Angiology脈管學(xué)培訓(xùn)課件-002

Angiology脈管學(xué)Angiology脈管學(xué)CompositionCardiovascularsystem

心血管系統(tǒng)

Lymphaticsystem

淋巴系統(tǒng)2Angiology脈管學(xué)Thecardiovascularsystem心血管系統(tǒng)

★OrganizationHeart心AmusclepumptomaintaintheflowofbloodConsistoffourchambers(rightandleftatria,rightandleftventricles)

Artery

動(dòng)脈bloodvesselscarringbloodawayfromtheheart

Vein

靜脈bloodvesselscarringbloodtowardstheheartCapillary毛細(xì)血管smallestbloodvessels，exchangesiteofsubstancesbetweenbloodandsurroundingtissues3Angiology脈管學(xué)TheHardWorkingHeartLVSV70ml/beatHMO70x70=5000mlHHO70x70x60=300000mlHDO70x70x60x24=7200000mlHAO70x70x60x24x365=2600000000mlHLO70x70x60x24x365x70=210,000,000,000ml210,000/50/50=84Trains4Angiology脈管學(xué)Thecardiovascularsystem心血管系統(tǒng)★BloodcirculationSystemiccirculation

體循環(huán)

Leftventricle→aortaanditsbranches→capillariesofbody→superiorandinferiorvenacava→rightatriumPulmonarycirculation

肺循環(huán)Rightventricle→pulmonarya.→capillariesoflung→pulmonaryv.→leftatrium5Angiology脈管學(xué)

Thecardiovascularsystem心血管系統(tǒng)Vascularanastomosis血管吻合Anastomosisbetweena.Anastomosisbetweenv.Arteriolovenularanastomosis

動(dòng)靜脈吻合Collateralvessels

側(cè)副管

Collateralcirculation

側(cè)支循環(huán)6Angiology脈管學(xué)Heart丁兆習(xí)山東大學(xué)醫(yī)學(xué)院人體解剖教研室Office:1205dingzhaoxi@7Angiology脈管學(xué)★Positionoftheheart

★PositionoftheheartLieswithinthepericardiuminmiddlemediastinumBehindthebodyofsternumandcoastalcartilages2to6InfrontandatthelevelofT5-8Athirdofitliestotherightofmedianplanand2/3totheleft8Angiology脈管學(xué)★SurfacesoftheheartPyramidalinshape,somewhatlargerthanaclosedfistOneapex-

Cardiacapex

Onebase-

Cardiacbase

TwosurfaceSternocostalsurfaceDiaphragmaticsurfaceThreebordersRightborderLeftborderInferiorborderFoursulcusesCoronarysulcusAnteriorinterventriculargroovePosteriorinterventriculargrooveInteratrialsulcus9Angiology脈管學(xué)Cardiacapex

心尖FormedbyleftventricleDirecteddownwards,forward,andtotheleftLiesatthelevelofthefifthleftintercostalspace,1-2cmmedialtotheleftmidclavicularline(9cmfromthemidline)★Surfacesoftheheart10Angiology脈管學(xué)★SurfacesoftheheartCardiacbase

心底FormedbytheleftatriumandtoasmallextentbytherightatriumFacesbackward,upwardandtotherightContinuouswiththelargevessels11Angiology脈管學(xué)★SurfacesoftheheartSternocostalsurface

胸肋面Formedmainlybytherightatriumandrightventricle,andalesserportionofitsleftisformedbytheleftauricleandventricleDirectedforwardsandupwardsLeftandrightauricles

左、右心耳12Angiology脈管學(xué)★SurfacesoftheheartDiaphragmaticsurface

膈面Formedtheventricles－chieflytheleftventricleDirectedbackwardsanddownwards,andrestuponthecentraltendonofthediaphragm13Angiology脈管學(xué)★SurfacesoftheheartBordersoftheheartRightborder

