血液中的二氧化碳最主要的運送形式為形成重碳酸離子。
決定血流速率(血流阻力)大小：血液黏滯度、血管半徑和血管兩端壓力差
心臟解剖概念：
房室結（atrioventricular node）
位於心臟的心房中隔（interatrial septum），心臟表面的冠狀溝，位於心房與心室的界線上。
關於右心房：
梳狀肌：位於心房內壁，主要位於右心房內面
卵圓窩：在右心房的後內側壁（或房間隔）下部，有一卵圓形的淺凹，稱卵圓窩，是胎兒時期卵圓孔閉合後的遺迹，房間隔缺損常發生在該處。 也是從右心房進入左心房心導管穿刺的理想部位。
心房顫動
左心房的結構較複雜、血流速度較快、心臟疾病常導致左心房擴大，所以左心房較常發生纖維顫動，不過右心房其實也可能發生
The left atrium has a more complex structure, faster blood flow, and is more likely to dilate due to heart disease, thus making it more prone to atrial fibrillation. However, right atrial fibrillation can also occur.
心房纖維顫動臨床處置Clinical management of atrial fibrillation
可服用鈉離子通道阻斷劑，阻斷心肌細胞的鈉離子通道，減慢心臟傳導速度，降低心室反應率，以降低心跳
Sodium channel blockers can be administered to block sodium channels in myocardial cells, slowing conduction velocity and reducing ventricular response rate to decrease heart rate.
關於心室及腱索：
腱索是附著在心室側的心臟瓣膜（或尖瓣）上的堅固的纖維束。這些纖維起源於乳頭肌，這些是從心室壁向內突出的肌肉塊。當尖瓣關閉時，腱索可以拉住瓣膜，以阻止它們過度向上翻回心房腔。
右心室的腱索固著在三尖瓣的帆狀結構上。
The chordae tendineae of the right ventricle are attached to the cusps of the tricuspid valve.
腱索是纖維狀的結構，將心室壁上的乳頭肌連接到心瓣膜。它們的作用是防止心瓣膜在心室收縮時逆流。
The chordae tendineae are fibrous structures that connect the papillary muscles of the ventricular wall to the heart valves. Their function is to prevent the heart valves from regurgitating during ventricular contraction.
三尖瓣由三個瓣膜組成，將右心室與右心房隔開。當右心室收縮時，腱索會阻止三尖瓣逆流，將血液泵入肺動脈。
The tricuspid valve is composed of three leaflets that separate the right ventricle from the right atrium. When the right ventricle contracts, the chordae tendineae prevent the tricuspid valve from regurgitating, allowing blood to be pumped into the pulmonary artery.
心室收縮開始時
在心動週期的起始階段，心臟的心房和心室處於舒張狀態，稱為心室舒張期（舒張期）。在這個階段，心臟的兩個心房充滿了血液，並將血液傳送到心室內。當心室開始收縮，血液被推向主動脈，這時心臟產生了聽診時聽到的第一心音，稱為S1音。這個音頻通常是由心臟的三尖瓣和二尖瓣在心室充滿血液並關閉時引起的。
法洛氏四重畸形主要影響心室收縮開始時
Tetralogy of Fallot primarily affects the onset of ventricular systole.
法洛氏四重畸形 是一種先天性心臟病，法洛氏四重畸形最明顯的影響就在於右心室出口梗阻，導致右心室收縮時無法有效地將血液泵入肺動脈。這會導致右心室壓力升高，形成一個右向左分流，使含氧量低的血液進入體循環，造成全身組織缺氧。
Tetralogy of Fallot is a congenital heart defect that primarily affects the beginning of right ventricular systole. The most significant impact of Tetralogy of Fallot is right ventricular outflow tract obstruction, which prevents the right ventricle from effectively pumping blood into the pulmonary artery during systole. This leads to increased right ventricular pressure, creating a right-to-left shunt that allows deoxygenated blood to enter the systemic circulation, causing systemic hypoxia.
但由於心臟是一個整體，其他心室收縮階段和舒張階段也會受到影響，例如左心室的負荷增加等。
However, since the heart functions as a unit, other phases of ventricular systole and diastole are also affected, such as increased workload on the left ventricle.
簡單來說，法洛氏四重畸形最直接的影響是右心室在收縮時無法順利將血液送出，導致血液分流，影響全身的血液循環。
In simpler terms, the most direct impact of Tetralogy of Fallot is the right ventricle's inability to efficiently pump blood during systole, leading to blood shunting and affecting systemic circulation.
