人体稳态与疾病基础 教学大纲(2013秋季).doc

四川大学华西临床医学院人体稳态与疾病基础教学大纲（临床医学八年制适用）“人体稳态与疾病基础”教研室修订日期：2013年8月“人体稳态与疾病基础”课程介绍一、课程基本信息课程名称：人体稳态与疾病基础英 文 名：Human homeostasis and the basis for disease课程号（代码）：可不填课程类别：专业与服务课程群必修课学 时：128学时（讲101学时，习18学时，小班讨论9学时） 学 分：8分二、教学团队基础课程负责人：黄 宁（病理生理学教研室）临床课程负责人：魏 兵（华西医院病理学教研室）基础指导教授： 岳利民（生理学教研室） 黄 宁（病理生理学教研室）临床指导教授： 李甘地（病理学教研室） 罗朝志（华西医院麻醉科）基础骨干教师： 杨志梅（病理生理学教研室） 王玉芳（病理生理学教研室）临床骨干教师： 刘键平（病理学教研室） 魏 兵（病理学教研室）课程秘书： 王晓樱（病理生理学教研室）键平（病理学教研室） 、教学目的及要求认知教学目标：掌握人体功能基本生命现象、活动规律及其调控机制；人体稳态的维持在生命活动中的重要生物学意义。掌握稳态紊乱将导致疾病的发生、发展并影响其转归，表现为形态、结构、功能、代谢的异常变化，为学习临床课程奠定必备的理论基础。理论授课注意生理与病理、基础与临床相结合，熟悉医学科研的基本思路及原则，体现医学的严谨性。技能教学目标：掌握相关的实验动物手术、仪器使用及操作技能，正确观察和准确描述实验动物或实验标本，生理和病理状态及其差异性，并能对其差异性予以合理解释，形成规范的实验报告。为临床诊断和/或科学研究等打下技能基础，从而强调医学的实践性。同时要求学生严格遵守医学动物伦理原则。通过病理学学习掌握临床诊断相关方法技能。 职业素养教学目标：在课堂教学中，培养学生以证据为基准的实事求是的精神。四、教学进度表：教学内容教学形式学时数教学单位生理学绪论大课讲授4生理学教研室细胞的基本功能大课讲授15生理学教研室血液的主要功能及生理止血大课讲授3生理学教研室能量代谢与体温大课讲授4生理学教研室人体主要器官系统的基本功能及其在稳态维持中的作用大课讲授3生理学教研室体液、电解质、酸碱平衡的调节大课讲授3生理学教研室肥胖发生机制及如何防止肥胖讨论1生理学教研室高血钾致肌无力病例病案分析1生理学教研室重症肌无力病例病案分析1生理学教研室疾病概论大课讲授3病理生理学教研室正常水电代谢，脱水大课讲授3病理生理学教研室水中毒，钾代谢异常大课讲授3病理生理学教研室水肿大课讲授3病理生理学教研室正常酸碱平衡，酸碱指标，酸碱失衡大课讲授3病理生理学教研室单纯酸碱失衡，混合酸碱失衡大课讲授3病理生理学教研室缺氧大课讲授3病理生理学教研室发热大课讲授3病理生理学教研室应激大课讲授4病理生理学教研室休克大课讲授3病理生理学教研室DIC大课讲授3病理生理学教研室缺血再灌注损伤大课讲授3病理生理学教研室黄疸大课讲授3病理生理学教研室病理学 绪论大课讲授0.5病理学教研室细胞、组织的适应和损伤大课讲授5.5病理学教研室细胞、组织的适应和损伤实习4病理学教研室损伤的修复大课讲授2病理学教研室损伤的修复实习2病理学教研室炎症大课讲授6病理学教研室炎症实习4病理学教研室局部血液循环障碍大课讲授6病理学教研室局部血液循环障碍实习4病理学教研室肿瘤大课讲授6病理学教研室肿瘤实习4病理学教研室病理生理学小班化课堂讨论讨论9病理生理学教研室五、教材1. 姚泰主编.生理学 (八年制教材). 人民卫生出版社.2006.北京2. 李桂源主编.病理生理学，第2版.人民卫生出版社.2010.北京3. 陈杰，李甘地主编病理学，第2版.人民卫生出版社.2010.北京4. 谭永淑等主编.病理学实习指导，第1版.科学出版社.2001.北京六、主要参考资料1. Ganong WF：Review of Medical Physiology.北京医科大学出版社.2001.北京2. Guyton AC：Textbook of Medical Physiology.北京医科大学出版社.2002.北京3. 秦晓群等译：医学生理学(从临床到基础医学生理学的途径).科学出版社.2005.北京4. James P.Ryan，Michael B.Wan. 美国医生执照考试（一）.生理学，第10版.人民卫生出版社(影印)，2002.北京5. Kaufman.C E，Mckee.PA. Essentials of Pathophysiology.中国协和医科大学出版社(英文影印版).2002.北京6. Barbara E.Gould，Ruthanna M. Dyer. Pathophysiology for the health professions，4th edition，Elsevier，20107. 杨宝峰主编.药理学，第7版.人民卫生出版社.2008.北京8. Kumar V，Abbas A.K.，Fausto N et al. Basic Pathology（8th edition）.Robbins：Elsevier，20079. J.C.U.UNDERWOOD. General and Systematic Pathology，2th edition，科学出版社，2005 .北京10. Bethan Goodman Jones. Pathology (mosbys crash course).科学出版社 Harcourt Asia Mosby.2002.北京11. 步宏，郭乔楠，龙汉安编. 病理学纲要. 科学出版社.2003.北京12. 张尚福，冯振卿主编. 病理学习题集. 高等教育出版社.2004.北京七、成绩评定办法成绩构成 成绩比例考核方法基础理论知识 70%笔试问题解决/团队协作20%实习、实验操作、小测验、病案讨论等学习态度、纪律 10%授课教师八、知识点与教学要求生理学绪论课程教学大纲掌握：内环境和稳态的概念；神经调节，体液调节；自动控制系统；负反馈及其生理意义。Master：Internal environment and homeostasis. Nervous regulation and humoral regulation，Autonomic control system. Negative feedback and its significance.熟悉：正反馈及其意义。Be familiar with：Positive feedback and its significance.了解：人体生理学以及与医学的关系；生理学的研究方法；自身调节；正反馈和前馈。