右緣VerticalFormedentirelybyrightatrium

Leftborder

左緣

RoundMainlyformedbytheleftventricleandpartlybytheleftauricleInferiorborder

下緣HorizontalFormedbytherightventricleandcardiacapex14Angiology脈管學(xué)★SurfacesoftheheartSulcioftheheartCoronarysulcus

冠狀溝(circularsulcus)whichmarksthedivisionbetweenatriaandventricles,containsthetrunksofthecoronaryvesselsandcompletelyencirclestheheartInteratrialsulcus

房間溝Separatesthetwoatriaandishiddenbypulmonarytrunkandaortainfront15Angiology脈管學(xué)★SurfacesoftheheartSulcioftheheartAnteriorinterventriculargroove

前室間溝Posteriorinterventriculargroove

后室間溝Markthedivisionbetweenventricles(whichseparatestheRVfromtheLV)Cardiacapicalincisure

心尖切跡Atrioventricularcrux

房室交點(diǎn)16Angiology脈管學(xué)★Chambersoftheheart心腔Chambersoftheheart心腔Consistsoffourchambers

Leftandrightatria左、右心房Leftandrightventricles左、右心室17Angiology脈管學(xué)★Rightatrium(RA)右心房ThreeinletsOrificeofsuperiorvenacava

上腔靜脈口

returnsbloodtotheheartfromtheupperhalfofthebodyOrificeofinferiorvenacava

下腔靜脈口

returnsbloodtotheheartfromthelowerhalfofthebodyOrificeofcoronarysinus

冠狀竇口returnsbloodtotheheartfromthecardiacmuscleOneoutlet

Rightatrioventricularorifice右房室口18Angiology脈管學(xué)★Rightatrium(RA)右心房Cristaterminalis界嵴

Verticalridgethatfromsuperiorvenacavetoinferiorvenacave

Sulcusterminalis界溝

GrooveonexteriorofheartthatcorrespondstocristaterminalisTwopartsSeparatedexternallybysulcusterminalisandinternallybythecristaterminalisAtriumproper固有心房Infrontofthecristaterminalis

Sinusvenarumcavarum腔靜脈竇19Angiology脈管學(xué)★

Rightatrium(RA)

右心房Atriumproper固有心房Rightauricle-心外科最常用手術(shù)入路之一PectinatemusclesinwallSinusvenarumcavarum腔靜脈竇Fossaovalis卵圓窩Anovaldepression,aremnantofthefetalforamenovaleLiesonthelowerpartofinteratrialseptumThemostcommonlocationofatrialseptaldefects(ASD)Limbusfossaeovalis卵圓窩緣Aorticmound主動(dòng)脈隆凸KochtriangleKoch三角20Angiology脈管學(xué)★Rightventricle(RV)

右心室Oneinlet

Rightatrioventricularorifice

右房室口Oneoutlet

Orificeofpulmonarytrunk肺動(dòng)脈口21Angiology脈管學(xué)★Rightventricle(RV)

右心室Supraventricularcrest

室上嵴

Amuscularridgebetweenrightatrioventricularorificeandorificeofpulmonarytrunk

TwopartsInflowtract流入道Outflowtract流出道(conusarteriosus動(dòng)脈圓錐)22Angiology脈管學(xué)Rightventricle(RV)

右心室Inflowtract★

Tricuspidvalve

三尖瓣GuardsrightatrioventricularorificeThreetriangularcusps:anterior,posteriorandseptalBaseofcuspsareattachedtofibrousTricuspidring

surroundingtheatrioventricularorifice

Chordaetendineae

腱索

fibrousbandthat

Connectthefreeedgesandventricularsurfacesofcuspstothepapillarymuscles

Papillarymuscles

乳頭肌Conical-shapedThree:anterior,posteriorandseptal23Angiology脈管學(xué)

Trabeculaecarneae肉柱

irregularlyarrangedbundlesofmyocardium★Septomarginaltrabecula隔緣肉柱/morderatorband節(jié)制索extendsfrominterventricularseptumtobaseofanteriorpapillarymuscle,containsrightbundlebranchRightventricle(RV)右心室24Angiology脈管學(xué)

