第三章 局部血液循环障碍

第三章局部血液循环障碍一、名词解释1.充血(hyperaemia)2.淤血(congestion)3.肺褐色硬化(brown induration of lung)4.槟榔肝(nutmeg liver)5.含铁结节(siderotic nodules)#6.无细胞性硬化(acellular sclerosis)7.血栓形成(thrombosis)8.血栓(thrombus)9.透明血栓(hyaline thrombus)10.栓塞(embolism)11.梗死(infarct)12.心衰细胞(heart failure cell)13.水肿(edema)14.减压病(decompression sickness)15.血栓栓塞(thromboembolism)16.再通(recanalzation)二、填空题1.血栓的类型有：①_____，②_____，③_____，④_____。

2.血栓对机体的影响包括：①_____，②_____，③______，④_______。

3.血栓形成的条件：①______，②______，③_______。

4.血栓的结局：①______，②_______，③______，④_______。

5.出血性梗死发生的条件：①______，②______，③_____，④______。

6.透明血栓的主要组成成分是①______和②________。

三、选择题(一)Ａ型题（1～28）1.急性肺淤血时肺泡腔内的主要成分是：A.“心力衰竭细胞”B.水肿液C.炎症细胞D.纤维蛋白E. 尘细胞2.因逆行栓塞引起的病变是：A.肝血吸虫病B.肠结核原发综合征C.Krukenberg瘤D.肠血吸虫病E.肠阿米巴病3.下列哪种因素与血栓形成无关?A.血管内膜损伤B.血流缓慢C.血小板数量增多D.癌细胞崩解产物E.纤维蛋白溶酶增加4.下述血栓中，哪种是白色血栓?A.疣状心内膜炎的瓣膜赘生物B.心房纤颤时心耳内球状血栓C.心肌梗死时的附壁血栓D.微循环内微血栓E.下肢深静脉的延续性血栓5.梗死的形状取决于：A.脏器的外形B.动脉阻塞的部位C.动脉阻塞的程度D.血管的分布E.有无淤血的基础6.大循环的动脉栓塞，栓子绝大多数来自：A.动脉粥样硬化溃疡形成B.动脉瘤内膜表面的血栓C.下肢静脉的血栓形成D.亚急性细菌性心内膜炎时二尖瓣瓣膜赘生物E.风湿性心内膜炎时心瓣膜疣状赘生物7.肠扭转一般不会引起下列哪种病理改变?A.病变肠段淤血、水肿B.病变肠段坏死C.病变肠段颜色变黑D.病变肠段纤维增生E.病变肠段出血8.病理诊断羊水栓塞的依据是：A.肺脏广泛出血B.弥漫性肺毛细血管内透明血栓形成C.肺泡内有角化上皮D.肺毛细血管内有角化上皮E.肺泡内透明膜形成9.下述有关肝淤血的记述中，哪一项是错误的：A.