對於一個新生兒來說，胎兒時期的循環系統與出生後不同，胎兒肺臟尚未發育成熟，主要靠胎盤進行氧氣交換。動脈導管，在胎兒時期連接肺動脈和主動脈，出生後通常會自行閉合，胎兒時期動脈導管的開放，使得部分含氧量較低的血液可以繞過肺臟，直接進入主動脈，供應全身。
In newborns, the fetal circulatory system differs from that of a newborn. Fetal lungs are immature and rely primarily on the placenta for oxygen exchange. The ductus arteriosus, which connects the pulmonary artery and aorta in the fetus, usually closes spontaneously after birth. In the fetal period, the open ductus arteriosus allows some deoxygenated blood to bypass the lungs and enter the aorta directly, supplying the body.
所以在矯正手術前，通常會依醫囑給與 prostaglandin E1（PGE1），可以使動脈導管保持開放，增加肺動脈的血流量，改善肺循環，減輕嬰兒的缺氧症狀，為手術做好準備。
Therefore, before corrective surgery, prostaglandin E1 (PGE1) is often administered as prescribed to keep the ductus arteriosus open, increasing pulmonary blood flow, improving pulmonary circulation, and alleviating hypoxemia in infants, preparing them for surgery.
心室收縮結束時
心室收縮隨後進入心室收縮期（收縮期），在這個階段，心臟的心室肌肉緊縮，將血液推向主動脈和肺動脈。心室收縮結束時，心臟進入心室舒張期。
心室舒張開始時
心室舒張期是心臟的舒張階段，此時心臟的心房和心室進行舒張，並開始充滿新的血液。在心室舒張期，心臟充滿了血液，並準備進入下一個心動週期的心室收縮階段。
二尖瓣狹窄
Mitral Stenosis
二尖瓣狹窄主要影響心室舒張開始時。
會因為：
Mitral stenosis can lead to several hemodynamic changes:
1.血液在左心房蓄積，回流受阻導致中心靜脈壓上升
Elevated central venous pressure: Blood accumulates in the left atrium due to the narrowed mitral valve, causing backflow and increased central venous pressure.
2.右心室壓力上升(左心房壓力升高傳導至肺循環，導致肺動脈壓升高，右心室為了克服阻力，壓力也隨之升高)-第一心音強度也會增強
Elevated central venous pressure: Blood accumulates in the left atrium due to the narrowed mitral valve, causing backflow and increased central venous pressure.
3.肺微血管楔壓（PCWP）上升：導致左心房壓力升高，直接反映在肺微血管楔壓上
Elevated pulmonary capillary wedge pressure (PCWP): Increased left atrial pressure is directly reflected in the elevated PCWP.
影響第一心音的原因
Impact on the First Heart Sound:
第一心音分裂： 二尖瓣狹窄時，由於左心室擴大，二尖瓣和三尖瓣的關閉時間可能不同步，導致第一心音分裂。
Splitting of the first heart sound: Due to left ventricular enlargement, the closure of the mitral and tricuspid valves may become asynchronous, causing a split in the first heart sound.
第一心音強度增加：右心室壓力升高會導致三尖瓣關閉力增加，第一心音的強度可能會增強。
Increased intensity of the first heart sound: The increased right ventricular pressure can lead to a stronger closure of the tricuspid valve, resulting in a louder first heart sound.
開瓣音：二尖瓣狹窄時，血液衝擊彈性尚好的瓣葉，會產生開瓣音，通常緊隨第一心音之後。
Opening snap: The forceful ejection of blood through the narrowed mitral valve against the relatively stiff leaflets can produce an opening snap, typically heard immediately after the first heart sound.
心室舒張結束時
心室舒張隨後進入心室收縮期，這個過程就是心臟的一個心動週期的循環。在心室舒張結束時，心室肌肉開始收縮，將血液推送到主動脈和肺動脈，進入下一個收縮階段。
位移痛
心臟的位移痛出現在左手臂內側皮膚，是因為心臟和左手臂內側皮膚由同一個神經節支配，也就是胸神經（T1-T4）。當心臟出現問題時，例如心絞痛或心肌梗塞，會刺激胸神經，進而產生位移痛，讓患者感覺左手臂內側疼痛。
Referred pain from the heart to the left inner arm occurs because the heart and the left inner arm skin are innervated by the same nerve ganglion, namely the thoracic nerves (T1-T4). When there is a problem with the heart, such as angina or myocardial infarction, it can stimulate the thoracic nerves, which in turn can produce referred pain, causing the patient to feel pain in the left inner arm.
