This process involve many cells and cytokine 这个过程涉及到许多细胞及细胞因子,4,创伤的病理生理,Inflammation after trauma Syst,inflammation staging 炎症分段,杀灭细菌和毒素去除坏死细胞促进组织愈合,促炎和抗炎平衡，炎性稍占上风,5,创伤的病理生理,inflammation staging 炎症分段(2)L,Injury损伤,Bodys response身体反应,SIRS,CARS,Uncontrolled systemic inflammatory response syndrome失控的全身炎症反应综合征,besides此外,sufficient 充分,Death 死亡,uns.不充分,Under control得到控制,6,创伤的病理生理,InjuryBodys responseSIRSCARSU,Clinical presentations of SIRS全身炎症反应综合征的临床表现,Body temperature（体温）38 Heart rate（心率）90/minBreathe（呼吸）Blood cell count（血细胞计数）12109/L,20/min,7,创伤的病理生理,Clinical presentations of SIRS,Types of inflammatory mediators炎性介质的类型,8,创伤的病理生理,Types of inflammatory mediator,Cytokines细胞因子,Tumor necrosis factor(TNF)肿瘤坏死因子Interleukin 白介素Interferon(ITF)干扰素Growth factor-(TGF-)生长因子-,9,创伤的病理生理,CytokinesTumor necrosis factor,Activation of inflammatory cells炎症细胞的激活(Macrophage)（巨噬细胞）,10,创伤的病理生理,Activation of inflammatory cel,多器官功能障碍综合征周荣斌,促 炎 介 质 过 度 产 生,原始病因 感 染 损 伤,抗 炎 介 质 过 度 产 生,全 身 反 应 全身炎症反应综合征（SIRS）代偿性炎症反应综合征（CARS）混合性抗炎反应综合征（MARS）,平 衡 SIRS、CARS,细胞调亡 SIRS过度,免疫功能障碍 CARS过度,MODS SIRS过度,休 克 SIRS过度,局部促炎介质,局部抗炎介质,SIRS临床发病过程,11,创伤的病理生理,多器官功能障碍综合征周荣斌促 炎 介 质 原始病因 抗,神经内分泌系统变化,2.全身反应 systemic response,12,创伤的病理生理,下丘脑-垂体-肾上腺皮质轴交感神经-肾上腺髓质轴肾素-血管紧,代谢变化,13,创伤的病理生理,水、电解质代谢紊乱基础代谢率增高，能量消耗增加机体的分解代谢,3.Wound healing 创伤的愈合,Wound healing is composed of several steps 创伤的愈合分为几个阶段 regeneration 再生 granulation 肉芽组织 angiogenesis 血管生成 epithelialization 形成上皮 The process is mediated by a variety of growth factors.各种生长因子参与 Primary healing and secondary healing 一期愈合、二期愈合,14,创伤的病理生理,3.Wound healing 创伤的愈合 Wound h,创伤的病理生理培训课件,What is Regeneration?再生,The process of the replacement of injured cells by cells of the same type.损伤细胞被周围同种细胞更换的过程,16,创伤的病理生理,What is Regeneration?The proc,What is granulation?肉芽组织,During the course of healing,fibroplasia is developed in the wound by fibroblasts.在伤口愈合的过程中，纤维母细胞转化形成纤维组织增生It includes:small blood vessels（小血管）fibroblasts（纤维母细胞）inflammatory cells（炎性细胞）,17,创伤的病理生理,What is granulation?,What is angiogenesis?血管生成,Angiogenesis is necessary feature of repair and started from preexisting venules,it becomes visible about 4 days after injury.血管再生是修复的重要特征，在损伤后4天左右时，由先前存在的小静脉开始,Preexisting venules,18,创伤的病理生理,What is angiogenesis?,What is epithelialization?上皮形成,Epithelial cells is stimulated by a variety of growth factors,such as TGF-1,and anchor on the first unepithelialized place.上皮细胞受到多种生长因子的刺激作用（例如TGF-1）后，集聚于早期非上皮化的部位,19,创伤的病理生理,What is epithelialization?,The process of repair 修复的过程,coagulation and inflammation 凝聚、炎症Matrix deposition and granulation 基质沉淀、肉芽组织Angiogenesis 血管再生Epithelialization 上皮形成Collagen maturation 胶原蛋白成熟Wound contraction 伤口收缩,20,创伤的病理生理,The process of repair 修复的过程,Types of wound healing 伤口愈合的类型,Primary healing一期愈合small,clean andless tissue damage.