心脏疾病患者的护理.PPT

心臟疾病患者的護理 邱愛富 心臟血管系統的解剖生理功能  邱愛富   一、心臟的構造與功能: heart size: 拳頭，250-350 gm heart location: 2/3 胸骨中線左側； Base:2nd肋骨；Apex:5th肋間 L’t鎖骨中線 heart function: deliver O2 and other essential substitute to tissue of body remove CO2 代謝產物 心臟壁層: 心包膜(pericardium) 1) 外層(壁心包膜)：纖維性—防止heart過度擴張、有保護、固定 2) 內層(臟心包膜)：漿膜性— 兩層間為心包膜腔，含15-50 cc心包膜液，可防止收縮時的磨擦 心外膜(epicardium); 心肌(myocardium)--不隨意肌，具橫紋及分枝的纖維，有收縮作用 心內膜(endocardium) Coronary vasculature Right coronary artery (RCA）、 Left main--Left anterior descending artery (LAD)、Left circumflex (LCX) Ascending aorta (75% at diastolic) ?RCA (supply RA, RV, post LV, 90% AV node) ?Left main? LAD (supply Ant. LV, apex)、LCX (supply lateral LV, LA)  The Cardiac Cycle Blood Circulation Circuits Pulmonary Circuit – lungs Systemic Circuit - whole body Cardiac Cycle Systole – contraction Diastole – relaxation Atria relax when Ventricles contract and vice versa  Steps in a contraction When atria fill pressure opens AV valves Atria contraction fills ventricles completely Ventricles begin to contract and AV valves snap shut (LUB) Increased contraction (inc. pressure) forces semilunar valves open Blood flows into vessels leading away. Pressure increases and forces SL valves shut (DUB) Process begins again  Cardiac Output 心輸出量(CO) = 心搏出量(SV) x 心跳速率(HR) 心搏出量(Stroke volume)：每一次心室收縮時所排出的血量，同時受到前負荷，後負荷及心臟收縮力的影響 心輸出量的決定因素 前負荷(preload):心室舒張末期, 心肌所承受的張力 後負荷(Afterload):心室收縮時所遭遇的阻力 心臟收縮力(Contractility) 心跳速率與節律 (heart rate rhythm) 前負荷(Preload) Frank-Starling 定律: 舒張容積 (=前負荷) ? 心室收縮強度 ? 輸出容積 (myocardium fiber length↑? preload ↑? LVEDV↑?SV↑) 臨床上：以進入心室的血量多寡為代表（一般用CVP及PAWP估計） Contractility收縮力 Vpk for the left ventricle is around 1.1 – 1.5 m/s in healthy patients. In patients with cardiac failure or low contractility/inotropy this figure might well be only 0.6 or 0.7 m/s or even less. For the right ventricle the figure would be 0.7 to 1.2 in healthy patients. 後負荷(Afterload) Ohm’s law: R = ? P/Q SVR = (MABP –