心血管系統(tǒng)精品課件

1、ANGIOLOGY脈 管 學(xué)第十一章 心血管系統(tǒng)The Cardiovascular System第一節(jié) 總論 Introduction心血管系統(tǒng)的組成 Organization of the cardiovascular system血管吻合及其功能意義 Vascular anastomosis and its function 血管的變異和異常血液循環(huán)一、心血管系統(tǒng)的組成心血管系統(tǒng)的組成和血液循環(huán)心血管系統(tǒng)由心、動(dòng)脈、毛細(xì)血管和靜脈組成。 The cardiovascular system comprises the artery, capillary and vein. 血液由心臟射出，

2、依次流經(jīng)動(dòng)脈、毛細(xì)血管和靜脈，最后又返回心，血液這種周而復(fù)始的流動(dòng)現(xiàn)象稱血液循環(huán),可分為肺循環(huán)和體循環(huán)兩部分。Pulmonary Circulation肺循環(huán)肺循環(huán) pulmonary circulation循環(huán)途徑：血液經(jīng)右心室射出（靜脈血）肺動(dòng)脈干左、右肺動(dòng)脈及其分支左、右肺泡壁毛血管網(wǎng)（氣體交換）左、右肺靜脈（動(dòng)脈血）左心房的途徑，稱肺循環(huán). The course of the blood from the right ventricle through the lung to the left atrium of the heart is termed the lesser or pu

3、lmonary circulation.特點(diǎn)：為行程短，分支少，分布范圍小。功能：是將靜脈血轉(zhuǎn)化為動(dòng)脈血。 Systemic Circulation體 循 環(huán)體循環(huán) systemic circulation循環(huán)途徑：血液經(jīng)左心室射出（動(dòng)脈血）主動(dòng)脈各級(jí)動(dòng)脈全身各組織器官的毛細(xì)血管（物質(zhì)交換）全身各級(jí)靜脈（靜脈血）上、下腔靜脈右心房的途徑，稱體循環(huán)。The course of the blood from the left ventricle through the whole body finally to the right atrium of the heart constitutes t

4、he greater or systemic circulation.特點(diǎn)：為行程長(zhǎng)、分支多、分布范圍廣。功能：是將營(yíng)養(yǎng)物質(zhì)運(yùn)送到器官、組織，并將靜脈血導(dǎo)回心臟。二、血管吻合Vascular AnastomosisArtery Capillary VeinArtery Connecting Vessel Artery Vein - Connecting Vessel VeinArtery Connecting Vessel VeinCollateral anastomosis 血管吻合與側(cè)支循環(huán)側(cè)支(副)循環(huán) Collateral CirculationTrunk artery Collate

5、ral branch1.視網(wǎng)膜中央動(dòng)脈Central artery of retina終動(dòng)脈 ending artery2. 闌尾動(dòng)脈Appendicular artery 終動(dòng)脈 ending artery功能性終動(dòng)脈1.腎動(dòng)脈的分支功能性終動(dòng)脈2. 腦動(dòng)脈的分支終動(dòng)脈ending artery的概念終動(dòng)脈：體內(nèi)少數(shù)器官內(nèi)的動(dòng)脈與相鄰動(dòng)脈之間無(wú)吻合，這種動(dòng)脈稱終動(dòng)脈，如視網(wǎng)膜中央動(dòng)脈、闌尾動(dòng)脈等。終動(dòng)脈的阻塞可導(dǎo)致供血區(qū)的組織缺血甚至壞死。功能性終動(dòng)脈：如果某一動(dòng)脈與鄰近動(dòng)脈雖有吻合，但當(dāng)該動(dòng)脈阻塞后，鄰近動(dòng)脈不足以代其血液供應(yīng)，這種動(dòng)脈稱功能性終動(dòng)脈，如腦、腎和脾內(nèi)的一些動(dòng)脈分支。三、血管

