孟庆义心血管疾病的活血化淤治疗.ppt

心血管疾病的活血化瘀治疗 中国人民解放军总医院 解放军医学院 北京301医院 孟庆义 血压的概念：大动脉的压力 大动脉的压力； 小动脉，降压与器官血流,微循环问题； 在“血压”这个帽子下,存在许多概念（冰山的一角）; 血压 是一“表面的，非内在的”，“标的，非本的”，“现象的，非本质性的”概念 动脉血压的形成：（一个前提，二个条件） 循环系统内有足够的血液充盈 取决于血量和循环系统容量之间的关系 心脏射血 心室每次收缩射出60～80 ml血液 外周阻力: 微动脉和小动脉对血流的阻力 血压： 物理学四定律 Ohm’s law: MAP = (heart rate × SV × SVR) + mRAP Simplified Windkessel model: Compliance = SV/aortic PP MAP = (2/3 × DAP) + (1/3 × SAP) Laplase Law: P＝2T/r 1. Ohm’s公式的意义: MAP = (heart rate × SV × SVR) + mRAP SVR is not a measured parameter but is calculated from the measured values of MAP, CO and mRAP. Despite clear limitations in Poiseuilles Law when it is applied to the human circulation, it is generally believed that SVR is inversely proportional to the fourth power of the functional radius of the systemic network (mainly that of the distal resistive arteries). For a given MAP, SVR depends only on the value of CO, regardless of the way in which CO is generated (e.g. low SV/high heart rate or high SV/low heart rate). 平均动脉压（MAP)的意义 When MAP falls below the lower limit of autoregulation, regional blood flow becomes linearly dependent on MAP. In some pathological settings, MAP overestimates the true perfusion pressure because of marked increases in extravascular pressure at the outflow level in specific vascular areas (intracranial hypertension, abdominal compartment syndrome) because of marked increases in systemic venous pressure (right heart failure). MAP:代偿机制受损时 Acute decreases in MAP are counteracted by the sympathetically mediated tachycardia, increases in SV (mediated via positive inotropic effect and veno-constriction) and arterial systemic vasoconstriction. In critically ill patients, especially those with sepsis or who are receiving sedative drugs, these compensatory mechanisms can be either impaired or overwhelmed. 2.脉压差(pulse pressure)的意义 Although it remains to be demonstrated, it is widely accepted that peripheral PP at rest depends mainly on SV and arterial stiffness (1/comp