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ImprovingLivesThroughmedicalinnovationPTCA基础知识ImprovingLivesThroughmedicalinnovation心脏的解剖位置和结构功能ImprovingLivesThroughmedicalinnovation心脏在胸腔内的位置ImprovingLivesThroughmedicalinnovation右心房右心室左心房左心室心脏结构ImprovingLivesThroughmedicalinnovationImprovingLivesThroughmedicalinnovation冠状动脉的解剖结构和功能ImprovingLivesThroughmedicalinnovation冠状动脉的功能营养心肌提供心脏活动所需的氧气和营养物质ImprovingLivesThroughmedicalinnovation右冠状动脉主动脉弓左主干左回旋支左前降支ImprovingLivesThroughmedicalinnovation冠状动脉的分支—左冠状动脉(LCA)—右冠状动脉(RCA)ImprovingLivesThroughmedicalinnovation左冠状动脉－左主干(LM)－前降支(LAD)－回旋支(LCx）ImprovingLivesThroughmedicalinnovation左主干(LM)长度：2-20mm直径：2-6mmImprovingLivesThroughmedicalinnovation左前降支（LAD）•供应：–左室的2/3前壁–右室的前侧壁–心尖至间隔ImprovingLivesThroughmedicalinnovation左回旋支（LCX)•供应：–左室的后侧壁–左房–窦房结ImprovingLivesThroughmedicalinnovation右冠状动脉(RCA)•供应:–左室的下壁–右室的前壁–右房–间隔的后方–窦房结，房室结ImprovingLivesThroughmedicalinnovation冠心病的病因和临床表现冠心病的概念:是冠状动脉粥样硬化性心脏病的简称ImprovingLivesThroughmedicalinnovation正常的冠脉斑块的形成斑块堆积阻塞血管ImprovingLivesThroughmedicalinnovation心绞痛Vs心肌梗塞心绞痛心肌梗塞临床表现胸骨后压榨性疼痛,疼痛范围固定,休息后缓解疼痛不固定,休息后不能缓解治疗硝酸甘油溶栓ImprovingLivesThroughmedicalinnovationNormalCoronaryArteries(RAO)正常的冠状动脉（右前斜位）冠脉造影显示ImprovingLivesThroughmedicalinnovation冠脉造影显示LADnarrowing左前降支狭窄ImprovingLivesThroughmedicalinnovationLCXnarrowing左回旋支狭窄冠脉造影显示ImprovingLivesThroughmedicalinnovation冠心病的诊断方法ImprovingLivesThroughmedicalinnovation冠心病的治疗•药物治疗—被动治疗•减少心肌耗氧—硝酸酯,B阻滞剂,钙拮抗剂•抗凝、抗血小板—阿斯匹林,波立维,肝素、LEMH•其他—ACEI,降脂药•旁路手术---主动治疗•体外循环自身动脉不停跳微创杂交•介入治疗（PCI)---主动治疗ImprovingLivesThroughmedicalinnovation介入治疗（PCI)ImprovingLivesThroughmedicalinnovation冠心病的治疗PTCA:球囊扩张PTCA:支架植入CABG:外科搭桥ImprovingLivesThroughmedicalinnovationPTCA原理ImprovingLivesThroughmedicalinnovation支架术原理ImprovingLivesThroughmedicalinnovation冠状动脉造影是冠脉介入治疗的基础ImprovingLivesThroughmedicalinnovation冠脉狭窄程度的评价方法目测直径法计算机辅助定量法（QCA）冠脉内超声面积测定法ImprovingLivesThroughmedicalinnovation冠脉病变的形态学评价ImprovingLivesThroughmedicalinnovation冠脉病变的形态学评价ImprovingLivesThroughmedicalinnovation冠状动脉病变分型(ACC/AHA–美国心脏病学院/美国心脏学会分型1988)ImprovingLivesThroughmedicalinnovation冠脉造影评价TIMI（心肌梗死溶栓试验）血流分级TIMI0级无血流TIMIⅠ级有血流，但不能充盈远端血管床TIMIⅡ级经3个以上心动周期后可充盈TIMIⅢ级在3个心动周期内充盈远端血管床ImprovingLivesThroughmedicalinnovationPCI流程--术前准备•签署知情同意书•做好药物准备•备皮•碘过敏试验•术前禁食水•术前排空小便ImprovingLivesThroughmedicalinnovationPCI流程—手术基本过程连接心电图连接压力监测系统消毒、铺巾连接三联三通前：压力监测中：硝酸甘油10mg/100ml葡萄糖注射液后：造影剂ImprovingLivesThroughmedicalinnovationImprovingLivesThroughmedicalinnovation1.PCI流程—手术基本过程穿刺股动脉置入动脉鞘：尽可能一针见血ImprovingLivesThroughmedicalinnovation2.送入导引导管建立体外与冠脉的连接准备导引导管选择连接导引导管推动过程导...