6、的變異和異常 血管在起始或匯入、分支、管徑、數(shù)目和行程等形態(tài)或數(shù)值的變化超出了正常型以外或與教科書(shū)的描述的不一樣，則為變異variation，若其形態(tài)和數(shù)值變化較大，造成器官的功能的異常，稱為異常。肝血供的變異腸系膜上動(dòng)脈分支的變異第二節(jié) 心 Heart一、心的位置、外形和毗鄰 Location, External Morphology, Relation 1. 心的位置 Location 心的位置 Location of heartThe heart is placed obliquely middle mediastinum in the chest, two-thirds of it o

7、n the left of the median sagittal plane and one-third on the right. 心斜位于胸腔的中縱隔內(nèi)，約2/3在正中矢狀面的左側(cè), 1/3在右側(cè)。心腔的方位各心腔的方位房間隔和室間隔與正中面、水平面和冠狀面均成45角，即右半心腔在心間隔的右前上方，左半心腔在心間隔的左后下方。心的長(zhǎng)軸自右肩斜向左肋下區(qū)，與身體正中線構(gòu)成約45角。2.心的毗鄰Relations 心 尖 cardiac apex構(gòu)成方位體表投影由左心室構(gòu)成The projection of the cardiac apex心尖的體表投影3.心的外形 The External

8、 Morphology心是一個(gè)中空的肌性纖維性器官，形似倒置的、前后稍扁的圓錐體，大小約與本人握拳相似（稍大于本人拳頭），周?chē)孕陌?The heart is a hollow, muscular and fibrous organ of a somewhat conical form, is about the size of (slightly larger than) a persons clenched fist； it is enclosed in the pericardium.心分為一尖、一底、兩面、三緣、四條溝和一個(gè)切跡、一個(gè)點(diǎn)。The heart has an apex,

9、 a base, two surfaces, three borders, fours grooves, and one notch, one point.心 尖 The Apex of the Heart心尖由左心室構(gòu)成，朝向左前下方。The cardiac apex, formed by the left ventricleIs， is directed downwards, forwards and left.心尖的體表投影：位于左側(cè)第5肋間隙鎖骨中線內(nèi)側(cè)1 2厘米處，或左側(cè)第5肋間隙距正中面9厘米處。在此可看見(jiàn)或捫及心尖搏動(dòng)。 The apex of the heart is loca

10、tion posterior to the left 5th intercostal space 12cm to the right of the left midclavicular plane or 9cm from the median plane.The cardiac apex is where maximal pulsation of the heart (apex beat) occurs and underlies the site where the “heartbeat” may be observed or palpated on the thoracic wall. 心

11、 底 Cardiac base構(gòu)成方位相連的血管心底 The Base of the Heart心底大部分由左心房，小部分由右心房構(gòu)成. The cardiac base is formed mainly by the left atrium, with a lesser contribution by the right atrium，and faces backwards, upwards and to the right 朝向右后上方.有四條肺靜脈和上、下腔靜脈與心底相連。 The four pulmonary veins, two on each side, open into the

12、 left atrium, while the superior vena cava opens into the upper part, and the inferior vena cava into the lower part, of the right atrium.胸 肋 面 The Sternocostal Surface構(gòu)成方位相連的血管右心房左心耳左心室左尖右心室胸肋面 The Sternocostal SurfaceIs called the anterior surface又稱前面.Is directed forwards , upwards and to the left

13、 . 朝向左前上方。Formed mainly by the right atrium and right ventricle, with a lesser contribution by the left auricle and left ventricle.大部分由右心房和右心室，小部分右左心耳和左心室構(gòu)成。膈面左心室右心室Left ventricleRightventricle膈面 The Diaphragmatic SurfaceIs called inferior surface.又稱下面;Is directed downwards and slightly backwards. 朝

14、向下后方;Is formed mainly by the left ventricle and partly by the right ventricle. 主要由左心室，部分由右心室構(gòu)成.Is related to the central tendon of the diaphragm. 與膈的中心腱相鄰.心的三緣 The Three Border of the Heart右緣左緣下緣右心房左心耳左心室心尖右心室The Three Border of the HeartThe right border 右緣Is formed by the right atrium. 由右心房構(gòu)成.Is al