小叶间静脉扩张B.中央静脉扩张C.肝窦扩张D.肝细胞萎缩E.肝细胞脂肪变性10.混合性血栓可见于：A.静脉内柱状血栓的尾部B.毛细血管内血栓C.急性风湿性心内磨炎的疣状血栓D.动脉血栓的头部E.心室内附壁血栓11.下腔静脉内的栓子不会引起下列哪个部位的栓塞?A.下腔静脉属支B.门静脉属支C.脑D.肺E.肾12.下列哪种情况与脑软化无关?A.主动脉附壁血栓B.脑血栓形成C.肺动脉栓塞D.二尖瓣疣赘E.左心房球形血栓13.下述有关血栓形成的记述中，哪一项是错误的?A.静脉血栓多于动脉血栓B.下肢血栓多于上肢C.动脉内血栓多为混合血栓D.静脉内血栓多为红色血栓E.毛细血管内血栓多为纤维素性血栓14.肺动脉栓塞患者死亡的常见原因是：A.急性右心衰B.急性左心衰C.肾功能衰竭D.中毒性休克E.大片肺出血15.下述疾病均可引起出血，哪个不属于漏出性出血?A.肺结核B.维生素C缺乏症C.血小板减少性紫癜D.肺淤血E.流行性出血热16.乳腺癌根治术后上肢水肿的主要原因是：A.血浆胶体渗透压低下B.静脉压上升C.毛细血管通透性增高D.淋巴管闭塞E.肝细胞对醛固酮、抗利尿激素灭活能力降低17.下述有关左心室附壁血栓的记述中，哪项是正确的?A.阻塞心室血流B.加重心肌梗死C.诱发心壁穿孔D.引起脑栓塞E.引起肺栓塞18.下肢大隐静脉内血栓完全机化大多需要：A.1天B.3天C.1周D.2周E.4周19.下述有关死后凝血块的记述中，哪项是错误的?A.湿润、有光泽B.质地柔软C.有弹性D.暗红色，均匀一致，上层似鸡脂样E.与血管壁粘连紧密，不易剥离20.弥散性血管内凝血（DIC）发生广泛出血的主要原因是：A.肝凝血酶原合成减少B.血管壁广泛损伤C.大量血小板及纤维蛋白原消耗D.单核巨噬细胞系统功能下降E.血浆中缓激肽浓度增高21.下述哪种情况不会发生气体栓塞?A.颈部外伤或手术B.胸部外伤或手术C.大隐静脉切开输液D.胎盘早期剥离E.锁骨下静脉插管输液22.脂肪栓塞患者死亡的常见原因是：A.急性右心衰竭B.急性左心衰竭C.脑出血坏死D.肾功能衰竭E.心源性休克23.下腔静脉血栓形成时，最主要的侧支循环是下述哪个静脉？A.脐旁静脉B.腹壁下静脉C.胃冠状静脉D.食管静脉E.上述均不是24.在触发凝血过程中起核心作用的是：A.血小板的活化B.胶原C.凝血因子ⅫD.纤维连接蛋白E.凝血酶敏感蛋白25.炎症水肿的主要原因是：A.血浆胶体渗透压降低B.静脉压升高C.毛细血管通透性增高D.淋巴管闭塞E.肝细胞对醛固酮、抗利尿激素的灭活能力降低26.脑动脉发生栓塞，其栓子最可能来自：A.下肢深静脉血栓B.下肢浅静脉血栓C.盆腔静脉血栓D.左心室附壁血栓E.门静脉血栓27.下列哪种梗死灶常发生化脓?A.心脏附壁血栓脱落造成的梗死灶B.心肌梗死C.急性细菌性心内膜炎赘生物脱落造成的梗死灶D.