Understand：Human physiology and its relationship with medicine. Three levels and methods of physiological research. Autoregulation. Positive feedback and feed-forward.细胞跨膜物质转运教学大纲掌握：细胞膜的物质跨转功能。Master：Substance transport through cell membrane.细胞跨膜信号转导教学大纲掌握：跨膜信号转导的特点；G蛋白耦联型受体介导的跨膜信号转导。Master：The characteristics of transmembrane signal transduction of cell. Signal transduction mediated by G protein-linked receptor.熟悉：酶耦联型受体介导的跨膜信号转导；离子通道型受体介导的跨膜信号转导。Be familiar with：Signal transduction mediated by enzyme-linked receptor. Signal transduction mediated by ion channel.细胞生物电现象教学大纲掌握：静息电位和动作电位及其产生的机制；动作电位的引起；阈电位概念；动作电位在同一细胞上的传播；兴奋性和兴奋。Master：Resting potential and action potenmtial and their generation. Inducing of action potential. Threshold potential. Conduction (propagation) of AP in one cell. Excitation and excitability.熟悉：局部电位Be familiar with：Local potential.了解：生物电现象的观察和研究方法；细胞兴奋过程中兴奋性的变化。Understand：The studing methods of bioelectrical activities of cell. The changes of excitability in cell after initiation of AP.骨骼肌细胞收缩功能教学大纲掌握：神经-骨骼肌接头处的兴奋传递；兴奋-收缩耦联。Master：Transmission of excitation at neuromuscular junction. Excitation-contraction coupling.熟悉：影响骨骼肌收缩效能的因素（前负荷、后负荷和收缩能力）。Be familiar with：The factors affecting contraction performance of skeletal muscle including preload，afterload and contractility.了解：骨骼肌细胞收缩的分子机制；骨骼肌收缩的形式。Understand：The molecular mechanism of skeletal muscle contraction. The types of muscle contraction.血液的主要功能及生理止血教学大纲掌握：血液的基本功能及其在维持内环境相对稳定中的作用，生理止血的概念、基本过程和意义；血液凝固的概念和基本过程；内源性凝血途径和外源性凝血途径的特点。Master：Basic function of blood and its role in maintaining homeostasis. The concept physiological hemostasis and its basic steps. The concept of blood coagulation and its basic steps. The characteristic of two pathway of blood coagulation.熟悉：血小板在生理止血中的作用；凝血因子；影响血液凝固的因素；抗凝系统的作用；纤维蛋白溶解。Be familiar with：The role of platelets in hemostasis，clotting factor，factors affecting blood coagulation，anticoagulative system，fibrinolysis.了解：体液的组成，血液的成分及其理化特性。Understand：Body fluid and its compartments (extracellular fluid and intracellular fluid ). The compositions，properties and functions of blood.能量代谢和体温教学大纲掌握：能量代谢的概念；影响能量代谢的因素；基础代谢和基础代谢率；体温的概念，产热及散热过程。Master：Concept of energy metabolism. Main factors affecting energy metabolism，Concept of basal metabolism and basal metabolism rate. Concept of body temperature. The way of heat production and heat lossing. 熟悉：体温的正常值及生理变动；体温调节体温调节(温度感受器，体温调节中枢，调定点学说)。Be familiar with：The normal value of BT and its physiological change. Thermoregulation (temperature receptor，thermotaxic center and “set point “theory ).了解：机体代谢过程中能量的释放、贮存、转化和利用；能量代谢测定的原理；深部体温和表层体温；临床常用的测定体温的方法和部位。Understand：The sources of energy utilized by organisms，the process of energy liberation; the storage，transformation and expenditure of enenrgy. Principles of measuring energy metabolism.Core temperature and shell temperature. The methods of Measuring temperature in clinic.