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Circulatory system 循環系統 本章重點: ‧循環系統的定義 ‧血液的組成 ‧各種血球之構造與功能 ‧心臟的基本構造與功能 ‧冠狀循環組成與功能 ‧心臟傳導系統的組成與功能 授課老師 : 解剖學科白滿惠 學校分機:3262

Email:pai0507@tmu.edu.tw


Circulatory system •Cardiovascular system 心血管系統

•Blood : carry materials •Heart : pump blood •Vascular system : transport

•Lymphatic system 淋巴系統

•Lymph: carry materials •Organs : thymus, spleen, lymph nodes, red bone marrow , diffuse lymphatic tissue (immune system) •Vascular system (vessels) : transport


Functions of the Circulatory System Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

1.Transportation運輸 2.Regulation 調節 • body temperature • pH levels • maintain normal fluid level

3. Protection 保護 Blood clotting  Immunity –antibody, WBC 


Blood

血液

•is a sticky fluid •about 38 0C •pH range is 7.35~7.45 •8% of body mass • consists of plasma and blood cells

血漿

Translucent, yellowish, and viscous supernatant

45%

(定形成分) 紅血球

Blood cells


Blood plasma (血漿) Electrolytes, glucose, gases, waste products……… Yellowish

•92% water

Blood plasma

•7% plasma proteins •1% other solutes •albumins 58% 白蛋白: 調節滲透壓 •globulins 37% 球蛋白    : transport lipid : 參與免疫反應 (immune response) •fibrinogen 4% (blood clotting凝血) 纖維蛋白原

* Serum血清不等於 plasma

• regulatory proteins 1% - enzyme, hormones….etc.


Blood plasma


Blood cells 45%

1. 紅血球erythrocytes (1cc約420到620萬個) 2. 白血球leukocytes (1cc約5000到1萬個) 3.血小板platelets (1cc約12到30萬個)

•Hematocrit 血球容積 –is an estimate of the volume of packed erythrocytes per unit volume of blood.(紅血球 在血液中所占的體積) - In male : 39%~54% - In female : 36%~47%


globin

Heme

Biconcave disk (facilitate oxygen exchange)

Fe2+ (four polypeptide chains; O2 carrying protein)

Erythrocytes •無核也無胞器 •呈雙凹盤狀(利於氣體交換) •功能 : 運送O2及CO2 •主要成分 : 33% hemoglobin

血紅素

= heme (contain Fe2+) + globin

•Reticulocytes 網狀紅血球: 未成熟的紅血球 無核 佔1%循環紅血球 •Anemia貧血 : 血液中血色素濃度低於正常值 (男:13.5~17.5g/dl, 女:12~16g/dl)


RBC life cycle

Life span 100~120夊, Destroyed in liver and spleen


Blood Types

血型

-Proteins (surface antigen or agglutinogens凝集素) on RBC 1. A and B antigens - ABO blood types 2. Rh factor - Rh blood types * Rh incompatibility (Rhmother with Rh+ fetus)


Transfusion

Type B

•Blood types must be compatible for blood transfusion from donor to patient •Safest transfusion is same blood type •Type O blood can be given to any ABO type (universal donors) •Type AB blood can receive any ABO type •incompatibility


顆粒白血球 (

白血球

3

have specific granules in the cytoplasm

嗜中性白血球

)

無顆粒白血球 (

- 比紅血球大 - 具有核跟粒線體等 胞器 為正式的細胞 - 在血流中無功用

嗜酸性白血球 嗜鹼性白血球

lack specific granules

(無顆粒白血球) 淋巴球

2 )

單核球


(Barr body)

Neutrophils (直徑10~14 m)

Eosinophils 嗜酸性球 (直徑 10~14 m) 嗜中性球 •佔2~4% of total WBC •數量最多的白血球 •細胞核為雙葉 (bilobed) •單核多葉 (約2 to 5 葉) •含有大型嗜酸性顆粒acidophilic •含有豐富嗜中性顆粒neutrophilic specific granules granules •可調節局部過敏反應 •吞噬摧毀細菌 (急性感染時量多) •吞噬antigen-antibody •in female: Drumstick appendage complexes or 巴氏體 barr body •kill certain parasites


