心脏、血管系统课件

TheHeartandAngiology

同济大学医学院解剖教研室孙红斌CompositionCardiovascularsystem心血管系统

Lymphaticsystem

淋巴系统ThecardiovascularsystemOrganizationHeart心Amusclepumptomaintaintheflowofblood,Consistoffourchambers(rightandleftatria,rightandleftventricles)Artery动脉a.

carrybloodawayfromtheheartVeins静脉v.

carrybloodbacktotheheartCapillary毛细血管microscopicvessels,theareaofexchangebetweenbloodandtissuefluidBloodcirculationSystemiccirculation体循环

leftventricle→aortaanditsbranches→capillariesofbody→superiorandinferiorvenacava→rightatriumPulmonarycirculation肺循环rightventricle→pulmonarya.→capillariesoflung→pulmonaryv.→rightatriumVascularanastomosis血管吻合Anastomosisbetweena.Anastomosisbetweenv.Arteriolovenularanastomosis动静脉吻合Collateralvessels侧副管

Circulation侧支循环RectalvenousplexusExternalcharacteristics－ahollowmuscularorgan,pyramidalinshape,somewhatlargerthanaclosedfist;consistsoffourchanbers(rightandleftatria,rightandleftventricles)Cardiacapexisformedbyleftventricleandisdirecteddownwardsandforwardstotheleft.Itliesatthelevelofthefifthleftintercostalspace,1~2cmmedialtotheleftmidclavicularline(9cmfromthemidline)Cardiacbaseisformedbytheleftatriumandtoasmallextentbytherightatrium.Itfacesbackward,upwardandtotherightTwosurfaceSternocostalsurfaceisformedmainlybytherightatriumandrightventricle,andalesserportionofitsleftisformedbytheleftauricleandventricle.ItisdirectedforwardsandupwardsDiaphragmaticsurfaceisformedtheventricles－chieflytheleftventricle,directedbackwardsanddownwards,andrestuponthecentraltendonofthediaphragmThreebordersRightborder－vertical,isformedentirelybyrightatriumLeftborder－round,ismainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborder－horizontal,isformedbytherightventricleandcardiacapexFourgroovesCoronarysulcus

冠状沟(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartInteratrialsulcus房间沟－separatesthetwoatriaandishiddenbypulmonarytrunkandaortainfrontInterventriculargrooves室间沟－anteriorandposterior,markthedivisionbetweenventricles(whichseparatestheRVfromtheLV),thetwogroovesextendfromthebaseoftheventricularpotiontoanotchcalled:thecardiacapicalincisure心尖切迹Atrioventricularcrux房室交点－ajunctionoftheposteriorinterventriculargrooveandcoronarysulcusChambersoftheheart

Rightatrium

右心房(RA)ThreeinletsOrificeofsuperiorvenacava上腔静脉口－returnsbloodtotheheartfromtheupperhalfofthebodyOrificeofinferiorvenacava下腔静脉口－returnsbloodtotheheartfromthelowerhalfofthebodyOrificeofcoronarsinus冠状窦口－returnsbloodtotheheartfromthecardiacmuscleOneoutle－rightatrioventricularorifice右房室口Cristaterminalis界嵴－verticalridgethatjfromsuperiorvenacavetoinferiorvenacaveSulcusterminalis界沟－grooveonexteriorofheartthatcorrespondstocristaterminalisTwoparts－separatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房InfrontoftheridgePectinatemusclesinwallRightauricle右心耳－asmallconicalmuscularpouch,projectstotheleftfromtherootofsuperiorvenacava,pectinatemusclesinwallSinusvenarumcavarum腔静脉窦LiesposteriortotheridgeSmoothwallsFossaovalis卵圆窝－anovaldepression,aremnantofthefetalforamenovale,onthelowerpartofinteratrialseptum,themostcommonlocationofatrialseptaldefects(ASD)Limbusfossaeovalis

卵圆窝缘–prominentmarginoffossaovalisTorusaortious

主动脉隆凸Rightventricle

(RV)右心室ReceivesdeoxygenatedbloodfromrightatriumthroughrightatrioventricularorificeOneinlet－rightartrioventricularorifice

