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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,学习研究,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,心脏的病理生理,浙大儿院,1,学习研究,心脏的病理生理浙大儿院1学习研究,课程目标：,了解心脏正常的血液动力学,掌握SVCOEF的概念,分析心电图的阶段,明白心室压力和容量之间的关系,2,学习研究,课程目标：了解心脏正常的血液动力学2学习研究,病理生理老师,十年前是,NICU,的,护士长；,博士毕业后，到,学校任教,创建自己的,Lab,3,学习研究,病理生理老师十年前是NICU的3学习研究,4,学习研究,4学习研究,5,学习研究,5学习研究,心脏循环,(Wiggers diagram),主动脉压力,心房压,心室压,心室容量,心电图,心音,二尖瓣关闭,主动脉瓣开放,等容收缩期,射血,等容舒张期,心房收缩,6,学习研究,心脏循环 (Wiggers diagram)主动脉压力心房,Cardiac Cycle (Wiggers diagram),QRS,预示收缩期的开始,在,Q,波最高点时，,LV,开始收缩,三尖瓣关闭同时,LV,的压力超过,LA (S1),LV,容量没有改变，没有血流从,LA,到,LV,或者,LV,到,aorta,主动脉瓣打开，当,LV,压力超过主动脉的压力,7,学习研究,Cardiac Cycle (Wiggers diagra,Cardiac Cycle (Wiggers diagram),血液快速射入主动脉，冲击主动脉血管壁,LV,容量明显下降,T,波出现是在,LV,收缩的高峰（快速射血的末期），,LV,压力开始下降,LV,压力下降至低于主动脉压力，但是主动脉瓣不关闭仍旧有血液从,LV,流至主动脉,LA,压力上升，因为有血液灌入当,LV,射血期,8,学习研究,Cardiac Cycle (Wiggers diagra,9,学习研究,9学习研究,Cardiac Cycle (Wiggers diagram),主动脉瓣不会马上关闭尽管有压力梯度存在，因为惯性作用仍旧使得血流从,LV,流至主动脉,10,学习研究,Cardiac Cycle (Wiggers diagra,Cardiac Cycle (Wiggers diagram),舒张末容量,END-DIASTOLIC VOLUME (EDV),收缩,末容量,END-SYSTOLIC VOLUME,(ESV),EDV ESV =,STROKE VOLUME,每搏输出量,SV X HR =,CARDIAC OUTPUT,心输出量,EJECTION FRACTION =,SV/EDV,射血分数,11,学习研究,Cardiac Cycle (Wiggers diagra,Cardiac Cycle (Wiggers diagram),主动脉的关闭产生,S2,，同时开始进入等容舒张期,12,学习研究,Cardiac Cycle (Wiggers diagra,Cardiac Cycle (Wiggers diagram),:,LV,压力持续下降,LV,容量保持不变,LA,压力持续上升,13,学习研究,Cardiac Cycle (Wiggers diagra,Cardiac Cycle (Wiggers diagram),三尖瓣开放当,LA,压力超过,LV,压力,血液快速从,LA,流至,LV,LV,容量快速增加,LV,压力不增加,No increase in LV pressure,心休息期：减少,Diastasis: reduced filling phase; occurs before LA contracts,P wave,在心房收缩前出现,= LA,压力上升, LV,容量和压力轻度上升,14,学习研究,Cardiac Cycle (Wiggers diagra,Duration of Cardiac Cycle Phase,心脏循环阶段的时长,Heart Rate = 75 beats/min,Phase,阶段,Duration (sec),Atrial systole心房收缩,0.11,Isovolumetric Contraction等容收缩期,0.05,Ejection射血,0.26,Isovolumetric Relaxation等容舒张期,0.08,Rapid Inflow快速流入,0.11,Diastasis,0.19,Systole = 0.31 sec; Diastole = 0.49 sec,15,学习研究,Duration of Cardiac Cycle Phas,心电图意义,P,波,LA,收缩前出现,QRS,预示,LV,收缩期的开始,在,Q,波最高点时，,LV,开始收缩,T,波出现是在,LV,收缩的高峰（快速射血的末期），,LV,压力开始下降,16,学习研究,心电图意义P 波LA收缩前出现16学习研究,LA,压力与容量图,Page 47,二尖瓣开放,二尖瓣关闭,主动脉瓣开放,主动脉瓣关闭,17,学习研究,LA压力与容量图Page 47二尖瓣开放二尖瓣关闭主动脉瓣开,Point A,二尖瓣,开放,Segment AB,LV,灌流,; LV,压力,从,7 mm Hg,掉至,5 mm Hg,因为,LV,肌肉,继续放松，尽管有血液灌流进来,Segment BC,容量,从,70,ml,增加到,120 ml;,容量,虽然增加很多，但是压力增加很少,(,说明,了,LV,高顺应性,),Point C,二尖瓣,关闭，心室灌流结束，准备开始进入射血期,Page 47,18,学习研究,Point A 二尖瓣开放Page 4718学习研究,Question?,19,学习研究,19学习研究,
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