心内科小讲课课件

1、冠状动脉粥样硬化性心脏病 心绞痛 冠状动脉粥样硬化性心脏病 指冠状动脉粥样硬化使血管腔狭窄或阻塞，或 （和）因冠状动脉功能性改变（痉挛）导致心肌缺血缺氧或坏死而引起的心脏病，统称冠状动脉性心脏病(coronary heart disease),冠心病（CHD），亦称缺血性心脏病。 1979年WHO将冠心病分为5型：无症状性心肌缺血心绞痛心肌梗死缺血性心肌病猝死锐普PPT论坛chinakui转载：稳定型心绞痛和不稳定型心绞痛稳定型心绞痛锐普PPT论坛chinakui转载： 亦称劳力型心绞痛，是冠状动 脉严重狭窄的基础上，由于心肌负荷的增加引起心肌急剧的、暂时的缺血缺氧的临床综合征病因 冠状动脉粥

2、样硬化 当冠状动脉的供血与心肌的需血之间发生矛盾，冠状动脉血流量不能满足心肌代谢的需要，引起心肌急剧的、暂时的缺血缺氧时，即可发生心绞痛。临床表现 胸骨体中段或上段之后，可波及心前区，常放 射至左肩、左臂内侧及无名指和小指，或至颈 、咽或下颌部。 压榨性、闷胀性或窒息性也可有烧灼感，偶有 濒死的恐惧感。 体力劳动或情绪激动、饱食、寒冷、吸烟、心 动过速、休克等。 35分钟，小于15min。 停止原来诱发症状的活动或舌下含用硝酸 甘油。 症状：以发作性胸痛为主要临床表现部位性质诱因持续时间 缓解方式体征：平时一般无异常体征。 心绞痛发作时常见心率增快、血压升高、表情焦虑、皮肤冷或出汗、有时出现第

3、四或第三心音奔马律，可有暂时性心尖部收缩期杂音，第二心音可有逆分裂或出现交替脉等非特异性体征实验室和其他检查放射性核素检查冠状动脉造影超声检查心绞痛严重度分级 I一般体力活动（如步行和登楼）不受限，仅在强、快或长时间劳力时发生心绞痛 II一般体力活动轻度受限。快步、饭后、寒冷或刮风中、精神应激或醒后数小时内发作心绞痛。一般情况下步行200米以上或登楼一层以上受限。 III一般体力活动明显受限，一般情况下步行200米，或登楼一层引起心绞痛。 IV轻微活动或休息时即可发生心绞痛。治疗原则避免诱发因素改善冠状动脉的血供和降低心肌耗氧治疗动脉粥样硬化治疗措施一、预防并发症 长期服用阿司匹林 减少血栓形

4、成降血脂治疗 使粥样斑块稳定二、发作时的治疗休息 停止活动后症状即可消除。药物治疗 硝酸酯制剂：扩张冠状动脉，增加冠状 循环的血流量；扩张周围血管，减少静脉回 心血量，减低心脏前后负荷和心肌的需氧。 常用药：硝酸甘油、硝酸异山梨酯等三、缓解期的治疗药物治疗：阿司匹林 硝酸脂制剂氯吡格雷 CCB-受体阻滞剂 代谢性药物调血脂药物 中医中药治疗ACEI非药物治疗运动锻炼疗法血管重建治疗增强型体外反搏心绞痛病人的护理休息与活动心理护理给氧疼痛观察用药护理减少避免诱因疼痛：胸痛 与心肌缺血缺氧有关其他的护理诊断/问题潜在并发症 心肌梗死知识缺乏 缺乏控制诱发因素及预防心绞痛发作的知识恐惧，焦虑 与缺乏

5、相关疾病知识和疼痛引的濒死感有关健康指导疾病知识指导用药指导病情监测指导THANK YOUClick To Edit Title Style锐普PPT论坛chinakui转载：Click To Edit Title StyleTEXTADD CONTENTSTEXTADD CONTENTSADD CONTENTSTEXTADD COsNTENTSADD CONTENTSTEXTADD CONTENTSADD CONTENTSTEXTADD CONTENTSADD CONTENTS锐普PPT论坛chinakui转载：Click To Edit Title StylePremiumDesignDi