人体主要器官系统在稳态维持中的作用及体液、电解质、酸碱平衡的调节教学大纲掌握：人体主要器官系统的基本功能及其在稳态维持中的作用Master：Basic functions of mian organs and systems and their significance for maintaining homeostasis in human body.熟悉：体液、电解质、酸碱平衡的调节。Be familiar with：The reguation of body fluid，electrolyte，acid base balance and blood pressure in human body. 重点英文词汇：physiology，internal environment，homeostasis，nervous regulation，humoral regulation，autoregulation，feedback control，feedback signal，negative feedback，positive feedback，feed-forward control. facilitated diffusion，voltage-gated ion channel，chemically- (ligand-)gated ion channel，mechanically gated ion channel，primary active transport，secondary active transport，exocytosis，endocytosis，transmembrane signal transduction，G proteins (GTP-binding proteins)，second messenger，tyrosine kinase receptor，resting potential，action potential，excitation，excitability，polarization，hyperpolarization，depolarization，repolarization，permeability，electrochemical driving force，threshold intensity，threshold stimulus，threshold potential，local excitation，conduction (propagation) of AP，end plate potential，excitation-contraction coupling，myosin，actin，tropomysin，troponin，cross-bridge，isometric contraction，isotonic contraction，preload，initial length，afterload，contractility，twitch，incomplete tetanus，complete tetanus. Hematocrit，crystal osmotic pressure，colloid osmotic pressure，iso-osmotic solution，physiological hemostasis，blood coagulation，clotting factors，intrinsic pathway of blood coagulation，extrinsic pathway of blood coagulation，physiological anticoagulant，heparin，fibrinolysis，blood groups，agglutinogen，agglutinin，agglutination，blood transfusion，cross-matching. Energy metabolism，energy intake，thermal equivalent of food，thermal equivalent of oxygen，respiratory quotient，basal metabolism. Body temperature，core temperature，heat production，heat loss，shivering thermogenesis，non-shivering thermogenesis，radiation，conduction，convection，evaporation，warm-sensitive neuron，cold-sensitive neuron，set-poinrenin，angiotensin，aldosterone system， antidiuretic hormone疾病概论教学大纲掌握：健康、疾病、病理过程、病因的概念;疾病的转规;死亡的现行概念，脑死亡的概念。Master：Concept of health，disease ， pathological process，and etiological factors; Outcome of disease; Concept of death and Brain death .熟悉：疾病发生的条件和诱因的概念；疾病发展的一般规律。Be familiar with：Concept of predisposing factors，and precipitating factor; General rules of development of disease.水电解质紊乱教学大纲掌握：低渗性脱水概念和对机体的影响，水中毒概念和对机体的影响，等容量性低钠血症概念和对机体的影响；高渗性脱水概念和对机体的影响，高容量性高钠血症概念和对机体的影响，等容量性高钠血症概念和对机体的影响；等渗性脱水概念和对机体的影响。钾代谢的调节，低钾、高钾血症的概念、作用机制和对机体的影响。 水肿、积水的概念和发生的基本机制；渗出液、漏出液、显性水肿（凹陷性水肿）隐性水肿的概念及其发生机制。Master：Concept and effects of hypotonic dehydration (hyponatremia with volume loss)，hypertonic dehydration (hypernatremia with volume loss)，isotonic dehydration and water intoxication.Regulation of K+ metabolism; concept，pathogenesis and effects of hypokalemia and hyperkalemia.Concept and pathogenesis of edema，hydrops，exudates，transudate，frank edema (pitting edema) and recessive edema. 