肺出血性梗死灶E.卵巢肿瘤蒂扭转性梗死灶28.下列哪个器官的梗死灶呈节段性：A.肠B.心脏C.脑D.卵巢E.肝(二)B型题（29～34）A.脂肪栓塞B.气体栓塞C.血栓栓塞D.羊水栓塞E.肿瘤细胞栓塞29.胸部手术时要防止30.长骨骨折病人突然死亡的原因可能是31.产妇死亡后尸解时发现肺小动脉内有角化上皮细胞，其死亡原因可能是 A.心衰细胞B.肺水肿C.下肢水肿D.颈静脉怒张E.肝细胞脂肪变性32.慢性肝淤血33.急性肺淤血34.慢性肺淤血(三)C型题（35～39）A.含铁血黄素沉积B.纤维组织增生C.二者均有D.二者均无35.慢性肺淤血36.慢性肝淤血37.肺动脉主干栓塞A.坏死B.淤血C.二者均有D.二者均无38.冠状动脉前降支栓塞39.肝内门静脉栓塞(四)X型题（40～53）40.来自静脉系统的血栓可以引起：A.肺动脉主干栓塞B.出血性梗死C.脾、肾、脑梗死D.肝梗死E.心肌梗死41.促进血栓形成的因子有：A.ADPB.血栓素A 2C.PGI 2D.凝血调解素E.VWF42.下腔静脉血栓脱落可引起：A.肺动脉栓塞B.门静脉栓塞C.肝静脉栓塞D.肾静脉栓塞E.股静脉栓塞43.肠出血性梗死可造成：A.麻痹性肠梗阻B.急性弥漫性腹膜炎C.肠破裂D.败血症E.休克44.下述哪些疾病可以引起槟榔肝?A.上腔静脉闭塞症B.缩窄性心包炎C.门静脉高压症D.二尖瓣狭窄E.肺动脉高压45.一病人因车祸致胫骨粉碎性骨折，整复时突然死亡，其原因最可能是：A.伤口感染后引起脑膜脑炎B.骨折源性脂肪栓塞C.股静脉血栓形成D.脑动脉粥样硬化E.左心房球形血栓脱落46.血栓的后果有：A.完全阻塞管腔B.被纤维蛋白溶酶系统溶解C.机化再通D.引起远端栓塞E.钙化47.脾脏淤血肿大多见于：A.左心衰竭B.班替脾C.右心衰竭D.门静脉血栓形成E.门静脉高压症48.血管内膜损伤时容易发生血栓形成，其原因是：A.损伤的内皮释放组织因子B.损伤的内皮释放二磷酸腺昔C.裸露的胶原纤维吸附血小板D.裸露的胶原纤维激活第Ⅻ因子E.裸露的胶原激活血小板49.弥散性血管内凝血可引起：A.休克加重B.微血栓形成C.多器官出血D.肾上腺皮质坏死E.血栓脱落后引起多器官梗死50.透明血栓可见于：A.微动脉B.微静脉C.毛细血管D.小动脉E.小静脉51.室间隔膜部缺损合并亚急性细菌性心内膜炎可引起：A.脑栓塞B.肺栓塞C.肾栓塞D.门静脉栓塞E.肺动脉主干栓塞52.引起肺动脉栓塞的血栓栓子多来自：A.月国静脉B.股静脉C.髂静脉D.盆腔静脉E.下肢浅静脉53.下列哪些血栓属混合性血栓：A.心房附壁血栓B.静脉血栓的体部C.动脉血栓的体部D.微循环内血栓E.动脉瘤内层状血栓四、病例分析1.男性，42岁，骑车跌倒引起右小腿胫腓骨骨折，经石膏固定后，回家卧床休息，此后小腿肿痛无明显缓解。