6、versityof CultureImmenseVisual AppealVisualAppealingImmenseVisual AppealSleek Diagram & ChartImmense visual appeal Premade PowerPoint Templates,Professional quality templates in a couple of clicks away!Eye-Catching VisualFeel the touch of art - PowerPoint Templates, PPT Slides,PPT Diagrams For Your

7、PresentationReady to UseSubscription offers you all designs youll ever need to make your PowerPoint 锐普PPT论坛chinakui转载：Click To Edit Title StyleStylish DesignIts about giving you the variety you need to meet the design on your mind. We create powerpoint templates based on new visual trends thats fres

8、h, relevant and always on the cutting edge.More choices andvisual trendsPresenterTemplates provides the themes that surrounds you every day. We cover a wide range of subjects including business, IT, lifestyle, nature, travel, technology, school, culture and much more for you to choose from and about

9、 200 are added every month.A wide range of subjectsPowerPoint is a complete presentation graphics package. It gives you everything you need to produce a professional-looking presentation. PowerPoint offers word processing, outlining, drawing, graphing, and presentation management tools- all designed

10、 to be easy to use and learn.PowerPoint PresentationEye-CatchingVisualImmense Visual AppealSleek Diagram & Chart锐普PPT论坛chinakui转载：More choices and visual trendsA wide range of subjectsDiversity ofCultureInspiration for your fine performance锐普PPT论坛chinakui转载：Click To Edit Title StyleCONTENTSCONTENTSC

11、ONTENTSCONTENTSCONTENTSCONTENTSCLICK TO EDIT TITLE STYLE锐普PPT论坛chinakui转载：Click To Edit Title StyleStylishtemplatescan be a valuable aid toCreative professionalsClarity &ImpactDesignInspirationPremiumDesignPictures speak1,000 words!Catch The feel of Design in contemporarycolors and stylesCreative Vi

12、sual Aids!Feel the touch of Design on the cutting edge锐普PPT论坛chinakui转载：Click To Edit Title Style0102030405060708091011121314151617Value 01Value 02Value 03Value 04Value 05Value 06Value 07Value 08Value 09Value 10Value 11Visual AppealingCaptivate your viewing audience - PowerPoint Templates & Backgrou

13、nds, Sleek Diagram & Charts For Your Presentation锐普PPT论坛chinakui转载：Click To Edit Title Style0%CONTENTS80%100%60%40%20%锐普PPT论坛chinakui转载：Click To Edit Title StylePowerPoint PresentationPowerPoint is a complete presentation graphics package.It gives you everything you need to produce a professional-lo

14、oking presentation.PowerPoint offers word processing, outlining, drawing, graphing, and presentation management tools- all designed to be easy to use and learn.VisualAppealingCaptivate your viewing audience - PowerPoint Templates & Backgrounds, Sleek Diagram & Charts For Your PresentationImmenseVisu

15、alAppealEye-Catching VisualSleekDiagram& Chart锐普PPT论坛chinakui转载：Click To Edit Title StyleVisual AppealingCaptivate your viewing audience - PowerPoint Templates & Backgrounds, Sleek Diagram & Charts For Your PresentationAnimationDynamic look to your presentation Animation PowerPoint Templates & Backg

16、rounds for Your Impressive PresentationEasy SearchOur easy to use and functional search engine helps you locate the right templates quickly saving you timeTo offer you what you want, when you wantClarity &ImpactPremiumDesignSubtleTouchVisualAppealingImmense Visual AppealEye-Catching VisualEasy To Us

17、eUniversal Design锐普PPT论坛chinakui转载：Click To Edit Title StyleNorth AmericaSouth AmericaAfricaAustraliaAsiaEurope锐普PPT论坛chinakui转载：Click To Edit Title StyleTEXT HEREClick to add textClick to add textClick to add textTEXTClick to add textClick to add textClick to add textTEXTClick to add textClick to add