心肌梗塞患者注意事項
Precautions for Myocardial Infarction Patients
飽餐後，胃腸道血流量增加，導致心臟血流量相對減少，如果此時進行劇烈運動，會增加心臟的負擔，可能誘發心絞痛或心肌梗塞。
After a heavy meal, blood flow to the gastrointestinal tract increases, leading to a relative decrease in blood flow to the heart. If strenuous exercise is performed at this time, it can increase the burden on the heart and potentially trigger angina or myocardial infarction.
且酒精會擴張血管，降低血壓，如果此時進行劇烈運動，可能會導致血壓驟降，誘發心肌梗塞。
Alcohol dilates blood vessels and lowers blood pressure. If strenuous exercise is performed at this time, it may cause a sudden drop in blood pressure and trigger myocardial infarction.
因此，心肌梗塞患者應避免在飽餐後或酒後進行劇烈運動。如果需要運動，應選擇在飯後1-2小時或酒後6小時以上，並注意循序漸進，避免過度勞累。
Therefore, myocardial infarction patients should avoid strenuous exercise immediately after a heavy meal or alcohol consumption. If exercise is necessary, it should be chosen 1-2 hours after a meal or more than 6 hours after alcohol consumption. It is also important to start slowly and avoid overexertion.
硝酸甘油（NTG）是一種血管擴張劑，可用於緩解心絞痛。如果心肌梗塞患者有心絞痛的症狀，可以在醫生指導下預防性服用硝酸甘油。
Nitroglycerin (NTG) is a vasodilator that can be used to relieve angina. If a myocardial infarction patient has symptoms of angina, they can take nitroglycerin preventively under the guidance of a doctor.
但是，硝酸甘油也可能導致低血壓等副作用。因此，心肌梗塞患者在服用硝酸甘油之前，應諮詢醫生，以確定是否適合服用。
However, nitroglycerin may also cause side effects such as low blood pressure. Therefore, myocardial infarction patients should consult with their doctor before taking nitroglycerin to determine if it is suitable for them.
永久性心臟節律器是一種植入人體內的電子裝置，用於治療心律失常。
心臟節律器由電池、導線和激搏器組成。
A permanent pacemaker is an electronic device that is implanted in the body to treat heart rhythm disorders.
The pacemaker consists of a battery, leads, and a pulse generator. The battery powers the pacemaker; the leads connect the pacemaker to the heart; and the pulse generator sends electrical signals to stimulate the heart to contract.
電池(激搏器會植入人體內，通常位於胸腔或腹腔。更換電池需要進行手術。)為心臟節律器提供動力；導線將心臟節律器連接到心臟；激搏器發出電信號，刺激心臟收縮。
激搏波是心電圖上反映心臟節律器發出電信號的圖形。無論是永久性心臟節律器還是暫時性心臟節律器，在心電圖上都會出現激搏波。
The battery powers the pacemaker; the leads connect the pacemaker to the heart; and the pulse generator sends electrical signals to stimulate the heart to contract.
The pulse generator is implanted in the body, usually in the chest or abdomen. Replacing the battery requires surgery.
A pacemaker spike is a graphical representation on an electrocardiogram (ECG) of the electrical signal sent by the pacemaker to stimulate the heart to contract. Pacemaker spikes are present on ECGs for both permanent and temporary pacemakers.
在裝設永久性心臟節律器後，患者應注意以下事項：
Post-Permanent Pacemaker Implantation Precautions
在術後4-6週內，患者應避免劇烈活動，如打球、游泳等。這是因為劇烈活動可能會導致導線移位或折斷。
Strenuous activities such as playing sports or swimming should be avoided during the initial recovery period of 4-6 weeks following pacemaker implantation. This is because strenuous activities can potentially dislodge or fracture the pacemaker leads.
在術後4-6週內，患者應避免提重物超過5公斤。如果需要提重物，應使用雙手或借助工具。
Avoid lifting heavy objects exceeding 5 kg in the 4-6 weeks following surgery.
If lifting heavy objects is necessary, use both hands or seek assistance from tools. Avoid placing excessive strain on the upper body during the initial recovery period.
保持傷口清潔乾燥，避免感染。如果傷口出現紅腫、熱痛等症狀，應及時就醫。
Maintain wound cleanliness and dryness to prevent infection.
Keep the incision site clean and dry to promote healing and prevent infection. If the incision shows signs of redness, swelling, warmth, or pain, consult a healthcare provider promptly.
定期複診，以便醫生監測心臟節律器功能。
Attend regular follow-up appointments for pacemaker monitoring.
