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ID:33473189
大小:11.44 MB
页数:119页
时间:2018-05-22
《冠心病的治疗(20111020)ppt培训课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、冠心病治疗重庆医科大学附属第一医院马康华 教授CoronaryArteryDiseaseLeadingcauseofdeathinAmericanAbout3-4millionheartattacksyearlythroughouttheworld30%deathrate50%deathoccurwithinthefirsthour中国面临心血管疾病第二次浪潮-----冠心病持续增长!-----脑卒中居高不下!WhatisCoronaryArteryDisease??CoronaryArteriesRightCoronaryOstiaLeftCoronaryO
2、stiaAorticValveCuspsCoronaryArteriesSinusesofValsalvaRightCoronaryOstiaLeftCoronaryOstiaAscendingAortaLeftAorticCuspPosteriorAorticCuspRightAorticCuspCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.LeftCircumfle
3、xArteryLeftAnteriorDescendingCoronaryArteriesLeftMainCoronaryArteryAnteriorViewRightCoronaryArtery1stDiagonalArtery2ndDiagonalArtery1st&2ndMarginalArteriesCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.BloodSup
4、plyoftheHeartDerivesfrom3coronaryarteriesleftanteriordescendingarteryLeftcircumflexarteryRightcoronaryarteryNarrowingofanyofthesecoronaryarteriescausescoronaryarterydisease定义冠状动脉粥样硬化性心脏病(coronaryatheroscleroticheartdisease)指冠状动脉粥样硬化使血管腔阻塞,导致心肌缺血、缺氧而引起的心脏病,它和冠状动脉功能性改变(痉挛)一起,统称冠状动脉性心脏病(
5、cronaryheartdisease),简称冠心病,亦称缺血性心脏病(ischemicheartdisease)。发病机制脂肪浸润学说:LDL和VLDL特别是氧化修饰的LDL,经损伤的内皮细胞或内皮细胞裂隙→中膜,平滑肌细胞增殖、吞噬脂质→泡沫细胞,脂蛋白又降解而释出各种脂质,刺激纤维组织增生,共同构成粥样斑块血小板聚集和血栓形成学说:粥样斑块实际上是机化了的血栓,并非真正的粥样斑块内皮损伤反应学说:各种危险因素损伤内膜→炎症反应→动脉粥样硬化斑块形成动脉粥样硬化的发病机理迄今为止AS的确切机制尚未完全阐明,近年来较一致的认为:多种危险因素↓内皮功能紊乱(炎症的
6、启动因子)↓OX-LDL浸润→形成泡沫细胞(关键环节)↓细胞因子、炎性介质、生物酶及平滑肌细胞增值迁移↓导致动脉壁炎症动脉粥样硬化的发病机理DiseaseProcessNormalCoronaryArteryCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.DiseaseProcessCopyright1989.Novartis.Reprintedwithpermissio
7、nfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.泡沫细胞脂质条纹中层受损粥样斑块纤维斑块继发损伤/破裂内皮损害firstdecadeThirddecadeForthdecadeAdaptedfromStaryHCetal.Circulation1995;92:1355-1374.冠脉疾病机理AT各阶段的治疗方案不同LibbyP.Circ2001;104:365,介入治疗ASA氯吡格雷肝素/LMWHGPIIb/IIIa拮抗剂Beta受体阻滞剂改善生活方式控制危险
8、因素ASA
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