15、most vertical. 幾乎垂直. Extends between the superior vena cava and the inferior vena cava.與上腔靜脈和下腔靜脈相連.The left border 左緣Formed mainly by the left ventricle, partly by the left auricle.主要由左心室、部分由左心耳構(gòu)成.Is rounded. 圓鈍.The inferior border 下緣Is formed mainly by the right ventricle and only slightly by the

16、cardiac apex of left ventricle.主要由右心室、小部分由左心室的心尖構(gòu)成.Is nearly horizontal.幾乎呈水平位.心表面的四條溝前室間溝、后室間溝冠狀溝、后房間溝 The Four Grooves（1）Anterior interventricular groove前室間溝位于心的胸肋面；是左、右心室在心表面的分界；是室間隔前緣在心表面的位置；含有前室間動(dòng)脈和心大靜脈等 。 Posterior interventricular groove 后室間溝位于心的膈面；是左、右心室在心表面的分界；是室間隔下緣在心表面的位置；含有后室間動(dòng)脈和心中靜脈等。Th

17、e Four Grooves（2）Coronary groove冠狀溝 (atrioventricular groove房室溝)幾呈冠狀位；近似環(huán)形，前方被肺動(dòng)脈干中斷；分隔右上方的心房和左下方的心室；含有左、右冠狀動(dòng)脈和心小靜脈，以及冠狀竇。Posterior interatrial groove后房間溝 在心底，右心房與右上下肺靜脈交界處的淺溝； 與房間膈后緣一致；是左、右心房在心表面的分界。心尖切跡 The apical cardiac notch房室交點(diǎn) The crux of heartA Notch and A PointThe apical cardiac notch 心尖切跡I

18、s situated a little to the right of the apex of the heart. 位于心尖稍右側(cè)；Is a crossing point of anterior and posterior interventicular groove in the inferior border.是前室間溝和后室間溝在心下緣的會(huì)合處。 The crux of heart (房室交點(diǎn)) is a crossing point of posterior interventricular groove , posterior interatrial groove, and cor

19、onary groove. 是后室間溝、后房間溝與冠狀溝的相交處；Is an important landmark on the cardiac surface.是心表面的一個(gè)重要標(biāo)志。二、心 腔The internal morphology of the heart1.右心房上腔靜脈卵圓窩下腔靜脈冠狀竇口梳狀肌界嵴右心耳分部：被表面的界溝sulcus terminalis或內(nèi)面的界嵴crista terminalis 分為前部的固有心房 atrium proper和后部的腔靜脈竇sinus venarum。固有心房：有右心耳 right auricle, 梳狀肌pectinate muscl

20、e, 右房室口right atrioventricular orifice等結(jié)構(gòu).腔靜脈竇：有上/下腔靜脈口orifice of superior and inferior vena cava，冠狀竇口orifice of coronary sinus，卵圓窩fossa ovalis等結(jié)構(gòu)。入口：上、下腔靜脈口orifice of superior and inferior vena cava和冠狀竇口orifice of coronary sinus。出口：右房室口right atrioventricular orifice。右心房 Right Atrium2A.右心室的分部流入道流出道2B

21、.右心室內(nèi)結(jié)構(gòu)前尖隔側(cè)尖后尖肉柱腱索后乳頭肌前乳頭肌隔緣肉柱室上嵴肺動(dòng)脈瓣的右半月瓣右心室 The Right VentricleThe right ventricle is separated into the inflowing and outflowing parts (流入道和流出道）by the supraventricular crest（室上嵴）. The inflowing part is termed the proper cavity 固有心腔or sinus part 竇部; The outflowing part is termed the conus ateriosu