熟悉：人体水、电解质摄入与排出途径；水、电解质的生理功能；水、电解质平衡的调节，渴感，抗利尿激素，醛固酮，心房利钠激素的作用及调节；低渗性脱水原因和机理，水中毒原因和机理，ADH分泌异常综合征原因和机理，高渗性脱水原因和机理，高容量性高钠血症原因和机理，等容量性高钠血症原因和机理；等渗性脱水原因和机理。钾代谢的生理学，低钾和高钾血症的病因；超级化阻滞、去极化阻滞、反常性酸性尿和反常性碱性尿的概念。水肿的原因和分类。Be familiar with：Intake and excretion of water and electrolytes. Physiology function of water and electrolytes . The normal regulation of body water and electrolytes balance. Function and regulation of thirsty sense，Antidiuretic hormone(ADH)，Aldosterone (ALD)，Natriuretic hormones(ANP). Causes and Pathogenesis of hypotonic dehydration，hypertonic dehydration and Isotonic dehydration water intoxication and syndrome of inappropriate ADH secretion. Physiology of K+ metabolism，Causes of hypokalemia and hyperkalemia; Concept of hyperpolarized blocking，depolarized blocking，paradoxical alkaline urine，paradoxical academia.Causes and classification of edema.了解：水肿对机体的影响。各种脱水的防治原则。 Understand：The effects of edema. The principles of treatment and and prevention on different kinds of dehydrations.酸碱代谢紊乱教学大纲掌握：酸碱平衡的调节；反映血液酸碱平衡的常用指标及其意义；代谢性酸中毒、呼吸性酸中毒、代谢性碱中毒和呼吸性碱中毒的概念、原因和机理、机体的代偿调节和对机体的影响；混合性酸碱平衡紊乱概念及基本类型，代偿预计值公式的使用及酸碱平衡紊乱类型的判别。Master：Regulation of acid-base balance; Laboratory parameters of acid-base balance; Concept，causes，pathogenesis，compensation and effects of four kinds of simple acid-base disorders (metabolic acidosis，respiratory acidosis，metabolic alkalosisand respiratory alkalosis) on body. Concept and patterns of mixed acid-base disorders. The use of the value compensation is expected to formula and the judgement of mixed acid-base balance disorder.熟悉：体内酸、碱的来源；挥发酸，固定酸的概念。Be familiar with：Sources of acids and bases. ，Concept of volatile acid and fixed acid.了解：酸碱平衡紊乱的防治原则。 Understand：The principles of treatment and and prevention on acid-base balance disorder. 缺氧教学大纲掌握：缺氧的概念和血氧参数、四种类型缺氧的原因和特点、发病机制; 缺氧的功能性和代谢性改变。Master：Concept of hypoxia and parameters for blood oxygen; causes，characteristics and pathogenesis of four kinds of hypoxia; Functional and metabolic changes in hypoxia.熟悉：缺氧的耐受、治疗和氧毒性。Be familiar with：Tolerance to hypoxia，principles of hypoxia treatment，and oxygen toxicity.了解：缺氧的防治原则。 Understand：The principles of treatment and and prevention on hypoxia.发热教学大纲掌握：发热、高温和生理性体温升高的概念。发热的病因学和发病机理。内生致热原和发热激活物的概念;发热的各阶段及其特征。Master：Concept of fever，hyperthermia and physiological body temperature elevation; Etiology and pathogenesis of fever; Concept of endogenous pyrogen and pyrogenic activator; The stages and characteristic of fever.熟悉：发热中代谢和功能性的变化。发烧的生物学的意义，发热治疗的病理生理学基础。Be familiar with：Metabolic and functional alterations during fever; Biological significance of fever and pathophysiologic basis of the principles of fever treatment.了解：发热的防治原则。 