Basophils

嗜鹼性球

(10~12 m in diameter) •數量最少 (0.5~1% of total WBC count) •嗜鹼性顆粒specific granules contain histamine and heparin •具有吞噬性 •可引發全身性過敏反應

Monocytes 單核球 (直徑14~24 m)

•最大的白血球 •細胞核呈圓形腎形或馬蹄形 •細胞質內無特殊顆粒 •具吞噬性 •移行到周圍組織後即特化為巨 嗜細胞 macrophage


Cell-mediated response

humoral-mediated response

Lymphocytes 淋巴球 • 佔20~40% of total WBC count (數量次多) • 細胞質內無特殊顆粒 •Large lymphocyte (14~18 m in diameter) •medium lymphocyte (10~12 m in diameter) •small lymphocyte (6~8 m in diameter) : mature • Small lymphocyte –immunological responses (B lymphocyte and T lymphocyte)

lymphocyte


Summary of WBC


Platelets (thrombocytes)血小板

巨核細胞

•are nonnucleated, disklike cells •直徑: 2~4m •壽命: 10天 •功能 : 凝血 (blood clotting) •來源 : 為megakaryocyte巨核細胞細胞質 碎片 (直徑約30~100m; Giant cells of red bone marrow)


Hemopoiesis

血球生成作用

- Formation of blood cells • Red bone marrow - the site of hemopoiesis • All blood cells arise from a single type of stem cells in the bone marrow–hemocytoblasts 血胚母細胞


Cardiovascular system

心血管系統

1. Blood : carry materials 2. Heart : pump blood 3. Vascular system : transport

Characteristics of Heart: •heart beats : 75/min •cardiac output : 5.25L/min (at rest) •unidirectional blood flow •generation of blood pressure


Heart

(250~300g)

base

Position of heart : - is in the middle mediastinum中縱膈of thoracic cavity胸腔 - Superior border : base (基部;約在2nd rib) 為上方有大型 血管進出的地方 - inferior border : 躺在橫膈(diaphragm) 上表面 - 心尖(apex)偏向中線左側 (約第5,6肋骨之間) - 被心包膜(pericardium)包裹


Heart coverings and heart wall A. Pericardium心包膜 - 為三層囊狀構造, 下方附著於橫膈上 1. 纖維性心包膜(fibrous pericardium) : - 緻密結締組織形成可固定心臟 2.漿液性心包膜 (serous pericardium) - 又可分為壁層(parietal layer)與臟層 (visceral layer) 漿液性心包膜 - 心包腔(pericardial cavity)位於壁層 與臟層漿液性心包膜之間, 有潤滑液 可減低心跳時的摩擦 B. Heart wall 1.心外膜 (epicardium) : 即為臟層漿液 性心包膜(visceral pericardium) 2.心肌層(myocardium) : 構成心臟壁 的主要部分 3.心內膜(endocardium) : 內襯心臟腔 室可形成瓣膜(valve)


Anatomy of the Heart A-atrium ;V-ventricle

LA

mitral valve

RA

tricuspid valve

LV RV

- 上有左、右心房(藉由心房中隔

interatrial septum分隔),

心耳 (auricle)

- 下有左、右心室(藉由心室中隔

interventricular septum分隔)

- 心室中隔在表面形成前、後室間溝 (interventricular sulcus) - 心房心室之間的表面界線為冠狀溝(coronary sulcus) - 右心房下方經由三尖瓣(tricuspid valve; 右房室瓣) 開口於右心室 - 左心房下方經由二尖瓣(mitral valve; 僧帽瓣) 開口於左心室


Right Atrium右心房 auricle心耳

• 可接收體循環回流與心肌本身的缺氧血(venous blood) • 3 openings : superior vena cava(回收上半部血液) 、 inferior vena cava(回收下半部血液) 、coronary sinus (回收心臟血液)

• posterior wall is smooth • anterior wall and auricle exhibit obvious pectinate muscles梳狀肌 and crista terminalis • 內面 : 心房中隔上有fossa ovalis


