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日本富士甲型流感病毒IgG 熒光PCR檢測(cè)試紙
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日本富士甲型流感病毒IgG 熒光PCR檢測(cè)試紙
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皮膚較厚,且含有色素,因而是白里透紅或微棕色透紅。靜脈血因含還原血紅蛋白多、氧合血紅蛋白少,所以它是暗紅色,透過皮膚,就呈現(xiàn)青紫色。手臂上一條一條的一般所稱的“青筋”就是靜脈。苯胺、硝基苯和亞硝酸鹽等化學(xué)品可使血紅蛋白變?yōu)樽冃匝t蛋白,這種血紅蛋白本身就是紫色的。因此,凡粘膜、指甲和皮膚里的毛細(xì)血管和小動(dòng)脈里血液的氧合血紅蛋白減少,而還原血紅蛋白增多或出現(xiàn)變性血紅蛋白的時(shí)候,都會(huì)出現(xiàn)紫紺。
根據(jù)引起紫紺的病因不同,臨床上將紫紺分為兩大類:血液中還原血紅蛋白增多引起的紫紺、血液中異常血紅蛋白衍生物引起的紫紺。其中,這兩類當(dāng)中數(shù)前者zui為多見,也更具有臨床意義。下面我們?cè)敿?xì)進(jìn)行進(jìn)一步分類。
血中含有還原血紅蛋白增加
根據(jù)不同病因引起又可以分為中央型紫紺、周圍型紫紺、混合型紫紺。
中央性紫紺(中心性發(fā)紺)由于心臟、呼吸系統(tǒng)疾病,導(dǎo)致血氧飽和度降低,臨床表現(xiàn)為彌漫性發(fā)紺。
心源性發(fā)紺:常見于先天性心臟病,如法洛四聯(lián)癥,因?yàn)閯?dòng)靜脈分流,靜脈血未經(jīng)肺泡即直接進(jìn)入動(dòng)脈系統(tǒng)。如分流量占心臟輸出量30%以上,則發(fā)生發(fā)紺。
肺源性發(fā)紺:見于肺動(dòng)脈受損,因?yàn)榉闻萃獠蛔?、肺通氣與肺血流比例失調(diào)、肺泡膜氧彌散功能障礙等因素所致。常見的疾病有阻塞性肺氣腫、肺炎、肺淤血、肺水腫等。
周圍型紫紺
周圍型紫紺(周圍性發(fā)紺)由于周圍循環(huán)障礙所致。其臨床表現(xiàn)特點(diǎn)是發(fā)紺常出現(xiàn)于肢體的末端,比如耳垂、顏面等。
靜脈淤血:比如下肢靜脈栓塞、靜脈曲張;
心排血量減少:嚴(yán)重休克時(shí),因?yàn)橹車苎骶徛把苁湛s,導(dǎo)致組織缺血缺氧。
肢體末端循環(huán)障礙:如雷諾病、雷諾現(xiàn)象。
周圍動(dòng)脈阻塞:動(dòng)脈硬化、閉塞性脈管炎等。
混合型紫紺
混合型紫紺(混合性發(fā)紺)較為容易理解,即中央型紫紺和周圍型紫紺同時(shí)存在。比如心功能不全時(shí),因?yàn)榉斡傺墒寡t蛋白氧合不足,同時(shí)血流緩慢、周圍組織耗氧過多,導(dǎo)致還原血紅蛋白增加而出現(xiàn)紫紺。
血液中含有異常血紅蛋白
藥物及化學(xué)物品中毒導(dǎo)致血中異常血紅蛋白衍生物的出現(xiàn)亦可形成紫紺,比如腸源性紫紺,高鐵血紅蛋白血癥等。
Thicker skin, and contains pigment, which is white or reddish brown. Venous blood contains more hemoglobin due to reduction, oxygenated hemoglobin less, so it is dark red, through the skin, it appears blue. The generally known "veins" on the arms are veins. Aniline, nitrobenzene and nitrite and other chemicals can make hemoglobin into denatured hemoglobin, the hemoglobin itself is purple. Therefore, where mucosa, nails and small intestine in the capillaries and arterial blood oxygenated hemoglobin decreased, and the reduction of hemoglobin increased or denatured hemoglobin, there will be cyanosis.
According to the different causes of cyanosis, cyanosis is clinically divided into two categories: cyanosis caused by increased hemoglobin in the blood, and cyanosis caused by abnormal hemoglobin derivatives in the blood. Among them, the former two types of the former is the most common, but also more clinically significant. Below we carry out further classification.
Blood contains reduced hemoglobin increased
According to different causes can be divided into central cyanosis, peripheral cyanosis, mixed cyanosis.
Central cyanosis (central cyanosis) due to the heart, respiratory diseases, leading to decreased oxygen saturation, the clinical manifestations of diffuse cyanosis.
Cardiac cyanosis: Common in congenital heart disease, such as tetralogy of Fallot, because arteriovenous shunt, venous blood directly into the arterial system without alveolar. If the sub-flow accounted for more than 30% of cardiac output, the occurrence of cyanosis.
Lung-derived cyanosis: seen in the pulmonary artery damage due to inadequate alveolar ventilation, pulmonary ventilation and pulmonary blood flow imbalance, alveolar oxygen diffusion dysfunction and other factors. Common diseases are obstructive emphysema, pneumonia, pulmonary congestion, pulmonary edema and so on.
The surrounding cyanosis
Peripheral cyanosis (peripheral cyanosis) due to the surrounding circulatory disorders. The clinical manifestations of cyanosis often appears in the extremities, such as earlobe, face and so on.
Venous congestion: such as lower extremity venous thrombosis, varicose veins;
Cardiac output reduced: severe shock, because of slow peripheral blood flow and vasoconstriction, resulting in tissue ischemia and hypoxia.
Circumferential limbs disorders: such as Raynaud's disease, Raynaud's phenomenon.
Peripheral artery obstruction: atherosclerosis, occlusive vasculitis and so on.
Mixed cyanosis
Mixed cyanosis (mixed cyanosis) is easier to understand, that is, central cyanosis and peripheral cyanosis exist. Such as cardiac insufficiency, because pulmonary congestion can make hemoglobin oxygen deficiency, while slow blood flow, the surrounding tissue oxygen consumption, resulting in reduction of hemoglobin increased cyanosis.
Blood contains abnormal hemoglobin
Drugs and chemical poisoning lead to abnormal blood hemoglobin derivatives can also form cyanosis, such as gut-derived cyanosis, methemoglobinemia and so on.