Understand：The principles of treatment and and prevention on fever.应激教学大纲掌握：应激的概念、应激物、应激应答、蓝斑-交感-肾上腺髓质系统、下丘脑-垂体-肾上腺皮质轴、急性期和急性期反应蛋白、热休克蛋白、GAS(全身适应综合症)、应激性溃疡。Master：Concept of stress，stressor，stress response，locus ceruleus norepinephrine neurons-sympathetic/adrenal medulla axis， hypothalamus-pituitary-adrenal cortex (HPA)，acute phase response acute phase protein，heat shock protein (HSP)，general adaptation syndrome (GAS) and stress ulcer.熟悉：功能和代谢反应，原发性高血压、心肌缺血和心律失常，应激相关性精神-心理紊乱。Be familiar with：Function and metabolic responses of streese; Concept of essential hypertension，myocardial ischemia，arrhythmias and stress related mental-psychogenic disorders.了解：应激的防治原则。 Understand：The principles of treatment and and prevention on stress.休克教学大纲掌握：休克的原因、各阶段特点、发病机制及代偿。休克中肺功能不全，肝功能不全，肾功能不全，心功能不全，MODS（多器官功能障碍综合征），SIRS（全身炎症反应综合征）的概念和发病机制。Master：Concept of shock. Characteristic，pathogenesis and compensation of stages of of shock; Concept and pathogenesis of pulmonary dysfunction，hepatic dysfunction，renal dysfunction，cardiac dysfunction，MODS (multiple organs dysfunction syndrome) and SIRS (systemic inflammatory response syndrome). 熟悉：休克的原因及分类，休克中细胞功能及代谢紊乱，胃肠功能的紊乱。Be familiar with：Etiology and classification of shock; Metabolism and function disturbances of celland gastrointestinal dysfunction during shock.了解：休克的防治原则。 Understand：The principles of treatment and and prevention on shock.DIC教学大纲掌握：弥散性血管内凝血的概念，原因，发病机制，诱因及后果。Master：Concept，causes，pathogenesis，predisposing factors，precipitating factors and consequences of Disseminated Intravascular Coagulation (DIC).熟悉：DIC的分期及类型，DIC诊断治疗的病理生理学基础。Be familiar with：Types and stages of DIC; pathophysiologic basis of DIC diagnosis and treatment.了解：DIC的防治原则。 Understand：The principles of treatment and and prevention on DIC.缺血再灌注损伤教学大纲掌握：缺血-再灌注损伤概念，自由基的概念，缺血-再灌注损伤时氧自由基增多的机制；钙超载的概念。Master：Concept ischemia - reperfusion injury，free radicals and calcium overload; The mechanism of increased generation of xygen free radicals during ischemia-reperfusion injury ; 熟悉：缺血-再灌注损伤时氧自由基增多损伤作用；钙超载损伤作用。Be familiar with：The damage effect of ischemia-reperfusion injury induced by oxygen free radicals and calcium overload injury.了解：缺血-再灌注损伤发生的原因和条件、缺血-再灌注损伤的表现及防治原则。Understand：The causes，conditions，performance and the principles of treatment of ischemia-reperfusion injury.黄疸教学大纲掌握：黄疸的概念，黄疸的发生机制。Master：The concept and mechanism of jaundice.熟悉：胆红素的代谢，黄疸的分类，黄疸对机体的影响。Be familiar with：The metabolism of bilirubin; The classification of jaundice; The impact on the body of jaundice.了解：黄疸的常见原因。Understand：Common cause of jaundice.病理学绪论、适应、细胞组织损伤教学大纲掌握：病理学的概念，病理学的内容和任务。适应、萎缩、肥大、增生、化生的概念；细胞、组织损伤的形态学变化：细胞可逆性损伤（变性）和细胞内外物质蓄积的概念、类型及其形态学特征；坏死的概念、类型、形态学变化和结局，细胞凋亡的概念和形态学特点。