Right Ventricle

右心室

•形成心臟大部分的前表面 •內壁上有許多trabeculae carneae(心肉柱) •3 cone-shaped papillary muscles(乳頭肌) anchor numerous chordae tendinae(腱索)與tricuspid valve(三尖瓣) 瓣尖處相接 •透過三尖瓣接收來自右心房 的血液,並且將其打入 pulmonary trunk (肺動脈幹) •右心室與肺動脈幹之間有 Pulmonary semilunar valves(肺動脈半月瓣) block blood backflow


Left Atrium左心房 auricle心耳

•形成心臟部分的後面,接受來自肺臟的充氧血 (oxygenated blood) •外面有 auricle心耳 (有pectinate muscles) •The smooth posterior wall contains openings for 4 pulmonary veins •經由二尖瓣(bicuspid valve or mitral valve) 開口至左心室


Left Ventricle左心室

• 主要位在心臟下後面,可形成apex心尖 • 此處心肌最厚 (generate enough force to push blood) • 可將血液經過主動脈半月瓣aortic semilunar valve打入體循環的升主動脈 • 內壁上有許多心肉柱 (trabeculae carneae) • 乳頭肌papillary muscles由壁突入心室腔內藉 腱索 chordae tendinae與二尖瓣瓣尖處相接


心臟瓣膜的位置 right

瓣膜閉鎖不全 - 心雜音 ( heart murmur)

left


Heart sound

•心室收縮 房室瓣關閉 產生第一心音 (lub) •心室放鬆 半月瓣關閉 產生第二心音 (dup)


Summary of heart chambers


Coronary Circulation of the Heart冠狀循環 •供應心臟本身 •起源於升主動脈 ascending aorta基 部 主要走在冠狀溝 前後室間溝 •左冠狀動脈可分為前室間溝動脈與 迴旋動脈 •右冠狀動脈可分為後室間溝動脈與 邊緣動脈 •心靜脈可將來自心臟壁的缺氧血送 至右心房 •心靜脈有三大分支可注入冠狀竇 : 大 心靜脈 、中心靜脈 、小心靜脈 •前心靜脈直接注入右心房


Conducting system

傳導系統

- Cardiac muscle cells are specialized to initiate and conduct muscle impulses to the contractile muscle cells of the myocardium - 5 components : 1. sinoatrial node (SA node )竇房結 - 位於右心房上腔靜脈入口附近 - act as the pacemaker (每分鐘70~80次) 2. atrioventricular node ( AV node)房室結 - 位於右心房三尖瓣附近 3. atrioventricular bundle or bundle of His 房室束 4. bundle branches束分支 5. Purkinje fiber 浦金氏纖維 - 位於心室心內膜最深層


Cardiac cycle : - A complete contraction and relaxation of the heart (heartbeat)

Steps of the cardiac cycle


Electrical Activity of the Heart Electrocardiogram (ECG) 心電圖 •Electrical impulses through the heart •P Wave –SA node activation •QRS Complex –The beginning of depolarization of the ventricles (atria repolarize) •T Wave –Ventricular repolarization http://www.youtube.com/watch?v=nK0_28q6WoM&NR=1


Innervation of the Heart (cardiac center)

A.心臟受自主神經系統控制(autonomic nervous system) 1. 交感神經系統 : 由sympathetic ganglion交感神經節到達心臟 可增加心臟收縮的速率與強度 2. 副交感神經系統 : 起源於vagus nerve迷走神經 可減緩心跳速率 B.心跳中樞 位於reticular formation of medulla 延腦網狀結構 - can increase or decrease the rate of the heartbeat


Cardiovascular system 心血管系統 1. Blood : carry materials 2. Heart : pump blood 3. Vascular system : transport

Blood vessels

血管

•is a closed-loop system •transport O2, CO2, nutrients, hormones, and waste products to and from body tissue •依流向可分為Artery 動脈(離心), vein 靜脈(回心) •capillary 微血管可連接動靜脈