動脈血流供應部分
「冠狀動脈」
由「升主動脈」分支出接「主動脈弓」後，主要分支為下列三條動脈
第一條分支頭臂動脈幹：主要供應頭部右側、右頸，及右臂的血流。
第二條分支左頸總動脈：頸部左側的頸總動脈
第三條分支左鎖骨下動脈：向左臂供血
冠狀動脈性心臟病（CHD）是一種常見的心血管疾病，其發病機制是冠狀動脈粥樣硬化斑塊破裂，形成血栓，導致冠狀動脈阻塞，引起心肌缺血甚至梗塞。
Coronary artery disease (CAD) is a common cardiovascular disease caused by the rupture of atherosclerotic plaques in the coronary arteries, leading to thrombus formation, coronary artery obstruction, and myocardial ischemia or even infarction.
阿司匹林（Aspirin）是一種血小板聚集抑制劑，可通過抑制血小板環氧酶（COX）活性，減少血栓素A2（TXA2）的生成，從而抑制血小板凝集，降低血栓形成的風險。
Aspirin is an antiplatelet aggregation inhibitor that can reduce the risk of thrombus formation by inhibiting platelet cyclooxygenase (COX) activity and reducing the production of thromboxane A2 (TXA2).
因此，冠狀動脈性心臟病人服用阿司匹林的主要目的是抑制血小板凝集，預防血栓形成，從而降低心肌梗塞和其他心血管事件的風險。
Therefore, the main purpose of aspirin use in patients with coronary artery disease is to inhibit platelet aggregation, prevent thrombus formation, and thereby reduce the risk of myocardial infarction and other cardiovascular events.
另外阿司匹林具有抗炎作用，可緩解冠狀動脈粥樣硬化斑塊破裂引起的炎症反應，從而緩解發作時胸痛。
阿司匹林可通過抑制血小板COX活性，減少血栓素A2的生成，而血栓素A2會引起血管平滑肌收縮。因此，阿司匹林可通過鬆弛血管平滑肌，改善血管通暢。
阿司匹林具有抗血小板聚集作用，可減少血小板對心肌的刺激，從而減緩心跳速率。
In addition, aspirin has anti-inflammatory effects, which can relieve the inflammatory response caused by the rupture of atherosclerotic plaques in the coronary arteries, thereby alleviating chest pain during attacks. Aspirin can also relax vascular smooth muscle by inhibiting platelet COX activity and reducing the production of thromboxane A2, which causes vascular smooth muscle contraction. Aspirin has antiplatelet aggregation effects, which can reduce platelet stimulation of the myocardium and thereby slow down the heart rate.
但是，阿司匹林也可能導致胃腸道出血等副作用。
However, aspirin can also cause side effects such as gastrointestinal bleeding. Therefore, patients with coronary artery disease should take aspirin under the guidance of a doctor and regularly monitor drug side effects.
而Clopidogrel氯吡格雷是新一代的抗血小板藥物，氯吡格雷會不可逆地抑制血小板上的P2Y12受體。ADP（腺苷二磷酸）是一種能活化血小板的物質，它會結合P2Y12受體，進而引發血小板的活化和聚集。氯吡格雷通過阻斷ADP的作用，達到抑制血小板聚集的效果。
Clopidogrel is a newer generation of antiplatelet drugs that irreversibly inhibits the P2Y12 receptor on platelets. ADP (adenosine diphosphate) is a substance that activates platelets. It binds to the P2Y12 receptor, triggering platelet activation and aggregation. By blocking the action of ADP, clopidogrel inhibits platelet aggregation.
氯吡格雷常與阿司匹林聯合使用，尤其在急性冠脈症候群、支架植入術後等高風險患者中。
兩者作用機制不同，聯合使用可以達到更全面的抗血小板效果，降低血栓形成的風險。
阿司匹林常作為初級預防，而氯吡格雷則更常在急性期或高風險情況下使用。
Clopidogrel is often used in combination with aspirin, especially in high-risk patients such as those with acute coronary syndrome or after stent placement. The two drugs have different mechanisms of action and, when used together, can provide more comprehensive antiplatelet effects and reduce the risk of thrombosis. Aspirin is often used for primary prevention, while clopidogrel is more commonly used in acute settings or in high-risk situations.
