课件：完整版第八版内科冠心病课件.ppt

* * * THANK YOU SUCCESS * * 可编辑 动脉粥样硬化的特点是受累动脉的病变从内膜开始 在动脉内膜积聚的脂质外观呈黄色粥样 * 动脉粥样硬化的特点是受累动脉的病变从内膜开始 在动脉内膜积聚的脂质外观呈黄色粥样 * 动脉粥样硬化的特点是受累动脉的病变从内膜开始 在动脉内膜积聚的脂质外观呈黄色粥样 * * Atherosclerosis is a complex disease. Atherosclerotic plaques can be subdivided in accordance with their age and state of development. It is the newly formed lesions with a large lipid core, thin capped, which are fragile and therefore likely to rupture and lead to an acute ischemic event. * * * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * 有很多危险因素可以导致冠心病，有的是可改变的，有的是不能改变的。 * * * 　　不稳定性心绞痛治疗目标，短期来说应该是尽快缓解心绞痛、预防心梗、保护存活的心肌（如有心梗）及防止死亡。长期的目标则是心脏功能恢复、明确及治疗冠心病危险因素／基础疾病和减少再入院治疗。 * 对脆弱和稳定斑块的不同特点进行的详细分析显示在稳定斑块中纤维帽厚且含更多平滑肌细胞。而不稳定斑块中常见到炎性细胞如T淋巴细胞及活化巨噬细胞。这些炎性细胞释放可致薄弱纤维帽进一步降解的细胞因子和组织因子，从而促进了血小板粘附和聚集。很明显，稳定斑块更能够经受血流的剪切力及防止破裂。 Libby. Circulation 1995;91:2844-50 * 对脆弱和稳定斑块的不同特点进行的详细分析显示在稳定斑块中纤维帽厚且含更多平滑肌细胞。而不稳定斑块中常见到炎性细胞如T淋巴细胞及活化巨噬细胞。这些炎性细胞释放可致薄弱纤维帽进一步降解的细胞因子和组织因子，从而促进了血小板粘附和聚集。很明显，稳定斑块更能够经受血流的剪切力及防止破裂。 Libby. Circulation 1995;91:2844-50 * * 我们知道心梗作为心血管事件链(危险因素-动脉粥样硬化-心梗-心室重构-心室扩大-心衰-终末期心血管疾