血液循环Blood Circulation

夏 强， PhD浙江大学医学院生理学系医学院科研楼 C 座 518 室

电话： 88208252Email ： xiaqiang@zju.edu.cn

心血管系统• 心脏 Heart• 血管系统 Vascular system• 血液 Blood

血液分布• 安静，舒适状态人体

心 脏Heart

• 泵血 Pumping• 内分泌 Endocrine

• 心肌类型：– 心房肌– 心室肌– 特殊传导系统

收缩细胞

自律细胞

特殊传导系统

心肌兴奋顺序

心脏各部分心肌细胞的跨膜电位

心室肌的动作电位

自律细胞的动作电位

• 窦房结 P 细胞

• 浦肯野细胞

心电图Electrocardiogram (ECG)

• 心电图中导联的位置

0.04 sec

ECG interpretation•Measurements •Rhythm analysis•Conduction analysis•Waveform description •Comparison with previous ECG (if any)

Normal

Partial block

Complete block

心肌的兴奋 - 收缩偶联Excitation-Contraction Coupling in Cardiac Muscle

心动周期Cardiac cycle

收缩期 Systole

舒张期 Diastole

心 音Heart Sounds

• 第一心音 1st sound– soft low-pitched lub– associated with closure of the AV valves– Marks the onset of systole

• 第二心音 2nd sound– louder dup– associated with closure of the PA and aortic valves– Occurs at the onset of diastole

Four traditional value areas – Aortic space: 2RIS – Pulmonic valve: 2LIS – Tricuspid valve: 4ICS LLSB– Mitral valve: Apex

RIS--right intercostal spaceLIS—left intercostal space ICS--intercostal space LLSB--left lower sternal border

血管生理Vascular Physiology

动脉血压Arterial blood pressure

• 血压测量– 直接有创法

• 血压测量– 间接无创法

Blood Pressure Classification Chart

Category Systolic (mm Hg) Diastolic (mm Hg)

Normal Lower than 120 Lower than 80

Prehypertension 120 - 139 80 - 89

Hypertension

Stage 1 140-159 90-99

Stage 2 160 or higher 100 or higher

Adapted from The Seventh Report on the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), NIH Publication No. 03-5233, May 2003

The classification chart is based on adults, aged 18 and older, who are not taking high blood pressure medicines and who are not acutely ill. If systolic and diastolic measurements fall into different categories, the higher category should be used to classify the person's blood pressure status.

Classification of blood pressure for adults age 18 years and older

JNC 8?

中国高血压防治指南（ 2005 ）

• 2014 Hypertension Guideline Management Algorithm

• http://jama.jamanetwork.com/article.aspx?articleid=1791497

动脉脉搏 Arterial pulse

微循环Microcirculation

• 主要功能：– 物质交换

• 毛细血管 Capillaries

EFP

Pc

静脉血压Venous pressure

At rest, approx. 60% of the total blood volume is in the veins. Sympathetically mediated venoconstriction can substantially increase venous return to the heart.

Varicose vein

淋巴系统Lymphatic System

Elephantiasis:

Chronic, often extreme enlargement and hardening of cutaneous and subcutaneous tissue, especially of the legs and external genitals, resulting from lymphatic obstruction and usually caused by infestation of the lymph glands and vessels with a filarial worm.

呼 吸Respiration

肺通气Pulmonary ventilation

Thorax & respiratory muscle

Primary muscles of respiration: external intercostals & diaphragm

The Heimlich maneuverincreases the alveolar pressure (Palv) by supplementingthe upward movement of the diaphragm, thus compressing the thoracic cavity to dislodge foreign objects in the airways.

气胸Pneumothorax

• Air escapes from the lungs or leaks through the chest wall and enters the pleural cavity

Lateral Bilateral

气体交换

Hemoglobinis the gas-transportmolecule inside erythrocytes.

发绀 Cyanosis

• Hb>50g/L

Carbon monoxide poisoning

• CO competes for the O2 sides in Hb

• CO has extremely high affinity for Hb

OO22

OO22 OO22COCO

COCOCOCO

呼吸调节

谢谢专注！