心血管疾病 黑龙江省精品课程网络制作系统2007高校版课件

Department of Epidemiology Public Health College of Harbin Medical University 心血管疾病 Cardiovascular Disease 哈尔滨医科大学流行病学教研室 Department of epidemiology ，Harbin Medical University 1 Department of Epidemiology Public Health College of Harbin Medical University 目 录 Content 心血管疾病的流行概况 高血压 脑卒中 冠心病 心血管疾病的预防策略与措施 CVD Epidemic outline Hypertension Stroke Coronary heart disease strategies and measurement for CVD 2 Department of Epidemiology Public Health College of Harbin Medical University 第一节第一节 概况概况 overviewoverview 广义的心血管疾病（ CVD）是一组以心脏和血管 异常为主的循环系统疾病， 它包括心脏和血管疾病、肺 循环疾病以及脑血管疾病 Generalized cardiovascular disease (CVD) is a group of circulatory diseases mainly focusing on cardiac and vascular anomalies, which includes the heart and vascular disease, pulmonary circulation disease, and cerebral vascular disease 3 Department of Epidemiology Public Health College of Harbin Medical University Among them, high blood pressure, stroke and coronary heart disease badly hazards human health hazards 该组疾病中以高血压、 脑卒中和冠心病对人类健 康的危害最为严重 4 Department of Epidemiology Public Health College of Harbin Medical University 流行状况 Epidemic situationEpidemic situation 发达国家CVD流行情况分为四个阶段 Four stagesFour stages of CVDCVD prevalence in developed prevalence in developed countriescountries 5 Department of Epidemiology Public Health College of Harbin Medical University 第一阶段（瘟疫期） 人群主要健 康问题是传染性疾病、饥 荒和营养缺乏,心血管疾 病仅占5%-10%，主要是 风湿性心脏病和肺源性心 脏病 The first stage (plague stage) The main health problems was infectious diseases, famine and nutritional deficiencies. Cardiovascular disease accounted for only 5% -10%, which were mainly Rheumatic heart disease and pulmonary heart disease 6 Department of Epidemiology Public Health College of Harbin Medical University 第二阶段 传染病、饥荒和 营养缺乏、风湿性心脏病和肺 源性心脏病的发病率下降，人 口平均年龄增长,饮食结构改变 和盐摄入增多，使高血压、高 血压性心脏病和出血性脑卒中 患病率增加 The second stage Hypertension, hypertensive heart disease and hemorrhagic stroke prevalence rate increased with economic development, and improvement of production and living standards. 7 Department of Epidemiology Public Health College of Harbin Medical University 第三阶段 随着社会进步，经 济发展，冠心病和缺血性脑卒中 提早出现于55-60岁的人群，动 脉粥样硬化的死亡占总死亡的 35%-65%，结果人群平均寿命下 降。 The third stage People intake more and more fat and calories with the economic development. coronary heart disease and cerebral ischemic stroke are early onset .As a result Population decline in the average life expectancy. 8 Department of Epidemiology Public Health College of Harbin Medical University 第四阶段 识到心血管病是严重的公 共卫生问题； 全社会采取了积极的防治 措施，加上医疗水平的不断 提高； 动脉粥样硬化的死亡率降 至50%以下。 The forth stage Realizing to the severity of CVD, the whole society actively take prevention and cure measures and the medical standards improve continuously. The mortality of CVD is declining more than 50%. 9 Department of Epidemiology Public Health College of Harbin Medical University Epidemic situation of cardiovascular disease in China 我国心血管疾病流行概况 10 Department of Epidemiology Public Health College of Harbin Medical University Stroke morbidity and mortality rates of our country is the second highest in the world . The CVD count for the primary cause of death in city. 我国脑卒中发病率 和死亡率高居世界第 二，以上，成为我国 城市人群死亡的主要 原因。 11 Department of Epidemiology Public Health College of Harbin Medical University 12 Department of Epidemiology Public Health College of Harbin Medical University 13 Department of Epidemiology Public Health College of Harbin Medical University 我国心血管疾病流行特征我国心血管疾病流行特征 Epidemiological Characteristics of CVD in ChinaEpidemiological Characteristics of CVD in China 发病年龄提前，青 壮年人群的发病与患 病水平明显升高 Age of onset earlier, and the incidence and prevalence of young adults population is increasing. 14 Department of Epidemiology Public Health College of Harbin Medical University 心血管疾病已不再是城市 或经济发达地区人口所特有 的“富贵病”，近年来农村和 非经济发达地区人口的发病 率、患病率和死亡率显著升 高 The incidence, prevalence, mortality, of cardiovascular disease significantly increased not only in city but also in rural. 