Master：The concept of pathology. Content and task of pathology.The concept of adaptation，atrophy，hypertrophy，hyperplasia and metaplasia. The morphological changes of reversible injury. The concept of degeneration (reversible injury) and intra/extracellular accumulations. The morphological characteristics of various type of degeneration. The concept of necrosis and their types，morphological changes and ending. The concept of apoptosis and morphological changs熟悉：病理学在医学教育、临床医疗和科研中的地位萎缩、肥大、增生、化生的类型；细胞、组织损伤的原因、发生机制及几种重要的损伤；常见细胞变性和细胞内外物质蓄积的原因。细胞凋亡的机制。Be familiar with：The status of pathology in medical education，clinical medicine and scientific researchTypes of atrophy，hypertrophy，hyperplasia and metaplasia. The reason and mechanism of cell/tissue injury and several important damage. Common reasons of degeneration and intra/extracellular accumulation. The mechanism of apoptosis了解：病理学的研究方法（常用的病理学研究方法和新技术）萎缩、肥大、增生、化生对机体的影响和结局；常见细胞可逆性损伤和细胞内外物质蓄积的各自发生机制；细胞、组织损伤对机体影响；凋亡的生理与病理意义；细胞老化的概念和可能的机制。Understand：Pathology research methods (commonly used study methods and new technology)The influence and ending of atrophy，hypertrophy，hyperplasia and metaplasia. The mechanism of cell/tissue reversible injury and intra/extracellular accumulations. The influence of cell/tissue reversible injury. The physiological and pathological significance of apoptosis. The concept of cell aging and possible mechanism损伤的修复教学大纲掌握：再生与修复的概念；细胞周期、生长因子和干细胞的概念；肉芽组织和瘢痕组织的概念、形态特点、功能和结局；皮肤创伤愈合的基本过程。熟悉：再生的方式；干细胞在组织修复与细胞再生中的作用；各种组织的再生能力和过程（上皮组织、纤维组织、软骨和骨组织、血管、肌组织和神经组织的再生）；骨折愈合过程。了解：细胞再生的影响因素（各种细胞外基质、生长因子、抑素和接触抑制）。肉芽组织和瘢痕组织的形成过程及机制。创伤愈合的类型。影响创伤愈合的因素。细胞的再生与分化调控的分子机制。Master：The concept of regeneration and repair. The concept of cell cycle，growth factors and stem cells. The concept of granulation tissue and the scar tissue，and their morphological characteristics，fuctions and ending. The basic process of skin wound healing. Be familiar with：Way of regeneration; the role of stem cells in the process of tissue repair and the regeneration; Regenerative capacity and the process of all kinds of tissue (epithelial tissue，fiber，cartilage and bone tissue，blood vessels，the muscle tissue and neural tissue regeneration); The course of fracture healing. Understand：The influence factors of the regeneration of cells (all kinds of extracellular matrix，growth factors，chalone and contact inhibition). The forming process and mechanism of granulation tissue and of scar tissue. The type of wound healing. Influence factors of wound healing. The molecular mechanism of cells regeneration and diversification regulation.炎症教学大纲掌握：炎症的概念、基本病理变化、急性炎症过程中的血管反应、白细胞反应；炎症的常见类型的病变特点：急性炎症浆液性、纤维素性、化脓性、出血性炎；慢性炎症非特异性慢性炎、肉芽肿性炎。有关术语：脓肿、积脓、蜂窝织炎、窦道、瘘管、溃疡、糜烂、菌血症、毒血症、败血症、脓毒败血症、肉芽肿等。Master：The concept of inflammation and basic pathological change. The reaction of vessels and leukocytes in acute inflammatory process. Characteristic of the common types lesions of inflammation：acute inflammation-serous inflammation，fibrinous inflammatio