腹主動脈（Abdominal aorta）
粥狀硬化（Atherosclerosis）是一種動脈壁的慢性疾病，通常由於血管壁內的脂質積聚和炎症反應所引起。這種疾病會導致動脈壁變厚，並且在病變區域形成稱為斑塊（plaque）的沉積物，最終可能導致血管狹窄和堵塞。
動脈瘤是血管壁的局部膨脹或擴張，通常在血管壁較弱的地方形成。腹部主動脈是一個常見的動脈瘤形成地點，這種現象稱為腹部主動脈瘤（Abdominal Aortic Aneurysm，AAA）。粥狀硬化對於腹部主動脈瘤的形成有一些影響因素：
脆弱的血管壁： 粥狀硬化導致動脈壁變得脆弱且容易受損，尤其是在病變區域。這使得在這些區域形成動脈瘤的風險增加。
炎症和局部病變： 粥狀硬化引起的炎症和脂質積聚可能導致動脈壁的結構改變，進一步削弱了血管的強度，促使動脈瘤的形成。
機械壓力： 在粥狀硬化區域，血管內的斑塊可能會造成機械壓力，增加了血管壁在這些區域擴張和膨脹的風險。
因此，粥狀硬化造成的動脈壁變化，以及在局部形成的斑塊和炎症，可能使腹部主動脈更容易發生局部膨脹，進而形成腹部主動脈瘤。這也強調了粥狀硬化的重要性，因為它不僅可能導致血管狹窄和堵塞，還可能增加動脈瘤的風險。
腎動脈（Renal artery）
是從腹主動脈（Abdominal aorta）直接分支而來，位於腹主動脈的上部，是腹部的主要動脈，主要供應腎臟的血流。
腹腔動脈幹（celiac trunk）
是從腹主動脈（abdominal aorta）直接分支而來，位於腹主動脈的上部，主要供應位於上腹部的器官，包括胃、脾臟、胰臟、肝臟、十二指腸和食道下段。
肝的血液供應
肝臟的功能複雜，需要負責代謝、合成和解毒，所以肝臟的血流供應是由兩套系統供應血液：
The liver has complex functions and is responsible for metabolism, synthesis, and detoxification. Therefore, the liver's blood supply is supplied by two systems:
肝總動脈：主動脈→腹腔動脈幹→肝總動脈→肝固有動脈（Hepatic artery proper），為肝臟提供富含氧氣的血液。
Hepatic artery: Aorta → Celiac trunk → Hepatic artery → Hepatic artery proper, which provides oxygen-rich blood to the liver.
門脈（Portal vein）是從消化道器官的靜脈收集富含養分的血液，將其帶入肝臟進行代謝。
Portal vein: Collects nutrient-rich blood from the veins of the digestive tract and brings it to the liver for metabolism.
這兩套系統共同為肝臟提供血液供應，滿足肝臟的氧氣和營養需求。
These two systems work together to provide blood supply to the liver, meeting the liver's oxygen and nutrient needs.
胰的血液供應
來自於腹主動脈的分支，包括肝胰動脈（Hepatopancreatic artery）和脾動脈（Splenic artery）。
脾的血液供應
來自於脾動脈（Splenic artery）。
腸繫膜上動脈（Superior mesenteric artery）
腸繫膜上動脈是腹主動脈的一個分支，位於腹主動脈的中間部位(，供應腸道的一部分，包括小腸、十二指腸後段、空腸、迴腸、盲腸、闌尾、升結腸部分大腸和腸系膜。
腸繫膜下動脈（Inferior mesenteric artery）
腸繫膜下動脈是腹主動脈的一個分支，位於腹主動脈的下部，供應下半部的大腸，包括直腸和乙狀結腸。
腹部區域的重要血管
Important Vessels in the Abdominal Region
腹腔動脈幹-供應肝臟充氧血。
Celiac Trunk - Supplies Oxygenated Blood to the Liver
腸繫膜上動脈：供應充氧血，主要供應小腸、結腸和闌尾。
Superior mesenteric artery: Supplies oxygenated blood, primarily to the small intestine, colon, and appendix.
肝門靜脈：供應缺氧血，主要供應肝臟。
Hepatic portal vein: Supplies deoxygenated blood, primarily to the liver.
肝靜脈：供應缺氧血，將肝臟的血液運回心臟。
Hepatic vein: Supplies deoxygenated blood, carrying blood from the liver back to the heart.