伤口小，清洁，较少组织损伤by stitching,mild inflammatory reaction.通过缝合，轻度炎症反应epidermalregeneration,a small amount of granulation tissue,few scars.表皮再生，少量肉芽组织，几乎无瘢痕,Primary healing一期愈合,21,创伤的病理生理,Types of wound healing 伤口,Types of wound healing 伤口愈合的类型,Secondary healing二期愈合 Large wound 伤口范围大Necrotic tissue and inflection 组织坏死、变形Granulation tissuefilled the wound 肉芽组织填充伤口Bigscars 瘢痕大,22,创伤的病理生理,Types of wound healing 伤口愈,Nutrition 营养水平 Metabolic status 代谢状态Circulatory status 循环状态Hormones 激素水平,Systemic factors全身因素,Local factors局部因素,Infection 感染Wound defect 伤口缺损Foreign bodies 异物 Size,location,and type of wound 伤口大小、位置、类型,23,创伤的病理生理,Systemic factorsLocal factors,plication of trauma创伤并发症,感染 休克脂肪栓塞综合症应激性溃疡凝血功能障碍器官功能障碍,24,创伤的病理生理,plication of trauma创伤并发,Section IV Trauma diagnosis创伤的诊断,25,创伤的病理生理,Trauma history examinationSysm,Relationship between systemic and local 系统与局部的关系,Systemic diagnosis（系统诊断）：Five vital signs/Glasgow scale/CRAMS 五项生命体征/Glasgow昏迷评分法/CRAMS评分 brain/viscus/chest/lung 脑/内脏/胸/肺Local diagnosis（局部诊断）：Wound types/scope/depth 伤口的类型、范围、深度 Infection/non-infection 是否感染 Bleeding/fracture 出血、骨折Systemic diagnosis be the most important 系统诊断尤为重要,26,创伤的病理生理,Relationship between systemic,Respiration 呼吸 respiratory rate:25/15/min,cyanosis.呼吸频率 25/15次/分，发绀Blood pressure and pulserate 血压、脉率 pulserate 100/min,blood pressure 100/min，血压90mmHgConsciousness and pupils motion 意识、瞳孔Glasgow scale and CRAMS Glasgow昏迷评分法/CRAMS评分,General physical examination(Five vital signs)一般体格检查（五项生命体征）,27,创伤的病理生理,RespirationGeneral physical ex,Local wound inspection principles 局部伤口检查的原则,wound size,depth and shape 伤口大小、深度、形状woundcontamination 伤口污染情况woundtraits 伤口特性blood vessel damage and bleeding 血管损伤及出血情况foreign bodies in the wound.伤口中异物情况whether involve deep viscus injury or not 是否涉及腹部深层脏器损伤,28,创伤的病理生理,Local wound inspection princip,Experimentalpuncture 诊断性穿刺abdominocentesis 腹腔穿刺thoracentesis 胸腔穿刺 Exploratorysurgery 探查术Adjunctive check 辅助检查 imaging:CT MRI X-ray 成像：CT、MRI、X线,Blunttraumaexamination(close wound check)闭合性创伤检查,29,创伤的病理生理,Experimentalpuncture 诊断性穿刺,Abdominocentesis腹腔穿刺术,30,创伤的病理生理,Abdominocentesis30创伤的病理生理,Thoracentesis胸腔穿刺术,injector,Diagnosticpunctureto determinewhetherthe chest cavityfluid(or gas),andsent tothe laboratorypuncturefluidand pathological examinationto determinethe nature andcause of effusion.诊断性穿刺后将穿刺液送检，可以确定胸腔积液（气）的性质和病因,31,创伤的病理生理,ThoracentesisinjectorDiagnosti,休息一会儿.,32,创伤的病理生理,休息一会儿.32创伤的病理生理,