Principal Arteries of the Body

Vascular system 1. 肺循環 Pulmonary Circulation –Between heart and lungs –獲得氧排出二氧化碳 –佔全身血液12% 2. 體循環 Systemic Circulation –組成有全身血管 (not including lungs) –可將含氧血自心臟左心室送至 全身再回收全身靜脈血 3. 冠狀循環Coronary Circulation –Vessels of the heart –供應心臟本身心肌 4. 胎兒循環 fetal circulation


Pulmonary Circulation 肺循環;小循環 •攜帶血液進出肺臟 •肺動脈幹pulmonary trunk帶缺氧血由右心室離開心臟 (此時肺動脈幹位於 主動脈前方) •肺動脈幹往上走在主動脈左側分支成左右肺動脈(pulmonary arteries) •肺動脈由肺臟縱隔面進入肺根並分支成數條葉動脈(lobar arteries; 左二右 三) •含氧血由肺靜脈(pulmonary veins)注入左心房 •Function : 藉此獲得氧並將二氧化碳排出


Systemic Circulation 體循環;大循環 • 組成包括全身血管(not including lungs) • aorta可將含氧血自心臟左心室送 至全身;是身體最大的動脈 • 主要的體動脈都源自於主動脈 • 再回收全身靜脈血經superior and inferior vena cava入右心房 • Aorta 可分成四個主要部分 1.Ascending aorta升主動脈 2.Aortic arch主動脈弓 3.Thoracic aorta胸主動脈 4.Abdominal aorta腹主動脈 (3、4二者又合稱為Descending aorta降主動脈)

Principal Arteries of the Body


Ascending aorta 升主動脈

Ascending aorta

- 起源於心臟左心室(位於肺動脈幹後方) - 其分支有左右冠狀動脈 (Right & Left coronary arteries) 可形成冠狀循環(Coronary circulation)供應心肌


Aortic arch 主動脈弓

• 位於manubrium of sternum後方 • 動脈韌帶(胎兒時的動脈導管遺跡)可連接主 動脈弓與肺動脈幹 • 有三個主要分支 : 1. brachiocephalic trunk頭臂動脈幹 - 在頸根 部分為右總頸跟右鎖骨下動脈

2. Left common carotid artery左總頸動脈 3. Left subclavian artery左鎖骨下動脈 • 供應頭頸部 上肢跟胸壁上半部

Aortic arch


Common carotid artery

總頸動脈

- Course up ward in the neck along the lateral side of the trachea - Major arteries of the Head & Neck - Bifurcation occurs at the superior border of the thyroid cartilage 1. External Carotid artery 外頸動脈 –8 main branches –Supply head and neck 2. Internal Carotid artery 內頸動脈 –Enters carotid canal of temporal bone –Supply internal skull structures (brain)


外頸動脈 External carotid artery - Supply head and neck

1. Superficial temporal a. 淺顳 - to the entire scalp region

2. Maxillary artery 3. Facial artery

上頜動脈

顏面動脈

- to the skin and the muscles of face

4. Lingual artery

舌動脈

5.Ascending pharyngeal a. 升咽 6.Superior thyroid a. 上甲狀動脈 7. Occipital artery 枕動脈 - to posterior region of the scalp

8. Posterior auricular a.

後耳


內頸動脈

Internal Carotid artery

•enter the cranial cavity through the carotid canal •Supply brain and eye •Three important vessels 1. ophthalmic a. 眼動脈 2. anterior cerebral a. 前大腦動脈 - anterior communicating artery 3. middle cerebral a. 中大腦動脈


Subclavian artery 鎖骨下動脈

1.

3. Inferior thyroid a.

4.

2.


椎動脈 (vertebral artery)

- Arise from subclavian a. - 沿著頸椎橫突孔上行 經由枕骨大孔foramen magnum進 入顱腔 - 兩邊的椎動脈進入顱腔後會合形成單一的基底動脈 basilar artery


Internal thoracic artery 內胸動脈

•Arise from subclavian a. •descend into the thorax

Internal thoracic a.