判讀動脈血液氣體分析報告
pH 正常範圍（7.35-7.45）
低於正常範圍表示血液偏酸性，即酸中毒；高於則為鹼性
PaCO2 正常範圍（35-45 mmHg）
高於表示血液中二氧化碳濃度過高。二氧化碳是酸性物質，濃度過高會導致血液酸度增加。
HCO3正常範圍（22-26 mEq/L）
HCO3- 是鹼性物質，當身體發生酸中毒時，腎臟會試圖增加HCO3- 的濃度來緩衝酸性。
呼吸性酸中毒：pH低於正常範圍、PaCO高於正常範圍、HCO3-變化不大表示非代謝性
呼吸性鹼中毒：pH高於正常範圍、PaCO2會降低，而非升高、HCO3-變化不大表示非代謝性
代謝性酸中毒：pH低於正常範圍、HCO3-會降低，且PaCO2會稍有升高（腎臟代償）。
代謝性鹼中毒：pH高於正常範圍、HCO3-會升高，且PaCO2會稍有降低（肺臟代償）。
動脈疾病
動脈粥狀硬化（arteriosclerosis）的高危險因子為高血脂、高血壓和抽菸。
高血壓
治療高血壓藥物
Propranolol 是一種非選擇性 β-受體阻滯劑，可通過血腦障壁，引起血糖上升，並抑制腎素分泌，主要是用來治療心律失常、高血壓、偏頭痛等疾病的常用藥物。在急性甲狀腺功能亢進的治療中，Propranolol 可以用於控制心率和血壓，但不能作為主要治療藥物。主要治療藥物是甲狀腺素抑制劑，如甲巰咪唑（methimazole）或丙基硫氧嘧啶（propylthiouracil）。
Propranolol is a non-selective β-blocker that can cross the blood-brain barrier, increase blood sugar, and inhibit renin secretion. It is mainly used to treat arrhythmia, hypertension, and migraine. In the treatment of acute hyperthyroidism, propranolol can be used to control heart rate and blood pressure, but it cannot be the main treatment. The main treatment is thyroid hormone inhibitors, such as methimazole or propylthiouracil.
低血壓
低血壓會同時降低動脈血壓波振幅（arterial pulse wave）與動脈血壓波速度（pulse wave velocity）
Low blood pressure can simultaneously decrease arterial pulse wave amplitude and pulse wave velocity.
名詞解釋：
Term explanation:
動脈血壓波振幅：動脈血壓在一個心動週期內的最大值與最小值之間的差異。
Arterial pulse wave amplitude: The difference between the maximum and minimum values of arterial blood pressure during a cardiac cycle.
動脈血壓波速度：動脈血壓波沿著動脈傳播的速度。
Pulse wave velocity: The speed at which the arterial pulse wave propagates along the arteries.
且低血壓會降低血管阻力及增加血管順應性，而粥狀動脈硬化、動脈老化和高血壓都會導致動脈血壓波振幅和動脈血壓波速度升高。
In addition, low blood pressure can reduce vascular resistance and increase vascular compliance, while atherosclerosis, arterial aging, and hypertension all lead to increased arterial pulse wave amplitude and pulse wave velocity.
量測血壓注意事項
血壓注意事項：
Blood Pressure Measurement Precautions:
1. 測量血壓時需將欲測量之手臂支托，使手臂與心臟同高，若手臂位置低於心臟，則測量值會偏高；若手臂位置高於心臟，則測量值會偏低。
During blood pressure measurement, the arm being measured should be supported to be at the same level as the heart. If the arm is positioned lower than the heart, the reading will be higher; if the arm is positioned higher than the heart, the reading will be lower.
2.量測血壓為準確，充氣速度要緩慢、均勻，且第二次測量時建議間隔1-2分鐘後再重複充氣
For accurate blood pressure measurement, the inflation rate should be slow and steady. It is recommended to wait 1-2 minutes before repeating the inflation for a second measurement.
3.慣用手與非慣用手血壓並無顯著差異
There is no significant difference in blood pressure between the dominant and non-dominant hand.
4.正常的人下肢血壓會比上肢血壓高一點
In healthy individuals, lower limb blood pressure is slightly higher than upper limb blood pressure.
靜脈血流供應部分
肝門靜脈
收集來自腸道(消化道)的富含養分的血液，將其帶入肝臟，參與肝臟的代謝和調節。位於肝門區域，連接小腸和肝臟。
肝靜脈（hepatic vein）
是肝臟內的血管，分別為右肝靜脈、中肝靜脈和左肝靜脈，與下腔靜脈（inferior vena cava）直接相連，主要將經過肝臟代謝的血液從肝臟中排出，進入下腔靜脈，返回心臟，從肝門靜脈出來。
The hepatic veins are three veins that drain blood from the liver. They are the right hepatic vein, the middle hepatic vein, and the left hepatic vein. They all directly connect to the inferior vena cava. The hepatic veins carry blood that has been metabolized by the liver to the inferior vena cava, which then returns it to the heart. The hepatic veins emerge from the hepatic portal vein.
肝門是位於肝臟前方，由肝小葉周圍的結締組織形成的一個開口。肝門內有肝動脈、肝門靜脈、肝管等重要結構通過，下腔靜脈會直接連結肝靜脈，但下腔靜脈的連結點位於肝臟後方，而肝門位於肝臟前方。因此，下腔靜脈並不會通過肝門。
The porta hepatis is an opening on the front of the liver, formed by connective tissue surrounding the hepatic lobules. Important structures such as the hepatic artery, portal vein, and hepatic duct pass through the porta hepatis. The inferior vena cava directly connects to the hepatic vein, but the junction of the inferior vena cava is located on the back of the liver, while the porta hepatis is located on the front of the liver. Therefore, the inferior vena cava does not pass through the porta hepatis.