15 Department of Epidemiology Public Health College of Harbin Medical University 与西方发达国家不 同，在我国脑血管病的 发病率、患病率和死亡 率高于冠心病 Different form western developed countries, the incidence, prevalence and mortality of cerebrovascular disease are higher than coronary heart disease. 16 Department of Epidemiology Public Health College of Harbin Medical University 因需要终身治疗和医疗费用 上涨过快过快，致使该组疾 病在我国的治疗率和控制率 相当低，从而导致因病引起 的残疾乃至残障的情况在我 国比较严重 Because of need life long treatment, fast rising of medical care fees, the treatment and control rate are lower in china， the disability and handicap leaded by CVD is very severity 17 Department of Epidemiology Public Health College of Harbin Medical University 第二节第二节 高血压高血压（Hypertension） v高血压是一种以动脉血压 升高为主要表现的心血管疾 病 pHypertension is a kind of cardiovascular disease with arterial blood pressure increasing as the main manifestations. 18 Department of Epidemiology Public Health College of Harbin Medical University 19 Department of Epidemiology Public Health College of Harbin Medical University 高血压的类型 types 原发性高血压 以血压升高为特征 ，原因不明的独立疾病 ，占高血压的95%以上 。 primary hypertension ： Blood increasing are special sign and an independent disease with unclear cause, account 95% of total hypertension. 20 Department of Epidemiology Public Health College of Harbin Medical University secondary hypertension pBlood increase is the express of some disease, 70% of them are kidney disease 继发性高血压 血压升高是某些疾病 的一部分表现，其中肾 脏疾病占70%以上。 21 Department of Epidemiology Public Health College of Harbin Medical University 一、高血压的流行病学特征 ( (epidemiological characteristics of Hypertensionepidemiological characteristics of Hypertension ) ) v 我国高血压的现状与流行趋势 vThe status and prevalence trend of hypertension in our country 三高三高：患病率高、致残率高、死亡率高 三低三低：知晓率低、服药率低、控制率低 三不三不：不规律服药、不难受不吃药、不爱用药。 22 Department of Epidemiology Public Health College of Harbin Medical University 2001年我国高血压的流行情况 The prevalence of hypertension in China in 2001 p患病率 （prevalence）27.2% p知晓率（awareness rate）44.7% p服药率（medication rate）28.2% p控制率（control rate）8.1% 23 Department of Epidemiology Public Health College of Harbin Medical University 一、高血压的流行病学特征一、高血压的流行病学特征 epidemiological characteristics ofepidemiological characteristics of HypertensionHypertension 24 Department of Epidemiology Public Health College of Harbin Medical University （一）地区分布(endemic distribution) 总的趋势总的趋势( (general tendencygeneral tendency) )： 我国各地区高血压患病率差别显著, 北方高于南 方，东部高于西部，且有自东北向西南递减的趋势， 在同一地区城市高于农村。 Prevalence of hypertension in various regions of China are significant differences, it is higher in the north than the south, the east than the west, and there is decreasing trend from northeast to southwest, urban is higher than rural in the same area. 25 Department of Epidemiology Public Health College of Harbin Medical University （二）时间分布(time distribution) 我国1959年-1991年进行了32次全国15岁以上人群高 血压患病情况抽样调查：结果显示高血压患病率呈上 升趋势。 Sample surveys of hypertension prevalence among age 15 and above population were carried out 32 times in China from 1959 to 1991. The results showed that prevalence of hypertension is on the rise. 26 Department of Epidemiology Public Health College of Harbin Medical University 27 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布 (population distribution) 1 1、年龄、性别年龄、性别(age and sex )(age and sex ) 2 2、职业职业 (occupation)(occupation) 3 3、民族民族(race)(race) 4 4 、文化程度文化程度(education)(education) 28 Department of Epidemiology Public Health College of Harbin Medical University （一）确认的危险因素 (conformed risk factor) 肥胖肥胖( (obesity) 膳食中的钠、钾膳食中的钠、钾 (sodium and potassium in the food ) 饮饮 酒酒 ( ( alcohol ) ) 遗传因素遗传因素( (hereditary factor) 29 Department of Epidemiology Public Health College of Harbin Medical University （二）不确定的危险因素 (uncertain risk factors) p膳食钙膳食钙（Dietary Calcium） pp避孕药避孕药（contraceptives） pp吸烟吸烟（smokingsmoking） pp体力活动体力活动（physical activity） pp精神紧张或应激精神紧张或应激（stressstress） 30 Department of Epidemiology Public Health College of Harbin Medical University 第三节第三节 脑卒中脑卒中（StrokeStroke） 脑卒中又称为脑血管意外或中风，是由于脑血管异常 所造成的突发性神经功能损害 A stroke (sometimes called a cerebrovascular accident (CVA) is the rapidly developing loss of brain functions due to disturbance in the blood supply to the brain, caused by a blocked or burst blood vessel. 