★

Tricuspidcomplex三尖瓣復(fù)合體Tricuspidring三尖瓣環(huán)Tricuspidvalve三尖瓣Chordaetendineae腱索Papillarymuscles乳頭肌★

Function:preventthereflowofbloodfromtherightventricleintorightatriumRightventricle(RV)右心室diastole

systole25Angiology脈管學(xué)

Ant.Post.septalTricuspidvalve三尖瓣Rightventricle(RV)右心室26Angiology脈管學(xué)ChordaetendineaePapillarymuscles27Angiology脈管學(xué)Rightventricle(RV)右心室★FunctionoftricuspidcomplexVentriclesrelax,bloodreturningtotheheartfillsatria,puttingpressureagainstatrioventricularvalves,atrioventricularvalesforcedopen.diastole28Angiology脈管學(xué)Rightventricle(RV)右心室★Functionoftricuspidcomplex

Ventriclescontract,forcingbloodagainstatrioventricularvalvecusps.Atrioventricularvalvesclosed.Papillarymusclescontractandchordaetendineaetighten,preventingvalveflapsfromevertingintoatria.systole29Angiology脈管學(xué)★Rightventricle(RV)

右心室Outflowtract--Conusarteriosus

動(dòng)脈圓錐

Cone-shape,smootharealeadingupwardtoorificeofpulmonarytrunkPumpsbloodthroughpulmonaryorificetopulmonarytrunkorificeofpulmonarytrunk肺動(dòng)脈口valveofpulmonarytrunk肺動(dòng)脈瓣30Angiology脈管學(xué)★Rightventricle(RV)右心室★PulmonaryValve

肺動(dòng)脈瓣GuardstheorificeofpulmonarytrunkThreesemilunarcuspseachwithfreeborderthathascentralnodulescalled

nodulesofsemilunarvalve半月瓣小結(jié)Pulmonarysinuses肺動(dòng)脈竇Bulgesinwallofpulmonarytrunkatlevelofvalvethatcorrespondtocusps★FunctionPreventthereflowofbloodfromthepulmonarytrunktorightventricle31Angiology脈管學(xué)Rightventricle(RV)右心室★FunctionofpulmonaryvalvesAsventriclescontractandintraventricularpressurerises,bloodispushedupagainstsemilunarvalves,forcingthemopen32Angiology脈管學(xué)Rightventricle(RV)右心室★FunctionofpulmonaryvalvesAsventriclesrelaxandintraventricularpressurefalls,bloodflowbackfromarteries,fillingthecuspsofsemilunarvalvesandforcingthemtoclose33Angiology脈管學(xué)

★

Leftatrium(LA)

左心房左心耳Leftauricles

-心外科最常用手術(shù)入路之一左心房竇leftatrialsinus

Fourinlets:

orificesofpulmonaryveins

肺靜脈口Oneoutlet:

leftatrioventricularorifice

左房室口34Angiology脈管學(xué)★L(fēng)eftventricle(LV)左心室Oneinlet:leftatrioventricularorifice

左房室口Oneoutlet:Aorticorifice

主動(dòng)脈口Twoparts:DividedbyanteriorcuspsofmitralvalveInflowtract－roughwallsOutflowtractAorticvestibule主動(dòng)脈前庭Smootharealeadingtoaorticorifice35Angiology脈管學(xué)

★Mitralvalve二尖瓣GuardsleftatrioventricularorificeTwotriangularcusps:AnteriorandposteriorFunction:preventthereflowofbloodfromtheleftventricleintoleftatrium

Leftventricle(LV)左心室36Angiology脈管學(xué)

★Mirtalcomplex二尖瓣復(fù)合體Mitralring二尖瓣環(huán)Mitralvalve二尖瓣Chordaetendineae腱索Papillarymuscles乳頭肌★Function：preventthereflowofbloodfromleftventricleintoleftatrium