靜脈血栓
下肢深部靜脈血栓（deep venous thrombosis）常引起的臨床表現有患側下肢遠端水腫、患側遠端疼痛，如果血栓脫落，會隨血液流動到肺部，導致肺栓塞。
肝臟靜脈有豐富的瓣膜，可以防止血液倒流。因此，即使下肢深靜脈血栓脫落，也有可能被肝臟靜脈的瓣膜阻擋，無法進入肝臟。
Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein in the leg. The clot can block blood flow, causing swelling and pain in the affected leg. If the clot breaks off, it can travel through the bloodstream to the lungs, causing a pulmonary embolism.
The hepatic vein has a rich network of valves that prevent blood from flowing backward. Therefore, even if a DVT clot breaks off, it is possible that it will be blocked by the valves of the hepatic vein and unable to enter the liver.
凝血因子
容易引發血管內不正常血栓形成的因素，為Hageman 因子的缺乏。Hageman 因子，也稱為凝血因子 XII，是血液凝血系統中的一種凝血蛋白質。它是血管內的一個蛋白質，通常不活躍，但當受到激活時，會啟動凝血過程。Hageman 因子的缺乏可能導致容易引發血管內不正常的血栓形成，這是由於它參與了凝血系統的啟動。
Hageman 因子的活化可以啟動凝血激酶生成的過程，從而促使血液中的其他凝血因子進行一系列的反應，最終形成凝血塊或血栓。然而，正常情況下，Hageman 因子的活性通常是受到嚴格調控的，以確保血液在需要時才會凝結。
Hageman 因子缺乏可能會導致過度的凝血反應，容易形成不正常的血栓，這可能增加心臟病、中風和其他血管疾病的風險。
心臟類疾病
限制性心包炎
慢性肉芽腫發炎反應所導致的限制性心包炎，最常見的病原菌或病因是結核菌（Mycobacteria tuberculosis），肉芽腫是由免疫細胞和結核菌組成的球形結構，特別是巨噬細胞，會試圖包圍和摧毀結核菌，但結核菌可能在細胞內存活。這種長期的免疫反應和細胞活動導致肉芽腫的形成，這是一種炎症性組織變化的結果，如果免疫系統無法完全清除結核菌，感染可能會進展為慢性結核病。在這種情況下，肉芽腫可能變得更大且更持久，可能在體內存在多年。
結核菌（Mycobacterium tuberculosis）是一種引起結核病的細菌，它可以引起多種器官的感染，包括肺部、淋巴結、骨骼等。
感染途徑： 結核菌通常透過空氣中的飛沫傳播，進入人體呼吸道後引起肺部感染。然而，它也可能進入血液循環，從而在體內傳播到其他組織，包括心臟和心包。
依據我國傳染病防治法第3條規定之傳染病分類，結核病屬於第三類傳染病
According to the classification of infectious diseases stipulated in Article 3 of the Infectious Disease Prevention and Control Act of the Republic of China, tuberculosis is a category 3 infectious disease.
免疫反應： 結核菌感染會引起免疫系統的反應，導致發炎。在心臟周圍的組織中，如果結核菌感染進一步擴散，可能會引起心包膜（心臟周圍的薄膜）的發炎，進而導致限制性心包炎。
結核菌的滲透和植入： 結核菌可能通過血液或淋巴途徑進入心包膜組織，並在那裡滲透到細胞中。這可能觸發免疫反應和發炎，導致心包膜的增厚和纖維化。
限制性心包炎是一種罕見但嚴重的疾病，可能導致心臟功能受損。結核菌所引起的心包炎可能需要適當的治療來控制感染並減少心臟功能的不良影響。
結核菌藥物
tetracycline是一種四環素類抗生素，可通過抑制細菌蛋白質合成來抗結核桿菌的藥物，但會降低以protease inhibitors治療愛滋病（AIDS）的效果，由於tetracycline和protease inhibitors之間有相互作用，像是Tetracycline 可與 protease inhibitors 結合、可誘導肝臟代謝酶還有可直接抑制 protease inhibitors 的活性。
Tetracycline is a tetracycline antibiotic that can fight tuberculosis by inhibiting bacterial protein synthesis. However, it can reduce the effectiveness of protease inhibitors used to treat AIDS. This is because tetracycline and protease inhibitors interact with each other in several ways, such as tetracycline binding to protease inhibitors, inducing liver metabolism enzymes, and directly inhibiting the activity of protease inhibitors.