22、s 動(dòng)脈圓錐or infundibulum part 漏斗部。流入道inflowing part :有肉柱trabeculae carneae, (前、后、隔側(cè)）乳頭肌papillary muscles, 隔緣肉柱septomarginal trabeculae(節(jié)制索moderator band), 右房室口right atrioventricular orifice, 三尖瓣復(fù)合體tricuspid valve complex(由三尖瓣環(huán)、三尖瓣、腱索和乳頭肌構(gòu)成的結(jié)構(gòu)和功能的整體，可防止右心室的血液逆至右心房）。流出道outflowing part ：有肺動(dòng)脈口orifice of pu

23、lmonary trunk，肺動(dòng)脈瓣 pulmonary valve等結(jié)構(gòu)。Entrance 入口：右房室口right atrioventricular orifice。Exit 出口：肺動(dòng)脈口orifice of pulmonary trunk。2C.三尖瓣復(fù)合體 tricuspid valve complex組成：由三尖瓣環(huán)、三尖瓣、腱索和乳頭肌構(gòu)成的結(jié)構(gòu)和功能的整體。功能：可防止右心室的血液逆流至右心房。2C.三尖瓣復(fù)合體 tricuspid valve complex組成：由三尖瓣環(huán)、三尖瓣、腱索和乳頭肌構(gòu)成的結(jié)構(gòu)和功能的整體。功能：可防止右心室的血液逆流至右心房。瓣膜腱索乳頭肌2D.

24、肺動(dòng)脈口和肺動(dòng)脈瓣肺動(dòng)脈瓣肺動(dòng)脈瓣 Pulmonary valve附于肺動(dòng)脈環(huán)上，為三個(gè)半月形瓣膜，分別稱前、左、右瓣；順血流開(kāi)放，逆血流關(guān)閉；在右心室舒張時(shí)，肺動(dòng)脈瓣可防止肺動(dòng)脈內(nèi)血液返流。 3. 左心房 The Left Atrium 左心耳左上肺靜脈右肺靜脈3. 左心房 The Left Atrium 分部：可分為前部的左心耳 left auricle和后部的固有心房。 左心耳 left auricle：內(nèi)有梳狀肌。固有心房/左心房竇：有4個(gè)肺靜脈口orifice of pulmonary veins，左房室口 left atrioventricular orifice。4A. 左心室的

25、分部流入道流出道4. 左心室的分部二尖瓣前尖4B. 左心室內(nèi)結(jié)構(gòu)Trabecular carneae肉柱后乳頭肌前乳頭肌二尖瓣后尖腱索二尖瓣前尖4B. 左心室內(nèi)結(jié)構(gòu)4C. Mitral Valve Complex 二尖瓣復(fù)合體組成：由二尖瓣環(huán)、二尖瓣、腱索和乳頭肌組成的結(jié)構(gòu)和功能的整體。功能：可防止左心室的血液逆至左心房。腱索二尖瓣后尖二尖瓣前尖后乳頭肌前乳頭肌前乳頭肌二尖瓣環(huán)二尖瓣4D.主動(dòng)脈口和主動(dòng)脈瓣主動(dòng)脈瓣右半月瓣主動(dòng)脈竇右冠狀動(dòng)脈口半月瓣小結(jié)4. 左心室 The Left VentricleThe interior of the left ventricle is separated

26、 into the inflowing and outflowing parts by the anterior cusp of the left atrioventricular valve.Inflowing part流入道/sinus part of left ventricle左心室竇部：有左房室口left atrioventricular orifice, left atrioventricular valve左房室瓣(mitral valve二尖瓣)，二尖瓣前尖/后尖anterior and posterior cusp of mitral valve，前外側(cè)/后內(nèi)側(cè)連合,腱索de

27、ndinous cords，乳頭肌papillary muscles，肉柱 trabecular carneae。Outflowing part流出道/aorta vestibule主動(dòng)脈前庭：有主動(dòng)脈口aortic orifice ,主動(dòng)脈瓣aortic valve（左冠狀動(dòng)脈半月瓣、右冠狀動(dòng)脈半月瓣和無(wú)冠狀動(dòng)脈半月瓣）,主動(dòng)脈竇aortic sinuses(right, left and posterior左冠狀動(dòng)脈半月竇、右冠狀動(dòng)脈半月竇和無(wú)冠狀動(dòng)脈半月竇）和左、右冠狀動(dòng)脈口.Entrance 入口：left atrioventricular orifice左房室口Exit 出口： ao