伤后2周，右下肢肿痛加重。

去医院复查，拆除原石膏并重新包扎固定，但肿胀进行性发展至大腿，胀痛难忍。

住院观察4天后，坐起吃饭时，突然高叫一声，当即心跳呼吸停止，抢救无效死亡。

分析病情：(1)此病人第2次小腿肿胀，且进行性加重，是因为：A.固定不良B.局部炎症C.石膏压迫D.血栓形成E.局部出血(2)病人突然死亡的原因是：A.心肌梗死B.脑血管意外C.创伤性休克D.窒息E.肺动脉栓塞(3)本例在处理上应引以为戒的是：A.处理不及时B.固定不良C.未用抗菌素D.病人缺乏适当活动E.抢救不力2.一乳腺癌患者，经检查发现，椎骨和脑部出现转移性肿瘤，而肺部未发现病灶。

(1)本例肿瘤的转移途径是：A.胸导管B.乳房内静脉C.上腔静脉D.脊椎静脉系统E.动脉系统(2)本例的转移物质是：A.血栓栓子B.细胞栓子C.脂肪栓子D.细菌栓子E.羊水栓子五、病理专业英文阅读1. HemorrhageHemorrhage obviously implies rupture of a blood vessel. Rupture of a large artery or vein is almost always caused by some form of injury, such as trauma, atherosclerosis, or inflammatory or neoplastic erosion of the vessel wall. Rupture of a large artery in the brain is a frequent cause of death in hypertensive patients. An increased tendency to hemorrhage is encountered in a wide variety of clinical disorders known collectively as the hemorrhagic diatheses.Hemorrhages may be external and exsanguinating. When the blood is trapped within the tissues of the body, the accumulation is referred to as a hematoma. Rupture of the aorta, for example in a dissecting or atherosclerotic aneurysm, may cause a massive retroperitoneal hematoma with sufficient loss of blood to cause death. When the blood accumulates in one of the body cavities it is referred to as hemothorax, hemopericardium, hemoperitoneum, or hemarthrosis. Minute hemorrhages into the skin, mucous membranes, or serosal surfaces are known as petehiae. Slightly larger hemorrhages are designated purpura. A large (over 1 to 2 cm in diameter) subcutaneous hematoma, an example of which is the common bruise, is called an ecchymosis. The released hemoglobin is converted into bilirubin and eventually into hemosiderin. Patients who sustain a large hemorrhage, such as massive gastrointestinal bleeding, a pulmonary hemorrhage or infarct, or a hematoma, sometimes become jaundiced owing to the breakdown of red cells and subsequent release of bilirubin.The significance of hemorrhage depends on the volume of blood loss, the rate of loss, and the site of hemorrhage. Sudden losses of up to 20% of the blood volume or slow losses of even larger amounts may have little clinical significance. Larger or more acute losses may induce hemorrhagic (hypovolemic) shock. The site of the hemorrhage is, of course, important; a hemorrhage that would be trivial in the subcutaneous tissues may cause death when located in the brain stem. Repeated external hemorrhages (i.e., those in which the blood is shed 1asfrom the skin, gastrointestinal tract, or female genital tract) represent losses of not only blood volume but also of valuable iron. Usually the small but repeated volume losses are rapidly corrected by movement of water from the interstitial spaces into the vascular compartment, but the chronic loss of iron may lead to an iron deficiency anemia. In contrast, when the red cells are retained, as occurs with hemorrhages into the body cavities, joints, or tissues, the iron can be recaptured for synthesis of hemoglobin.2. Fat EmbolismMinute globules of fat can often be demonstrated in the circulation following fractures of the shafts of long bones (which have fatty marrows) and, rarely, with soft tissue trauma and burns. Presumably the microglobules are released by injury to marrow or adipose tissue and gain access to the circulation by rupture of the marrow vascular sinusoids or venules. It should be emphasized that whereas traumatic fat embolism can be demonstrated anatomically in approximately 90% of individuals who sustain severe skeletal injuries, only about 1% of these individuals manifest clinical signs or symptoms known as fat embolism syndrome. It is characterized by pulmonary insufficiency (resembling the acute respiratory distress syndrome), neurologic symptoms, anemia, and thrombocytopenia. Typically the symptoms appear after a latent period of 24 to 72 hours after injury. There is sudden onset of tachypnea, dyspnea, and tachycardia. Neurologic symptoms include irritability and restlessness, which progress to delirium or coma. Petechial skin rash is common. The fat embolism syndrome is fatal in about 10% of cases.The pathogenesis of this symptom complex is not entirely clear but is believed to involve both mechanical obstruction and chemical injury. It is proposed that microaggregates of neutral fat cause occlusion of pulmonary or cerebral microvasculature, and the free fatty acids released from fat globules result in toxic injury to the vascular endothelium. The petechial skin rash is related to rapid onset of thrombocytopenia. Presumably myriad fat globules become coated with platelets, thus depleting circulating platelets.The microscopic demonstration of fat microglobules in tissues or organs requires special techniques using frozen sections and fat stains because the emboli are dissolved out of the blood by the usual solvents employed in paraffin embedding of tissues. Sometimes the microemboli can be identified in the gross specimen by gentle pressure on fresh tissue slices immersed in saline, which releases the droplets and permits them to float to the surface.六、问答题1.心力衰竭细胞是如何形成的？2.全心衰竭时，主要脏器可发生什么病理变化？3.为什么静脉发生血栓比动脉多？4.血栓形成后，可引起哪些循环障碍？有哪些危险？有没有好处？5.栓子的种类有哪些？其主要来源及运行方向怎样？6.贫血性梗死和出血性梗死各有哪些特点？7.用橡皮筋将一手指紧紧捆住，过1～2分钟后，手指末端有什么变化？如何解释？8.为什么在骨折固定上夹板或绑石膏带时不能过紧？9.淤血、血栓形成、栓塞、梗死、坏死和坏疽的相互关系如何？10.血液循环障碍和组织细胞损害有何关系？举例说明。