冠状动脉疾病
冠状动脉疾病(coronary artery disease,CAD)简称冠脉病[11][12],是冠状动脉结构和(或)功能异常,引起冠脉狭窄、痉挛、闭塞、动脉瘤、夹层的疾病[13][14][15]。冠脉病最常见由粥样硬化引起,其他尚有因痉挛、栓塞、炎症,及先天畸形等所致。由于冠脉病使心肌的血流灌注降低,轻可导致胸痛(心绞痛),重则引起心脏病发作(心肌梗死)。
冠状动脉疾病 coronary artery disease | |
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同义词 | Atherosclerotic heart disease,[1]atherosclerotic vascular disease,[2]coronary heart disease[3] |
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冠状动脉粥样(atherosclerosis)硬化示意图 | |
症状 | 胸痛、呼吸困难[4] |
并发症 | 心脏衰竭、心律不整[5] |
类型 | 动脉疾病[*]、心血管疾病、疾病 |
病因 | 心脏的动脉 粥样硬化[6] |
风险因素 | 高血压、吸烟、糖尿病、缺乏运动、肥胖症、高胆固醇血症[6] |
诊断方法 | 心电图、心脏压力测试, 冠状动脉血管电脑断层扫描, 冠状动脉血管摄影 |
预防 | 健康的饮食、规律运动、维持健康的体重、不吸烟[7] |
治疗 | 经皮冠状动脉介入治疗 (PCI), 冠状动脉旁路移植 (CABG)[8] |
药物 | 阿司匹林, β受体阻滞剂, 硝酸甘油[8] |
患病率 | 1.1 亿 (2015)[9] |
死亡数 | |
分类和外部资源 | |
医学专科 | 心脏病学、心脏外科 |
ICD-9-CM | 410-414.99、414.0、414.9、414.00 |
OMIM | 300464、607339、608316、608318、608320、610947、611139、612030、614293 |
MedlinePlus | 007115 |
eMedicine | 349040 |
冠状动脉心脏病(coronary heart disease,CHD[16][17])简称冠心病,是造成心肌缺血和(或)梗死的一组临床综合征,属于最常见的心血管疾病[18]。
临床上,冠脉病与冠心病两者范围常重叠且混用,但前者不一定具有心肌缺血或梗死,且可为后者的早期病变。简言之,冠脉病含盖范围较广,冠心病属于一种冠脉病[19]。冠脉病或冠心病有许多异名或近义词,如:心肌缺血(myocardial ischemia)、缺血性心脏病(ischemic heart disease,IHD)[20]、冠状动脉粥样硬化心脏病(coronary atherosclerotic heart disease,CAHD)[21][22]、冠状动脉粥样硬化心血管疾病[23]等等。
症状
编辑常见的症状包括胸痛或不适,有时会转移到肩膀、手臂、背部、颈部或下颚。有些人可能会有胸口灼热的感觉。通常症状在运动或情绪压力下出现,持续时间不超过数分钟且休息会缓解。有时会伴随呼吸困难,有时则是毫无症状[4]。少数人以心肌梗塞为最初的表现。其他可能的并发症包含心脏衰竭或心律不整[5]。
成因与诊断
编辑危险因子包括:高血压、抽烟、糖尿病、缺乏运动、肥胖、血液中胆固醇含量过高、营养不良和酗酒等[6][25]。其他的危险因子也包括忧郁症[26]。潜在的病理机制与冠状动脉血管的粥状硬化有关[6]。心电图、心脏压力测试与冠状动脉血管摄影(一种血管摄影)是常见有助于诊断的工具[27]。
预防与治疗
编辑预防方式包括:健康饮食、规律运动、体重控制以及戒烟[7]。视情况合并使用药物控制高血糖、高胆固醇或高血压[7]。只有很有限的证据支持对低风险且没有症状的民众实施筛检[28]。
由于冠状动脉是主动脉的分支,负责供应足够氧和营养素予心肌,当冠状动脉被胆固醇或血凝块阻塞时,会形成斑块而引致心脏供血不足。最初治疗和预防措施一样,包括生活方式调整以及三高(高血糖、高胆固醇或高血压)的控制[8][29]。进一步的药物治疗包括阿司匹林、乙型交感神经阻断剂或硝酸甘油的医疗用途[8]。在病况较严重的情形下,会考虑进行经皮冠状动脉介入治疗或是冠状动脉绕道手术[8][30]。对于稳定型心绞痛,经皮冠状动脉介入治疗或是冠状动脉绕道手术,对于提升存活年限或降低未来心脏病发的效果仍不明确[31]。
冠状动脉球囊粤语称“通波仔”,冠状动脉球囊成形术是以气球(球囊)扩张冠状动脉,使之畅通。若冠状动脉血液被严重阻塞,可引致很严重的后果。血液不能供应到心脏会引致剧烈的心绞痛,然后心脏会衰竭,最严重的可导致死亡。当冠心病发作时,须立即口含医师处方的“脷底丸”(粤语舌下丸之义),其可扩张血管,以增加冠状动脉血流量。冠心病发作可引致严重后果,应立即叫救护车求助。
健康的生活方式
编辑- 卡德维尔·爱色斯坦与科林·坎贝尔证明,素食对改善冠心病和动脉硬化有很大效果。他们的同事也从许多研究中确认,素食使得许多患者的病情得以停止发展,甚至出现好转[32][33]。此类建议(增加素食,减少荤菜)已经在至少50年前就被提出了[34][35]。
- 控制体重
- 停止吸烟、酗酒
- 锻炼
- 适量的鱼油(尤其是海鱼,如金枪鱼、三文鱼)摄入,以补充ω−3脂肪酸[36]
药物治疗
编辑手术治疗
编辑流行病学
编辑冠状动脉疾病在公元2002年是全球第一大死因[38],也是人们住院的主要原因之一[39]。2013年也是全球死因首位,死亡人数自1990年574万人(12%)攀升至2013年814万人(16.8%)[18]。而随着诊断及治疗技术进步,经年龄校正后的冠状动脉疾病死亡率自1980年至2010年则呈现下降趋势,尤其在发达国家更为显著[40]。同时经年龄校正后的冠状动脉疾病病例数在1990至2010年间亦呈现下降趋势[41]。根据美国本土于2010年统计,冠状动脉疾病盛行率于大于65岁族群为20%、45至64岁为7%、18至45岁为1.3%。针对同一年龄层相比,男性的发生率较女性高[42]。
参考资料
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外部链接
编辑- Risk Assessment of having a heart attack or dying of coronary artery disease, from the American Heart Association.
- Coronary Artery Disease. MedlinePlus. U.S. National Library of Medicine. [2022-05-03]. (原始内容存档于2020-07-29).