常见的2013冠状动脉粥样硬化性心脏病.ppt

冠脉介入治疗最新亮点 药 物 支 架 Drug Eluting Stent 再狭窄:新内膜过度增生所致 治疗方案 放射治疗 药物治疗 Stent Basecoat Basecoat = 聚合物 + 雷帕霉素 + Topcoat = 弥散屏障 控制释放雷帕霉素的聚合物 Topcoat (TC) DES in FIM 术前 术后 FU　1年　　　　　　　　　　　FU　4年　　　　　 冠心病的治疗新近展 ---干细胞移植 干细胞治疗-选好“种子”了吗？ 骨髓干细胞 心脏干细胞 组织前体细胞 其他细胞来源 干细胞移植途径 经心外膜心肌内注射 经导管冠脉内导入 经导管心肌内注射 经心内膜心肌内注射 血管内注射 自体骨髓干细胞移植临床试验结果 自体干细胞移植可以改善心功能 自体干细胞移植可以增加心肌灌注 自体干细胞移植防治缺血性心脏病安全可行 需大规模随机对照临床试验进行评价 冠心病的治疗最新近展 1.急性心肌梗塞再灌注治疗★ （1）溶栓疗法：尿激酶 rt-PA （2）急诊PCI+Stent 药物支架Drug Eluting Stent 2、自体骨髓干细胞移植 * * * * * * * * * * * * * * * * * * 到目前为止，国内外大规模、多中心的临床药物干预试验结果相继揭晓，阿司匹林（aspirin)、?-受体阻止剂(?-receptor block) 及调脂疗法(cholesterol)，已成为世界公认的治疗和预防冠心病的疗效肯定的“ABC”三大疗法 。 * 左心室后壁和室间隔左室侧可见有心肌梗塞。坏死的心肌呈奶黄色，外周由肉芽肿组织组成的暗色条带包围，提示梗塞发生不超过两周。以外膜上的冠状动脉因粥样硬化而狭窄呈现黄色。 * * * * * * * As shown in this figure, coronary arteries are multilayered. The three layers of the coronary artery walls are the: Adventitia Outermost layer of the coronary artery Attaches the vessel to the surrounding tissue Provides support for the entire vessel, like the foundation of a house Media Middle layer of the coronary artery Provides support and regulates blood flow Consists mostly of thin, cylindrical smooth muscle cells (SMCs) Surrounded by two elastic layers: - external elastic lamina layer of elastic tissue that lies between the media and adventitia - internal elastic lamina layer of elastic tissue that lies between the media and intima Excessive proliferation of the SMCs of the media after injury leads to restenosis Intima Innermost layer of the coronary artery Composed of connective tissue and endothelium (single layer of epithelial cells) The cells of the endothelium line the inner surfaces of all blood vessels While the endothelium appears deceptively simple, it serves many vital and complex functions, which are reviewed in the next slide. * The composition of the polymer, as per slide text. * 与冠脉内注射和静脉注射相比，心肌内