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高血脂与心脑血管疾病课件_1

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高血脂 脑血管 疾病 课件 _1
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As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 高血脂与心脑血管疾病 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病致残 致死率高 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 很多熟知的人都死于心脑血管疾病 高秀敏 古月 梁左 悲剧时刻有可能在你我身边上演 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 什么是心脑血管疾病 心脑血管疾病主要包括冠心病和脑卒中 冠心病 心绞痛 心肌梗死 心源性猝死 脑卒中 脑血栓 脑栓塞 脑出血 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病与哪些因素有关 不可变的因素 年龄 随着年龄增高发病率增加 性别 男性高于女性 冠心病家族史 中国高血压防治指南 2005 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病与哪些因素有关 高胆固醇血症 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 高胆固醇血症是重要危险因素 高胆固醇增加冠心病和中风危险 美国一项研究发现 总胆固醇高于300毫克 分升者 90 可发生冠心病 亚太地区的一项研究发现 总胆固醇每增高 1mmol L 缺血性卒中增加25 赵水平 临床血脂100问 第32 33页 Int J Epidemiol 2003 32 563 572 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 高胆固醇血症怎样导致心脑血 管疾病 坏 胆固醇 LDL C 可沉积在动脉壁中形成斑 块 斑块有 稳定斑块 和 不稳定斑块 图 稳定斑块 皮厚馅小 不易破裂 冠心病 心绞痛 心肌梗死 脑卒中 脑血栓 图 不稳定斑块 皮薄馅大 容易破裂 形成血栓 急性心肌梗死 猝死 脑 栓塞 血管变 窄或缓 慢堵塞 血管突 然堵塞 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 降低心脑血管疾病危险重在预防 防发病 一级预防 在发病前 对多种危险因素进行综合控制 防事件 二级预防 已发生过冠心病 脑卒中的 防止急性心肌 梗死 猝死等急性事件发生和卒中的再发 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 降胆固醇治疗可防止发病 降胆固醇治疗可使血液中 坏 胆固醇减 少 防止斑块形成 从而可减少稳定斑 块导致的冠心病和脑卒中发生 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 降胆固醇治疗可防止急性事件 降胆固醇治疗可使不稳定斑块变得稳定 减少斑块破裂风险 从而防止急性心 肌梗死 猝死 急性脑卒中事件的发生 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 降胆固醇治疗减少心脑血管疾病 发生 胆固醇每降低1 冠心病的危险可降低 2 最近许多研究发现 降胆固醇治疗可减 少脑卒中的发生 血脂异常防治指南 1997 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 积极降胆固醇治疗 防治心脑疾病 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 怎样进行降胆固醇治疗 积极与医生沟通 了解自己正常的胆固 醇水平是多少 合理选择降胆固醇药 已发生心脑血管疾病者降胆固醇应该更 积极 长期控制血胆固醇达标 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 看看自己的血胆固醇应降到什么 水平 TC mg dL LDL C mg dL 0 1个危险因素 240 160 2个及以上危险因素 200 130 冠心病 糖尿病 卒中 高血压压 3个危险险因 素 160 100 急性冠脉综综合征 介入术术 后 冠心病 糖尿病 卒 中 糖尿病 120 80 2006年中华心血管病年会 厦门 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 如何选择理想降胆固醇药物 常用的降脂药有4类 胆酸螯合剂 烟酸及其衍生物 其中 他汀类是最理想的药物 他汀类 贝特类 赵水平 临床血脂100问 第43 44页 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 选择他汀类药物的理由 证据最充分 从1994年至今 他汀类药物积累了丰富的临 床研究证据 降胆固醇疗效最强 具有对血管的保护作用 可以预防冠心病 中风的发生 可以延长寿命 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 他汀类药物对冠心病 中风的预 防 使用他汀类药物降胆固醇治疗 可减少 重要冠心病事件34 他汀类药物可使中风降低21 胡大一 健康未来从 心 开始 第52页 Amarenco P et al Stroke 2004 35 2902 2909 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病者降脂应该更积极 心脑血管疾病患者 疾病再发的风险更 大 应该更积极的进行预防 积极降脂可有效预防心脑血管疾病再发 在一项研究中 一组冠脉综合征患者接受标 准降脂治疗 另一组接受更积极的强化降脂 治疗 结果强化降脂组比标准降脂组主要心 脏事件减少了16 PROVE IT研究 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病者如何积极降脂 使用他汀类药物要足剂量 LDL C一定要达到目标水平或目标幅度 2006年中华心血管病年会 厦门 患者类型LDL C目标LDL C降低幅度 冠心病 卒中者 100mg dL30 40 急性冠脉综合征 冠 心病 糖尿病 卒中 糖尿病者 40 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 为什么降胆固醇一定要达标 只有胆固醇达标 才能有效降低心脑血 管疾病再发 在一项达标研究中 冠心病患者血脂达到 LDL C 100mg dL的目标 与未达标的病人 相比 总死亡率和各种心脑血管事件均降低 50 左右 GREACE研究 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 血胆固醇达标后能停药吗 千万不要随便停药 高胆固醇血症是一种慢性代谢异常 目前只能 靠药物控制 如果停药 多数病人在1 2周后 血脂又回升到治疗前水平 降胆固醇治疗的目的是防止心脑血管疾病 降 胆固醇药只有长期服用才能达到这一目的 如果胆固醇达标 应与医生沟通 听从医生指 导 赵水平 临床血脂100问 第90页 