冠心病的治疗精品医学ppt课件

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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??CoronaryArteriesRightCoro

2、naryOstiaLeftCoronaryOstiaAorticValveCuspsCoronaryArteriesSinusesofValsalvaRightCoronaryOstiaLeftCoronaryOstiaAscendingAortaLeftAorticCuspPosteriorAorticCuspRightAorticCuspCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,illustratedbyFra

3、nkH.Netter,M.D.Allrightsreserved.LeftCircumflexArteryLeftAnteriorDescendingCoronaryArteriesLeftMainCoronaryArteryAnteriorViewRightCoronaryArtery1stDiagonalArtery2ndDiagonalArtery1st&2ndMarginalArteriesCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasof

4、HumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.BloodSupplyoftheHeartDerivesfrom3coronaryarteriesleftanteriordescendingarteryLeftcircumflexarteryRightcoronaryarteryNarrowingofanyofthesecoronaryarteriescausescoronaryarterydisease定义冠状动脉粥样硬化性心脏病(coro

5、naryatheroscleroticheartdisease)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(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

6、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.Reprintedwithper

7、missionfromtheAtlasofHumanAnatomy,illustratedbyFrankH.Netter,M.D.Allrightsreserved.DiseaseProcessCopyright1989.Novartis.ReprintedwithpermissionfromtheAtlasofHumanAnatomy,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firstdecade

8、ThirddecadeForthdecadeAdaptedfromStaryHCetal.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因素ASA他汀