•serve the thoracic wall, thymus, pericardium, the mediastinum, and the diaphragm •is divided into superior epigastric artery and musculophrenic artery

Superior epigastric artery

Musculophrenic artery


(3)

(2)

Thyrocervical trunk 甲狀頸動脈幹 - inferior thyroid, suprascapular, transverse cervical Costocervical trunk 肋頸動脈幹 - Deep cervical and superior intercostal


Arteries of the Shoulder & Upper limb - Originates with subclavian artery

- Axillary a. 腋動脈 continues from subclavian artery (clavicle為分界) - Brachial a. 肱動脈continues from axillary artery (teres major為分界) - Ends as radial a. 橈骨動脈 and ulnar a. 尺骨動脈 (around elbow fossa)


1st part

Branches of Axillary artery

胸肩峰動脈

1.superior thoracic a.: runs along the upper border of pectoralis minor (to supply 1st and 2nd intercostal space)

2nd part

上胸動脈

3rd part

外側胸動脈 後旋肱動脈

肩胛下動脈

1.thoracoacrominal a.: pierces the clavipectoral fascia and divides into 4 terminal branches 2.lateral thoracic a. : runs along the lower border of pectoralis minor (supply to serratus anterior) 1.subscapular a.: runs along the lower border of the subscapularis 2.anterior circumflex humeral a.: wind around the front of the surgical neck of the humerus 3.posterior circumflex humeral a.: wind around the back of the surgical neck of the humerus


Brachial artery

č‚ąĺ‹•č„ˆ

- begins at the lower border of the teres major - provides the main arterial supply to the arm - divides into radial and ulnar arteries (at the level of the neck of the radius) 1. muscular branches : to the anterior compartment of the upper arm 2. nutrient a. : to the humerus 3. Deep brachial a. - arises near the beginning of the brachial a. and follows the radial nerve - supplies the triceps muscle and takes part in the anastomosis around the elbow joint 4. superior ulnar collateral a. : arises near the middle of the upper arm and follows the ulnar nerve 5. inferior ulnar collateral a. : arises near the end of the artery and takes part in the anastomosis around the elbow joint


Radial artery 橈動脈 radial recurrent a

- crosses the superficial surface of the pronator teres with the superficial radial nerve - is coped by brachioradialis (radial pulse) 1. radial recurrent a.: leaves the forearm by winding around the lateral aspect of the elbow to reach the posterior surface of the arm

Ulnar artery 尺動脈

- passes deep to the pronator teres and median nerve - is the principal source of supply to the forearm 1. common interosseous a. : is the principal branch in the forearm a. it passes to the upper border of interosseous membrane b. divides into anterior and posterior interosseous a.


Arteries of Hand and Wrist Ulnar artery 尺動脈 - can be felt lateral to the tendon of flexor carpi ulnaris - accompanies with ulnar nerve Radial artery 橈動脈 - can be easily felt anterior to the distal third of the radius

radial pulse

Superficial palmar arch 淺掌弓 - is located in the central part of palm - lies at the level of the distal border of the fully extended thumb - mainly from the ulnar a. Deep palmar arch 深掌弓 - is located in the central part of palm - lies at the level of the proximal border of the fully extended thumb - mainly from the radial a.


Arterial Supply to the Shoulder and Upper limb clavicle Teres major Cubital fossa


Descending aorta降主動脈 -主動脈弓往下延伸成為降主動脈 (沿著脊椎椎體往下走) - 包含兩個部分 : 胸主動脈跟腹主動脈(供應胸腹器官與體壁) 1. 胸主動脈 : 沿著胸椎椎體(T5~T12)中線的左側下行, 在T12的 高度穿過橫隔 進入腹腔形成腹主動脈 2. 腹主動脈 : 走在腰椎椎體中線在L4高度分為左右總髂動脈(供 應骨盆腔與下肢)


Thoracic aorta Sternal angle

•is the continuation of the aortic arch - Give off arteries to the organs and muscles of the thoracic region a. visceral branches : - Bronchial arteries - Esophageal arteries - pericardial arteries - mediastinal arteries b. parietal branches - Posterior intercostal arteries - Subcostal arteries - superior phrenic arteries