Leftventricle(LV)左心室37Angiology脈管學(xué)Leftventricle(LV)左心室

FunctionofmitralcomplexOpenduringdiastoletoallowbloodtoenterventriclesfromatriaClosedduringsystoletopreventregurgitationofbloodintoatria38Angiology脈管學(xué)Leftventricle(LV)左心室★

Aorticvalve主動(dòng)脈瓣GuardstheaorticorificeThreesemilunarcusps(right,leftandposterior)Eachwithfreeborderthathasnodulesofsemilunarvalve半月瓣小結(jié)Aorticsinus

主動(dòng)脈竇BulgesinaorticwallatlevelofvalvethatcorrespondtocuspsRight－containsopeningofrightcoronaryarteryLeft－containsopeningofleftcoronaryarteryPosterior－noopening★

Function：preventthereflowofbloodfromaortaintoleftventricleLRP39Angiology脈管學(xué)Leftventricle(LV)左心室★FunctionofaorticvalvesOpenedduringsystole,withcuspspressedtowardwallofvesselasbloodisforcedupwardClosedduringdiastole

VentricularpressuredropsindiastoleFloatingtogetherofvalvecusps,withfreebordersmeeting,thusclosingthevalve

40Angiology脈管學(xué)41Angiology脈管學(xué)42Angiology脈管學(xué)43Angiology脈管學(xué)StructuresoftheheartEndocardium

心內(nèi)膜

Myocardium心肌Epicardium

心外膜

44Angiology脈管學(xué)Wallsoftheheart

Endocardium

心內(nèi)膜

InnercoatoftheheartwallContinuouswiththevalveflapsMyocardium心肌ArrangedspirallyAttachedtofibrousringssurroundingthefourorificesofheartThewallsofleftventricleareaboutthreetimesthickerthanthatofrightEpicardium

心外膜

OuterViscerallayerofserouspericardium45Angiology脈管學(xué)Structuresoftheheart★Interatrialseptum

房間隔LocatedbetweenrightandleftatriaContainsfossaovalisASD(AtrialSeptalDefect)★Interventricularseptum

室間隔LocatedbetweenrightandleftventriclesHasuppermembranouspart

HasthicklowermuscularpartVSD(VentricularSeptalDefect)Atrioventricularseptum

房室隔46Angiology脈管學(xué)Membranouspartofinterventricularseptum

Muscularpartofinterventricularseptum

47Angiology脈管學(xué)48Angiology脈管學(xué)VentricularSeptalDefect49Angiology脈管學(xué)Fibrousskeletonofheart纖維骨骼

Fibrousringsthatsurroundtheatrioventricular,pulmonary,andaorticorificesLeftandrightfibroustrigones50Angiology脈管學(xué)Fibrousskeletonofheart纖維骨骼

51Angiology脈管學(xué)Conductionsystemofheart

心傳導(dǎo)系統(tǒng)52Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)竇房結(jié)房室結(jié)房室束左、右束支Purkinje纖維Composedofspecializedmyocardialcells★ComponentsSinoatrialnode竇房結(jié)(pacemaker)Internodaltracts結(jié)間束Atrioventricularnode房室結(jié)Atrioventricularbundle房室束Rightandleftbundlebranches左、右束支Purkinjefibers(network)普肯野氏纖維網(wǎng)53Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)★Sinuatrialnode(SAnode)竇房結(jié)

Calledthepacemaker(Pcell)(60-100pulses/min)Locatedattheupperpartofthesulcusterminalisclosetothesuperiorvenacava,undertheepicardium竇房結(jié)Clinicaltip:竇性心動(dòng)過(guò)速sinustachycardia竇性心動(dòng)過(guò)緩sinusbradycardia54Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)★Atrioventricularnode(AVnode)

房室結(jié)

LocatedintheKochtriangleUndertheendocardiumLowerpartrelatedtomembranouspartofinterventricularseptum房室結(jié)55Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)Atrioventricularbundle(AVbundle)房室束

PassesforwardthroughrightfibroustrigonetoreachinferiorborderofmembranouspartofinterventricularseptumDividesintorightandleftbundlebranchesatupperborderofmuscularpartofinterventricularseptum房室束56Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)Rightandleftbundlebranches

