课件：功能失调性子宫出血-北京协和医院妇产科 郁琦.ppt

* The internal equilibrium of the body involves the maintenance of a constant rate of conditions or concentration of certain molecules and ions that are essential to life. This maintenance of equilibrium, or constant conditions, through the means of automatic mechanisms which counteract internal or external causes for disequilibria, is known as homeostasis (i.e. temperature regulation, salt water balance, etc.). In the process of bleeding, the homeostasis phenomenon is evident through the opposing arms of the “Coagulation System” and the “纤维蛋白olysis System”. When injury leads to hemorrhage, a series of mechanisms kick into action to activate the coagulation system in order to prevent the excessive loss of water and vital nutrients from the bleeding. A cascade of molecular events occur at the injured site that ultimately leads to the activation of thromboplastin, an enzyme which in turn, activates prothrombin to thrombin – the molecule responsible for activating the blood soluble 纤维蛋白ogen into its solid counterpart, 纤维蛋白. However, in order to prevent an excessive formation of the “纤维蛋白-mesh” that constitutes the functional portion of a blood-clot, an opposing system also kicks-in for preventing the excessive formation of 纤维蛋白 clots, which in large amounts, may be dangerous for occluding vascular flow. This is the 纤维蛋白olysis system. In the 纤维蛋白olysis system, tissue-纤溶酶ogen activators (t-PA) are released from the surrounding injured site, which enzymatically cleaves 纤溶酶ogen into 纤溶酶. The now active 纤溶酶, in turn, binds to 纤维蛋白 molecules, breaking it up into what is known as “纤维蛋白 Degradation Products” (FDP). * Mefenamic acid 止血（子宫内膜生长修复法） 给予足量雌激素，使部分脱落的子宫内膜增殖生长，使所有子宫内膜处于同步增殖的水平 苯甲酸雌二醇2mg，每4～8小时肌肉注射一次 结合雌激素针剂：25mg，静脉注射，可4～6小时重复一次，一般用药2～3次 结合雌激素（CEE）1.25mg～2.5mg，8～6小时一次 戊酸雌二醇（E2V）3mg～5mg，8～6小时一次 血止2～3天后按每三天减量不超过1/3的方法递减至血红蛋白允许时，孕激素撤退 止血（避孕药） 同时给予大量孕激素和雌激素 止血较快 适于长期而严重的出血 第三代口服避孕药 妈富隆、达英-35、敏定偶 2-3片/d×3天，减量2片/d×3,减量1片/d，血色素正常时，停药来月经 治疗要点 采取何种治疗方法的抉择依据 血色素和一般状况（生命