28、rtic orifice主動(dòng)脈口。三、心的構(gòu)造 The structure of the heart心纖維支架 fibrous skeleton of the heart心壁 the wall of the heart心間隔 1.心纖維支架1. 心纖維支架二尖瓣環(huán)三尖瓣環(huán)右纖維三角主動(dòng)脈瓣環(huán)肺動(dòng)脈瓣環(huán)左纖維三角心外膜心肌層心內(nèi)膜漿膜心包的臟層2.心壁漿膜心包的壁層纖維心包心包腔漿膜心包心間隔房間隔室間隔房室隔膜部房室間部肌部室間部Interatrial septumAtrioventricular partInterventricular partAtrioventricular septum

29、Musculous partInterventricular septumMenbranous part房間隔和室間隔室間隔膜部（室間部）房間隔和室間隔室間隔膜部（房室間部）心壁的結(jié)構(gòu)The structure of the wall of the heart心壁的組成：the wall of the heart comprises three layer, named from within outwards endocardium(心內(nèi)膜）, myocardium（心肌層） and epicardium（心外膜）。心的纖維性支架：The fibrous skeleton心纖維骨骼 is c

30、omposed of four fibrous rings纖維環(huán) and two fibrous trigone纖維三角. 纖維環(huán)：圍繞在房室口和動(dòng)脈口周?chē)?，作為心房肌、心室肌、房室瓣和?dòng)脈瓣的附著處，包括二尖瓣環(huán)、三尖瓣環(huán)、肺動(dòng)脈瓣環(huán)和主動(dòng)脈瓣環(huán)。心間隔：interatrial septum房間隔，interventricular septum室間隔 and atrioventricular septum房室隔。室間隔分為肌部和膜部，后者又分為房室部和室間部。四、心傳導(dǎo)系房室結(jié)竇房結(jié)右束支房室束浦肯野纖維四、心傳導(dǎo)系左束支浦肯野纖維房 室 結(jié) 區(qū)koch三角心傳導(dǎo)系 Conduction S

31、ystem of heart組成與功能：由特殊心肌細(xì)胞構(gòu)成，包括竇房結(jié)sinoatrial node、結(jié)間束internodal tract、房室結(jié)區(qū)atrioventricular nodal region、房室束atrioventricular bundle(His束)、左/右束支left and right bundle branch和Purkinje 纖維網(wǎng)。具有自律性和傳導(dǎo)性，主要功能是產(chǎn)生和傳導(dǎo)沖動(dòng)，控制心的節(jié)律性活動(dòng)。竇房結(jié)：位于上腔靜脈與右心房交界處的（或界溝上1/3）心外膜深面，是心的正常起搏點(diǎn)。 房室結(jié)區(qū)：位于koch三角內(nèi)（由Todaro腱、冠狀竇口前內(nèi)緣與三尖瓣隔側(cè)尖附著緣之間），由房室結(jié)、房室結(jié)的心房擴(kuò)展部(結(jié)間束的終末部)、房室束（His束）的近側(cè)部(穿部和末分叉部)組成。功能：是將來(lái)自竇房結(jié)的興奮延擱下傳至心室，使心房肌和心室肌依次先后順序分開(kāi)收縮；為重要的次級(jí)起搏點(diǎn)。五、心的血管The vessels of the heart1. 心的動(dòng)脈左冠狀動(dòng)脈右冠狀動(dòng)脈左冠狀動(dòng)脈及其分支左冠狀動(dòng)脈旋支前室間支左冠狀動(dòng)脈旋支左室后支右冠狀動(dòng)脈右冠狀動(dòng)脈后室間支竇房結(jié)支房室結(jié)支左室后支緣支右冠狀動(dòng)脈Branches to back of left ventricle右冠狀動(dòng)脈后室間支左室后支