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 他汀服用时间越长获益越多 在一项研究中 LDL C水平相等的情况 下 他汀服用时间与获益的关系 他汀服用时间心脏事件的降低 1 2年6 3 5年19 6年21 Law MR et al BMJ 2003 326 1423 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 哪些卒中患者需要强化 他汀治疗 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 小动脉疾病 大动脉粥样硬化 心源性栓塞 其他原因 缺血性卒中亚型 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 梗死面积往往比较大 病人有房颤 病史 心电图 Holter 心源性栓塞 超声心动不一定还有附壁血栓 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 病理 动脉粥样硬化 高危因素 高血脂 高血压 吸烟 糖尿病 强化他汀治疗 大动脉粥样硬化性 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year NCEP ATPIII 动脉粥样硬化性卒中 TIA应按冠心病等危症处理 Meadows TA et al Circ Res 2007 100 1261 1275 脑动脉粥样硬化性卒中脑动脉粥样硬化性卒中 TIA TIA 冠心病 心绞痛 心梗 肾动脉狭窄或堵塞 外周动脉疾病 NCEP ATPIII 动脉粥样硬化是一种 全身系统性疾病 基 于动脉粥样硬化性的 卒中 TIA应作为冠心 病的等危症处理 Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults JAMA 2001 285 2486 2497 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 2008AHA ASA二级预防指南 基于SPARCL研究的证据 对于动脉粥样 硬化性卒中或TIA的患者 即使无冠心病 病史 也推荐强化降脂治疗 以降低卒中 和心血管事件风险 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 病理 脂质透明样改变 腔隙 梗死灶 高危因素 高血脂 高血压 糖尿病 他汀治疗 小动脉病变 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 基底节 腔梗样 梗死不一定都是小血管病变 小 腔梗 未必都是小血管病变 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 大脑中动脉狭窄导致穿支闭塞 小动脉闭塞 MCA狭窄所致基底节孤立梗死灶与 经典腔梗有什么不同 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 大动脉病变大梗死大动脉病变小梗死 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 小动脉病变小梗死 小动脉病变大梗死 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year CT 腔梗 DWI 多发梗死灶 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 小动脉疾病 大动脉粥样硬化 心源性栓塞 10 20 40 50 20 30 其他原因 10 他汀治疗的卒中患者 小动脉疾病 大动脉粥样硬化 60 80 他汀治疗 强化他汀治疗 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 长期服用他汀安全性勿庸置疑 很多研究均证实 他汀长期服用是安全的 他汀类药物的研究 从数月至数年不等 其中很多研究在3 5年之间 有的研究进行了10年之久 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 服药期间定期复查 在开始服用他汀类药物后4 6周 要复查 血脂 调整用药 胆固醇水平正常后 要坚持服药 定期 复查 一般为6个月 1年复查一次 赵水平 临床血脂100问 第89页 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 支架或搭桥术后还需降胆固醇治疗 吗 此时更应降胆固醇治疗 因为支架或搭桥手术只是对已发生堵塞 血管的治疗 而斑块遍布全身血管 随 时有再发心梗的可能 支架或搭桥术后 应长期坚持降胆固醇 治疗 使LDL C降至 80mg dL 从而控 制斑块进展 2006年中华心血管病年会 厦门 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 降胆固醇同时积极治疗其它危 险因素 降胆固醇同时应积极治疗其它危险因素 使发生心脑血管事件的风险降至最低 如 控制高血压 控制糖尿病 控制肥胖 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 改善生活方式 合理膳食 适量运动 戒烟限酒 控制体重 心理平衡 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病患者的膳食 不要暴饮暴食 暴饮暴食会增加心脏负担 减少脂肪 胆固醇的摄入 减少盐的摄入 多吃蔬菜 水果 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 心脑血管疾病患者怎样运动 选择有氧运动形式 运动强度不要过强 每周运动3 5次 每次持续20 60分钟 冠心病患者应在医生指导下运动 中风患者不要在早晨运动 因为早晨血 压容易波动 易诱发中风 中国高血压防治指南 2005 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 戒烟限酒 吸烟是心脑血管疾病的重要危险因子 一定要戒烟 过量饮食会使心脏兴奋性增加 极易诱 发急性心脏事件 心脑血管疾病患者最 好不饮酒 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 注意心理平衡 当精神紧张 激动或愤怒时 会诱发心 绞痛 心肌梗死或中风 因此 心脑血 管疾病患者一定要注意缓解精神压力 保持心理平衡 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 出现下列现象要警惕冠心病 反复发作的左肩痛 经一般治疗反复不 愈 劳累或紧张时 突然出现胸骨后或左胸 部疼痛伴出汗 性生活时感到心跳 胸闷或胸痛不适 As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year As the only big agricultural village in Tianding Township some achievements have been made through the beneficial exploration of villagers autonomy in family planning for more than a year 积极降胆固醇治疗 保护心脑健康
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