Abdominal aorta

L4

Middle sacral artery

•Between the diaphragm and the level of the 4th lumbar vertebrae 1. celiac trunk 2. superior mesenteric a. 3. inferior mesenteric a. 4. middle sacral a. (= tail a.) 5. inferior phrenic a. - serve the diaphragm 6. renal a. - to the kidney 7. suprarenal arteries serve the adrenal glands 8. ovarian or testicular arteries –supply the gonads (ovary or testis) 9. Lumbar arteries


Celiac trunk Common hepatic artery

stomach

Left gastric artery Spenic artery

Celiac trunk spleen - An unpaired vessel

pancreas

- A short and thick trunk - Divide into 3 arteries -supply the Liver, pancreas, duodenum, stomach, esophagus, spleen


Branches of Celiac trunk

1. left gastric (esophageal branches) 2. common hepatic (hepatic artery proper, right gastric and gastroduodenal) 3. Splenic (short gastric, left gastroepiploic, pancreatic)


Left gastric Branches of Celiac artery trunk spleen Common hepatic artery Gastroduodenal artery

Duodenum


Superior mesenteric artery

- arise just below the celiac trunk - supply the small intestine, pancreas, cecum, appendix, ascending colon and proximal 2/3 of the transverse colon - Jejunal and ileal arteries (intestinal arteries) ,ileocolic a. right colic a., middle colic a.


Inferior mesenteric artery

- arise just before the iliac bifurcation - supply distal 1/3 of transverse colon, descending, and sigmoid colon, rectum - Left colic a., sigmoid a., and superior rectal a.


Arteries of the abdomen


Arteries of the Pelvis

•Abdominal aorta terminates as right and left common iliac arteries (at L4). •Common iliac divides into external and internal iliac arteries. •Branches of the internal iliac serves pelvic structures


Internal iliac artery 內髂動脈

- supply the pelvic viscera, the muscles of the gluteal and lumbar region, the walls of the pelvis, the external genitalia, and the medial thigh

1. posterior division (3) Iliolumbar artery Lateral sacral artery Sup. Gluteal artery

2. anterior division (7) Inferior gluteal artery Middle rectal artery Internal pudendal a. Inferior vesical artery Obturator artery Superior vesical artery Umbilical artery


External iliac artery 外髂動脈

L5

- supply the muscles and skin of the lower abdominal wall

1. inferior epigastric artery - supply the skin and muscles of the anterior abdominal wall 2. Deep iliac circumflex artery - supply the muscles attached to the iliac fossa 3. Femoral artery : the continuation of the external iliac a.


Arteries of the Lower limb (I)

外旋股動脈

•External iliac a. exits pelvic cavity becoming femoral a. •femoral artery serve the thigh region •Femoral a. continues as popliteal a. at the posterior aspect of the knee •Genicular aa. supply the knee 膝動脈

1.Deep femoral artery 深股動脈 - supply muscles of the posteriorcompartment of the thigh 2.Lateral and medial circumflex femeral a. 外、內旋股動脈- supply the region of proximal end of femur 3.popliteal artery 膕動脈


Arteries of the Lower limb (II) popliteal artery enters leg as

anterior and posterior tibial arteries 1. Anterior tibial a. 前脛動脈 - supply the muscles of the anterior compartment of the leg - dorsalis pedis a.足背動脈 : supply the dorsum of the foot 2. Posterior tibial a.後脛動脈 - supply the muscles of the post. compartment of the leg - fibular a. : supply the peroneal m. - lateral and medial plantar a. - plantar arch - plantar metatarsal - plantar digital arteries


Inguinal ligament Popliteal fossa

Arteries of the Lower limb


Blood supply of brain •來源主要有內頸動脈與椎動脈 •兩者的分支可會合形成circle of Willis (cerebral arterial cycle) 1. 內頸動脈 (供應眼窩及80%腦) - 總頸動脈(common carotid a. )的分支 - 通過頸動脈管(carotid canal)進入顱腔 - 可發出眼動脈及前、中大腦動脈 - 兩側前大腦動脈經由前交通動脈 彼此吻合 2. 椎動脈 (vertebral artery) - Arise from subclavian a.