左、右束支Rightbundlebranchpassesdownonrightsideofinterventricularseptumtoreachtheseptomarginaltrabecularandintothebaseofanteriorpapillarymuscle.HereitbecomescontinuouswiththefibersofPurkinjefibresLeftbundlebranchpassesdownonleftsideofinterventricularseptumbeneaththeendocardiumItusuallydividesintotwobranches,whicheventuallybecomecontinuouswiththePurkinjefibersPurkinjenetwork

普肯野氏纖維網(wǎng)

Continuouswithmyocardium左、右束支Purkinjenetwork57Angiology脈管學(xué)Conductionsystemofheart心傳導(dǎo)系統(tǒng)58Angiology脈管學(xué)ArterialsupplyoftheheartArteries：leftcoronaryarteryrightcoronaryartery59Angiology脈管學(xué)ArterialsupplyoftheheartLeftcoronaryartery左冠狀動(dòng)脈★

Course

ArisesfromleftaorticsinusRunsbetweenpulmonarytrunkandleftauricleintocoronarysulcus★

BranchesAnteriorinterventricularbranch前室間支RunsdownwardinanteriorinterventriculargroovearoundinferiormarginofhearttoposteriorinterventriculargrooveCircumflexbranch旋支Travelstoleftincoronarysulcustoposterioraspect★

Distribution

suppliesleftatriumandventricle,lesserportionofanteriorwallofrightventricle,andanterior2/3ofinterventricularseptum60Angiology脈管學(xué)Arterialsupplyoftheheart

Rightcoronaryartery右冠狀動(dòng)脈★

CourseArisesfromtherightaorticsinusRunsforwardbetweenrightauricleandpulmonarytrunkintocoronarysulcus★

BranchesBranchofsinoatrialnode竇房結(jié)支Rightmarginalbranch

右緣支

travelsalonginferiorborder

Posterorinterventricularbranch后室間支travelsdownwardinposteriorinterventriculargrooveitanastomosisesneartheapexwiththeanteriorinterventricularbranchoftheleftcoronaryartery★

Distributionsuppliesrightatriumandventricle,posterioinferior1/3ofinterventricularseptum,posteriorwallofleftventricle,thesinuatrialnodeandatrioventricularnode61Angiology脈管學(xué)ArterialsupplyoftheheartThrombusinCoronaryArteryAngiogram冠狀動(dòng)脈造影顯示動(dòng)脈血栓62Angiology脈管學(xué)ArterialsupplyoftheheartStentinanarteryPrecutaneoustranslaminalcoronaryangioplasty(PTCA)Coronaryarterybypassgrafting(CABG)63Angiology脈管學(xué)Venousdrainageoftheheart

Coronarysinus

冠狀竇Greatcardiacvein心大靜脈Middlecardiacvein心中靜脈Smallcardiacvein心小靜脈Anteriorcardiacveins

心前靜脈Smallestcardiacveins

心最小靜脈64Angiology脈管學(xué)Venousdrainageoftheheart

★Coronarysinus

冠狀竇LiesinposteriorpartofcoronarysulcusCarriesmostofvenousbloodfrommyocardiumtorightatrium

TributariesGreatcardiacvein心大靜脈Middlecardiacvein心中靜脈Smallcardiacvein心小靜脈65Angiology脈管學(xué)Venousdrainageofheart

Anteriorcardiacveins

心前靜脈3~4smallvessels,drainintorightatriumSmallestcardiacveins

心最小靜脈Drainintoallchambers,mainlyatria66Angiology脈管學(xué)Pericardium心包Fibrouspericardium

纖維心包Serouspericardium

漿膜心包Pericardialcavity

心包腔67Angiology脈管學(xué)★Pericardium心包Fibrouspericardium

纖維心包AttachedtocentraltendonofdiaphragminferiorlyBlendswithoutercoatofgreatvesselssuperiorlySerouspericardium

漿膜心包Viscerallayer(epicardium)ParietallayerPericardia