右房室口Oneoutlet－orificeofpulmonarytrunk肺动脉口Twoparts－dividedbythesupraventricularcrest室上嵴,amuscularridgebetweenrightatrioventricularorificeandorificeofpulmonarytrunkInflowtract－roughwallsTrabeculaecarneae肉柱－irregularlyarrangedbundlesofmyocardiumSeptomarginaltrabecula隔缘肉柱－extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranchPapillarymuscles乳头肌－conical-shaped,anterior,posteriorandseptalOutflowtractConusarteriosus动脉圆锥cone-shaped,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunk

Leftatrium(LA)

左心房Leftauricle左心耳－projectingtotheright,pectinatemusclesinwallFourinlets－fourorificesofpulmonaryveins

肺静脉口openthroughtheposteriorwallOneoutlet－leftatrioventricularorifice左房室口,bloodleavesthroughleftatrioventricularorificetoleftventricleLeftventricle(LV)左心室HaswallthreetimesthickerthanthatofrightventricleOneinlet－leftatrioventricularorifice左房室口Oneoutlet－aorticorifice

主动脉口Twoparts－dividedbyanteriorcuspsofmitralvalveInflowtract－roughwallsOutflowtract–aorticvestibule主动脉前庭,smootharealeadingtoaorticorificeValves

Tricuspidvalve三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptal,thebaseofcuspsareattachedtofibrousringsurroundingtheatrioventricularorificeChordaetendineae腱索－fine,white,connectivetissuecords,attachmarginofcuspstopapillarymuscles乳头肌Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcusps－anteriorandposteriorwithcommissuralcuspsbetweenthem(posteromedialandanterolateralcommissures)SimilarstructurestothoseofrightValveofpulmonarytrunk肺动脉瓣GuardstheorificeofpulmonarytrunkHasthreesemilunarcusps–eachwithfreeborderthathascentralnodulesofsemilunarvalve半月瓣小结Aortivavle

主动脉瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandpost)Threeaorticsinuses–bulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRight－containsopeningofrightcoronaryarteryLeft－containsopeningofleftcoronaryarteryPosterior－noopeningSimilarfunctionsforpulmonaryandaorticvalvesOpeningduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastoleVentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalveStructureoftheheartWallsofheartEndocardium心内膜－innercoatoftheheartwall,andcontinuouswiththevalveflapsMyocardium

心肌ArrangedspirallyAttachedtofibrousringssurroudingthefourorificesofheartEpicardium心外膜－serousmembrane(visceralpericardium)Interatrialseptum

房间隔LocatedbetweenrightandleftatriaContainsfossaovalisandlimbusInterventricularseptum室间隔LocatedbetweenrightandleftventriclesHasuppermembranouspartHasthicklowermuscularpartFibrousskeleton纤维骨骼

Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigonsConductionsystemofheart心传导系

ConsistsofspecializedmyocardialcellsSinuatrialnode窦房结(SAnode)Calledthepacemakercell(Pcell)Locatedatthejunctionofrightatriumandsuperiorvenacava,upperpartofthesulcusterminalis,undertheepicardiumAtrioventricularnode房室结(AVnode)Locatedinthelowerpartofinteratrialseptumjustabovetheorificeofcoronarysinus,undertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptumAtrioventricularbundle

房室束(AVbundle)PassesforwardthroughrightfibroustrigontoreachinferiorborderofmembranouspartDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptumRightandleftbundlebranches左、右束支Rightbundlebranch－passesdownonrightsideofinterventricularseptumtoreachtheseptomarginaltrabecularandintothebaseofanteriorpapillarymuscle.HereitbecomescontinuouswiththefibersofPurkinjefibresLeftbundlebranch－passesdownonleftsideofinterventricularseptumbeneaththeendocardium.Itusuallydividesintotwobranches,whicheventuallybecomecontinuouswiththePurkinjefibersPurkinjefibers普肯野氏纤维－continuouswithmyocardium

Arterialsupply

Leftcoronaryartery

左冠状动脉ArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcusBranchesAnteriorinterventricularbranch前室间支－travelsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支－travelstoleftincoronarysulcustoposterioraspectDistribution－suppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptumRightcoronaryartery右冠状动脉ArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcusBranchesRightmarginalbranch右缘支－travelsalonginferiorbordPosterorinterventricularbranch后室间支－travelsdownwardinposteriorinterventriculargroove,itanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryarteryDistribution:suppliesrightatriumandventricle,posterior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnodeVenousdrainage

Coronarysinus冠状窦LocatedinposteriorpartofcoronarysinusCarriesmostofvenousbloodfrommyocardiumtorightatriumTributariesGreatcardiacvein心大静脉Middlecardiacvein心中静脉Smallcardiacvein心小静脉Anteriorcardiacveins心前静脉－3~4smallvessels,drainintorightatriumSmallestcardiacveins

心最小静脉－drainintoallchambers,mainlyatriaPericardium心包Fibrouspericardium

纤维心包AttachedtocentraltendonofdiaphragminferiorlyBlendswithoutercoatofgreatvesselssuperiorlySerouspericardium

浆膜心包Visceralpericardium(epicardium)ParietalpericardiumPericardialcavity心包腔PotentialspacebetweenvisceralandparietalpericardiumContainsfilmofpericardiumfluidPericardiumsinusTransversesinusofpericardium心包横窦－posteriortoascendingaortaandpulmonarytrunk,anteriortosuperiorvenacavaandleftatrium.Obliquesinusofpericardium心包斜窦－cul-de-sac,posteriortoheart,boundedbypulmonaryveinsoneithersideSurfacemarkingsofheart

Rightborder－correspondstoalinerunningfromtheupperborderofrightthirdcostalcartilage±1.2cmfromthemarginofsternum,downwardstosixthsternocostaljointApex－inthefifthleftintercostalspace7~9cmfromthemidlineLeftborder－representedbyalinerunningfromapexupwardsandmediallytoapointonlowerborderofleftsecondcostalcartilage±1.2cmfromsternalmarginLowerborder－representedbyalinejointthelowerendofrightbordertoapexDissectionoftheheartTheArteriesCharacteristicsSymmetry对称Inthetrunkofthebodyconsistparietalandvisceralbranches壁支和脏支ShortestpossiblecourseRunonflexorsurfacesUsuallydonotpassdirectlythroughmuscles,avoidingcompressionTogetherwiththeveinsandnervesinasheathoffasciatoformneurovascularbundle血管神经束Arteriesofpulmonarycirculation

肺循环的动脉Pulmonarytrunk

肺动脉干ArisesfromrightventricleRunsup,back,andtotheleftBifurcatesinferiortoaorticarchintorightandleftpulmonaryarteries,oneforeachlungArteriesofsystemiccirculation

体循环的动脉Aorta主动脉Ascendingaorta升主动脉Aorticarch主动脉弓Brachiocephalictrunk头臂干rightcommoncarotida.右颈总动脉rightsubclaviana.右锁骨下动脉Leftcommoncarotida.左颈总动脉Leftsubclaviana.左锁骨下动脉Descendingaorta降主动脉Thoracicaorta胸主动脉Abdominalaorta腹主动脉ArteriesofheadandneckCommoncarotida.颈总动脉Externalcarotida.颈外动脉Internalcarotida.颈内动脉Subclaviana.锁骨下动脉ArteriesofupperlimbAxillarya.腋动脉Brachiala.肱动脉Radiala.桡动脉Ulnara.尺动脉Superficialpalmararch掌浅弓deeppalmararc掌深弓Thoracicaorta胸主动脉Parietalbranches壁支Ninepairsposteriorintercostalsarteries肋间后动脉Onepairsubcostal肋下动脉Visceralbranches脏支Abdominalaorta腹主动脉

Visceralbranches脏支PairedbranchesMiddlesuprarenalartery肾上腺中动脉Renalartery肾动脉Testicular(ovarian)artery睾丸（卵巢）动脉UnpairedbranchesCeliactrunk腹腔干Superiormesenterica.肠系膜上动脉Inferiormesenterica.肠系膜下动脉ParietalbranchesArteriesofpelvisCommoniliaca.髂总动脉Internaliliaca.髂内动脉Externaliliaca.髂外动脉ArteriesoflowerlimbFemorala.股动脉Popliteala.腘动脉Posteriortibiala.胫后动脉Anteriortibiala.胫前动脉dorsala.offoot足背动脉TheVeins静脉GeneralfeatureThinwalls,largerlumens,venousvalves,venousplexus,venousreteTwosetsS