31 Department of Epidemiology Public Health College of Harbin Medical University 中国的脑卒中现状 p 第一二大死因 p 每年新发脑卒中患者1,500,000人 p 每年死于脑卒中患者1,000,000人 p 脑卒中存活病6,000,000人 p 成人致残的主要原因 p 出院后需长期护理的主要疾病 p 每年经济损失100亿人民币 32 Department of Epidemiology Public Health College of Harbin Medical University 一、一、脑卒中的流行病学特征脑卒中的流行病学特征 epidemic characteristic of strokeepidemic characteristic of stroke （一）地区分布(geographic distribution) ) 脑卒中在地理分布上存在差异，这种差异不仅仅是国家间 ，还存在于同一国家的不同地区之间. There is difference in the geographical distribution of stroke, such differences exist not only among countries, but also in different parts of the same country. 33 Department of Epidemiology Public Health College of Harbin Medical University 34 Department of Epidemiology Public Health College of Harbin Medical University （二）时间分布时间分布(time distribution) 除东欧国家外，英、法、美、加、澳、日等工业 发达国家，在过去40年里脑卒中死亡率持续下降. The mortality rate of stroke continued to decline in Britain, France, United States, Canada, Australia, Japan and other industrialized countries during the past 40 years, except for the Eastern European countries, 35 Department of Epidemiology Public Health College of Harbin Medical University 36 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布(population distribution) 年龄、性别分布(sex and age) u人群脑卒中的发病率和死亡率均为男性高于女性，男女发 病率和死亡率均随年龄增加而上升，在50岁后呈大幅上升 趋势 uPopulation morbidity and mortality rates of stroke were higher in male than female, morbidity and mortality rates were increased with age in both male and female, showing a substantial upward trend after age 50 . 37 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布(population distribution) 年龄、性别分布(sex and age) u世界各国的发病率男女之比多数为1.3-2.0：1 u我国脑卒中发病率男女之比为1.3-1.5：1 uThe ratio of male to female for incidence of the most countries in the world is 1.3-2.0:1 uThe ratio of male to female for incidence of stroke in China is 1.3-1.5:1 38 Department of Epidemiology Public Health College of Harbin Medical University 种族分布种族分布(race)(race) q美国同一地区的黑人脑卒中患病率高于白人 q我国汉族脑卒中患病率高于少数民族 qThe prevalence rate of stroke is higher in black persons than whites in the same area of United States qThe prevalence rate of stroke is higher in Han ethnic than the minorities of China 39 Department of Epidemiology Public Health College of Harbin Medical University 职职 业业(occupation)(occupation) n 重体力劳动者脑卒中发病率较高 n 经常上夜班者发病率明显高于上白班者 n Heavy manual workers have a higher prevalence of stroke n The incidence rate is significantly higher among the persons with regular night shift work than those with day shift work 40 Department of Epidemiology Public Health College of Harbin Medical University 二、脑卒中的危险因素二、脑卒中的危险因素 Risk factors of strokeRisk factors of stroke 高血压高血压(hypertension)(hypertension) 心脏病心脏病 (heart disease)(heart disease) 糖尿病糖尿病(diabetes mellitus)(diabetes mellitus) 短暂性脑缺血发作短暂性脑缺血发作（transient ischemic attacktransient ischemic attack ） 吸吸 烟烟(smoking)(smoking) 饮饮 酒酒(alcohol)(alcohol) 41 Department of Epidemiology Public Health College of Harbin Medical University 第四节第四节 冠心病冠心病 ( (Coronary heart disease) ) vv冠心病（冠心病（CHDCHD）是冠状动脉粥样硬化性心脏病的简称 ，是由于冠状动脉功能性或器质性改变而引起的冠状 动脉血流和心肌需求不平衡所导致的心肌缺血性心脏 病 vCoronary disease (or coronary heart disease) refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue. 42 Department of Epidemiology Public Health College of Harbin Medical University 一、冠心病的流行病学特征一、冠心病的流行病学特征 epidemic characteristic of epidemic characteristic of coronary heart disease （一）地区分布地区分布(endemic distribution )(endemic distribution ) p冠心病的发病率和死亡率存在明显的地区差异，不同国 家间甚至一个国家内不同地区间存在着很大差别 pThere is difference in the geographical distribution of incidence an mortality rate of CHD, such differences exist not only among countries, but also in different parts of the same country. 