颈动脉斑块与冠心病患者教育解读.ppt

什么是颈动脉斑块？ 造成颈动脉斑块的原因 导致动脉粥样硬化的危险因素均可导致颈动脉斑块形成，如年龄、性别、家族中有心脑血管疾病患者、高总胆固醇、高低密度脂蛋白、高甘油三酯血症、肥胖、高血压、糖尿病、吸烟等。 如果存在以上多项危险因素，出现颈动脉斑块的几率会明显增加。 颈动脉斑块的危害 导致脑梗死 颈动脉斑块的危险主要在于不稳定斑块，也就是在血管壁上不牢固容易脱落的斑块。当斑块整块或者部分脱落后就成了血流中的栓子，随血流到达大脑堵塞远端脑动脉，导致栓塞事件。根据堵塞血管的大小及堵塞的时间会导致不同的结果。 小血管堵塞症状较轻或者无症状，大血管堵塞会导致突发的偏瘫、失语等症状。堵塞时间短的，会出现一过性的言语不清、头晕、肢体麻木或者无力。 如何处理颈动脉斑块？ 积极控制危险因素：高血压，糖尿病，高血脂 改变不健康生活方式：吸烟，酗酒 药物治疗：根据个人具体情况可选择抗血小板药物，如阿司匹林预防心脑血管疾病。亦可使用控制和减缓颈动脉斑块进展的药物，目前经临床研究证实有效的药物有他汀类降脂药物如辛伐他汀，以及普罗补考和叶酸等。 手术：严重的颈动脉狭窄有时需要做颈动脉内膜剥脱术或支架手术。 定期体检：定时查体可观察斑块的大小和性质，并及时咨询神经内科医师，调整药物，以控制病情发展。 因此目前认为动脉粥样硬化的始动环节是内皮功能异常、早期表现是泡沫细胞形成、关键环节是LDL的氧化修饰。 The primary event in atherosclerosis is thought to be damage caused to the endothelium of arterial walls, resulting in endothelial dysfunction. This damage may be caused by a variety of factors; haemodynamic forces (shear stress caused by e.g. hypertension), a number of vasoactive substances, mediators (cytokines) from blood cells, cigarette smoke, atherogenic diet, elevated glucose levels and oxidised LDL cholesterol.1 Initially, damage causes the endothelial cells to express cellular adhesion molecules such as cytokines (interleukin-1, IL-1; tumour necrosis factor alpha, TNF-alpha), chemokines (monocyte chemoattractant factor 1, MCP-1; IL-8) and growth factors (platelet-derived growth factor, PDGF; basic fibroblast growth factor, bFGF).1 This ‘sticky’ surface encourages inflammatory cells such as monocytes and T lymphocytes to attach to the endothelial surface. Once attached they migrate through the intact endothelium into the subendothelial space. Many of the monocytes differentiate into macrophages and take up oxidised LDL, which is more atherogenic than native LDL; these macrophages then become foam cells.1 Oxidised LDL promotes death of endothelial cells and an inflammatory response resulting in impairment of normal function of the endothelium. In addition, it modifies the response to angiotensin II, resulting in vasodilatory impairment, and induces a prothrombic state