- 沿著頸椎橫突孔上行 經由枕骨 大孔foramen magnum進入顱腔 - 兩邊的椎動脈進入顱腔後會合形 成單一的基底動脈basilar artery - 最後形成成對後大腦動脈藉由後 交通動脈與中大腦動脈相通


Arterial Blood Flow to the Brain


Summary of arterial system


Vein靜脈 •所有的靜脈都匯入上、下腔 靜脈(除了肺部的以外) 然後 注入右心房 •數量比動脈多 •可分為淺靜脈跟深靜脈兩種 1.superficial veins - 通常位於皮膚下常用於 抽血跟靜脈注射 2. Deep veins通常與同名的 動脈伴行

Principal Veins of the Body


Venous Drainage of Head & Neck Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

外頸靜脈

•External jugular veins –Drain face, scalp, neck –Empty into subclavian vv. •Internal jugular veins內頸靜脈 –Drain brain, meninges, deep face and neck –Arise from venous sinuses Internal jugular and subclavian veins converge forming brachiocephalic vein


Superficial veins of upper limb - Highly variable - Found just below skin •the site of iv injection 1. Dorsal venous arch 2. Cephalic vein 頭臂靜脈 3. Basilic vein 貴要靜脈 4. Median cubital vein正中肘靜脈 5. Median antebranchial vein 正中前臂靜脈


Superficial Veins of Lower limb Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

• Great Saphenous vein大隱靜脈 –Longest vessel in body –Empties into femoral v.

• Small Saphenous v.小隱靜脈 –Empties into popliteal v.


Azygos system

奇靜脈系統

- 回流胸部大部分的靜脈血液 - 走在脊柱旁, 最後注入上腔靜脈 - 組成包括有奇靜脈 半奇靜脈及副半奇 靜脈 1.奇靜脈 azygos vein - 沿著椎體右側或中央上行 - 回收所有右側後肋間靜脈及肋下靜脈 -最後注入上腔靜脈 2.半奇靜脈 hemiazygos vein -沿著椎體左側上行 -回收左側第9~11後肋間靜脈及肋下靜 脈 - 在胸部中央處橫過脊柱注入奇靜脈 3.副半奇靜脈 accessory hemiazygos v. - 可視為半奇靜脈往上的延伸 -回收左側第4~8後肋間靜脈 - 亦會往右注入奇靜脈


Summary of venous system


Hepatic Portal System 肝門靜脈 •hepatic portal vein(肝門靜脈) 位在胰臟後方肝臟下方 •is formed by the union of superior mesenteric vein and splenic vein •portal vein collects blood from the abdominal part of GI tract and carries it to the liver •之後匯集形成hepatic veins 注入inferior vena cava回 到體循環


Fetal Circulation (I) 胎兒循環 •所有主要血管在第三個月時已完成 •胎兒必須將血液經臍帶Umbilical cord送至胎盤 (placenta)由此與母 體的子宮相連接獲得氧氣與養分 •胎兒的呼吸器官為胎盤 •臍帶內有一條臍靜脈兩條臍動脈 1.臍動脈 - 為內髂動脈分支 攜帶血液到胎盤 以獲得養分氧氣 -出生後退化成內側臍韌帶 2.臍靜脈 -將血液帶回胎兒 經過肝靜脈下腔 靜脈回到心臟右心房 -出生後退化成肝圓韌帶


Fetal Circulation (II) 胎兒循環 •胎兒肺沒有作用 所以不需要 太多血液 •可藉由foramen ovale卵圓孔 與ductus arteriosus動脈導 管分流 避免未成熟的肺負擔 太大 1. foramen ovale卵圓孔 -血液直接由右心房到左心房 2. ductus arteriosus動脈導管 - 肺動脈幹血液經過回到主動 脈弓 - 出生後退化成動脈韌帶


Summary of Fetal Circulation


參考書目 : 1. Memmler's Structure and function of human body. 2. Tortora GJ : Principles of Human Anatomy. 3. Marieb and Mallatt : Human Anatomy 4. Drake Gray's Anatomy for Students, 2nd Edition 5. McKinley's human anatomy, 2nd Edition http://www.youtube.com/watch?v=bKtvDv7eykg&feature=fvw

20130415 circulatory system  
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