43 Department of Epidemiology Public Health College of Harbin Medical University 44 Department of Epidemiology Public Health College of Harbin Medical University （二）时间分布二）时间分布(time distribution)(time distribution) p同发达国家相比，我国冠心病的发病率和死亡率属于较 低水平，但我国冠心病的发病率和死亡率近30年来逐步 升高。 pThe morbidity and mortality rates of coronary heart disease are in low levels in China compared with developed countries, but they are increased gradually in nearly 30 years. 45 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布三）人群分布 (population distribution)(population distribution) 年龄年龄 (age)(age) p男女冠心病发病率均随年龄增加而增加 pIncidence rates of coronary heart disease increased with age for both men and women 46 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布三）人群分布 (population distribution)(population distribution) 性别性别(sex)(sex) p在各年龄组冠心病的发病率和死亡率均是男性 高于女性 pMorbidity and mortality rates of coronary heart disease are higher in male than female in all age groups 47 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布三）人群分布 (population distribution)(population distribution) 种族种族(race)(race) 据MONICA资料，亚洲黄种人冠心病死亡率，除个别国家外 （如新加坡），总的说来是黄种人低于白种人。 According to MONICA data, the mortality of coronary heart disease, apart from several countries (e.g. Singapore), is lower in Asian yellow race than white race in general. 48 Department of Epidemiology Public Health College of Harbin Medical University （三）人群分布三）人群分布 (population distribution)(population distribution) 职业职业(occupation)(occupation) 脑力劳动者比体力劳动者的冠心病患病率高 Prevalence of coronary heart disease is higher in mental workers than in manual workers. 49 Department of Epidemiology Public Health College of Harbin Medical University 二、冠心病的危险因素二、冠心病的危险因素 the risk factor of the risk factor of coronary heart disease 致病性危险因素 (Pathogenic risk factors) 斑块负荷 (Plaque burden) 条件性危险因素 (Conditional risk factors) 促发性危险因素 (Perpetuating risk factors) 易感性危险因素 (Susceptibility risk factors) 50 Department of Epidemiology Public Health College of Harbin Medical University 二、冠心病的危险因素二、冠心病的危险因素 the risk factor of the risk factor of coronary heart disease 高血压高血压 (hypertension)(hypertension) 高胆固醇血症高胆固醇血症 (hypercholesterolemia)(hypercholesterolemia) 吸烟吸烟 (smoking)(smoking) 糖尿病糖尿病 (diabetes mellitus)(diabetes mellitus) 肥胖肥胖 (obesity)(obesity) 51 Department of Epidemiology Public Health College of Harbin Medical University 体力活动体力活动 ( (physical activity) ) 遗传遗传 (heredity) A A型性格和其它社会因素型性格和其它社会因素 (A-type personality and social factor) 二、冠心病的危险因素二、冠心病的危险因素 the risk factor of the risk factor of coronary heart disease 52 Department of Epidemiology Public Health College of Harbin Medical University 第五节 心血管疾病的防治策略与措施 (prevention and care strategy and measure)(prevention and care strategy and measure) 53 Department of Epidemiology Public Health College of Harbin Medical University 一、心血管疾病的防治策略一、心血管疾病的防治策略 prevention and care Strategies of CVD prevention and care Strategies of CVD v维多利亚心脏卫生的宣言指出，心血管疾病的预防应包 括一级与二级预防及三级预防 v Primary prevention Secondary prevention Tertiary prevention 54 Department of Epidemiology Public Health College of Harbin Medical University （一）心血管疾病全人群策略 population policy （二）高危人群策略 high risk group policy 55 Department of Epidemiology Public Health College of Harbin Medical University 二、心血管疾病的三级预防措施二、心血管疾病的三级预防措施 ( ( tertiary prevention of CVD)CVD) 56 Department of Epidemiology Public Health College of Harbin Medical University 二、心血管疾病的三级预防措施二、心血管疾病的三级预防措施 ( ( tertiary prevention OF CVD)CVD) （一）一级预防一）一级预防(Primary prevention)(Primary prevention) 57 Department of Epidemiology Public Health College of Harbin Medical University 合理膳食合理膳食( (Reasonable dietReasonable diet ) ) FF限盐增钾限盐增钾 (limit of salt and addition of (limit of salt and addition of potassium ) ) FF减少脂肪摄入减少脂肪摄入 (reduce fat intake )(reduce fat intake ) 58 Department of Epidemiology Public Heal