除此之外還有利福黴素（Rifampin），也是抗結核桿菌的藥物，但會抑制protease inhibitors的活性。
In addition, rifampin (rifampicin) is also an anti-tuberculosis drug, but it can inhibit the activity of protease inhibitors.
同樣會影響protease inhibitors的藥物如下：
protease inhibitors治療愛滋病（AIDS），不可同時使用的藥物
肝臟代謝酶的誘導劑：
苯巴比妥（phenobarbital）：是一種用於治療癲癇、焦慮和失眠的鎮靜劑。
卡馬西平（carbamazepine）：是一種用於治療癲癇、三叉神經痛和躁狂症的抗癲癇藥。
苯妥英（phenytoin）：是一種用於治療癲癇的抗癲癇藥。
利福黴素（Rifampin）：是一種用於治療結核病、其他細菌感染和衣原體感染的抗生素。
聖約翰草（St. John's Wort）：是一種用於治療抑鬱症的草藥補充劑。
四環素類抗生素(Tetracycline) ：是一種用於治療多種細菌感染的抗生素。
相互作用的藥物：
利托那韋（ritonavir）：是一種用於治療愛滋病的抗病毒藥物，也可作為增效劑用於提高其他 PIs 的血藥濃度。
奈韋拉平（nevirapine）：是一種用於治療愛滋病的抗病毒藥物。
德拉維丁（delavirdine）：是一種用於治療愛滋病的抗病毒藥物。
沙奎那韋（saquinavir）：是一種用於治療愛滋病的抗病毒藥物。
印地那韋（indinavir）：是一種用於治療愛滋病的抗病毒藥物。
福沙韋酯（fosamprenavir）：是一種用於治療愛滋病的抗病毒藥物。
阿塔扎那韋（atazanavir）：是一種用於治療愛滋病的抗病毒藥物。
替拉維林（darunavir）：是一種用於治療愛滋病的抗病毒藥物。
心肌炎
最常引起心肌炎（myocarditis）的原因是病毒，約 50-75% 的心肌炎是由病毒感染引起的。
The most common cause of myocarditis is a virus, accounting for about 50-75% of cases.
最常見的病毒包括：
The most common viruses include:
腺病毒：Adenovirus
克沙奇病毒：Coxsackievirus
腸道病毒：Enterovirus
風疹病毒：Rubella virus
人類免疫缺陷病毒：Human immunodeficiency virus (HIV)
心肌炎是一種心臟肌肉的炎症，可能由病毒、細菌、寄生蟲等感染引起，也可能與自身免疫反應有關。
心肌炎的症狀包括胸痛、心悸、呼吸急促、疲勞等。
在嚴重的情況下，心肌炎可能導致心力衰竭甚至死亡。
Myocarditis is an inflammation of the heart muscle that can be caused by infections from viruses, bacteria, parasites, or autoimmune reactions. Symptoms of myocarditis include chest pain, palpitations, shortness of breath, and fatigue. In severe cases, myocarditis can lead to heart failure or even death.
在心肌炎急性期，病患應臥床休息，避免劇烈活動，以免加重心臟負擔
During the acute phase of myocarditis, patients should rest in bed and avoid strenuous activities
且休息可以幫助心臟修復受損的肌肉
Rest can also help the heart repair damaged muscle
因此，教導心肌炎病人阻力運動，提升活動耐力是不適宜的。
Therefore, teaching patients with myocarditis resistance training to improve exercise tolerance is inappropriate
應注意均衡飲食，多吃富含蛋白質、維生素和礦物質的食物
A balanced diet should be followed, with plenty of protein, vitamins, and minerals
需減少水分攝取，減少心臟前負荷。
Fluid intake should be reduced to decrease cardiac preload
根據病患的具體情況，醫生可能會開具藥物治療，如抗病毒藥物、抗炎藥物、利尿劑和強心藥等。
Depending on the individual patient's condition, the doctor may prescribe medications, such as antiviral drugs, anti-inflammatory drugs, diuretics, and inotropes.
類固醇是一種抗炎藥物，可用於治療心肌炎的炎症反應。但在某些情況下，類固醇可能會導致大便性狀改變，如大便變黑、柏油樣便，應注意觀察大便顏色
Corticosteroids are a type of anti-inflammatory drug that can be used to treat the inflammatory response of myocarditis. However, in some cases, corticosteroids can cause changes in bowel habits, such as black stools or tarry stools. Patients should pay attention to the color of their stools.
毛地黃是一種強心藥，可用於治療心肌炎引起的心力衰竭。毛地黃的副作用包括心律失常、低鉀血症等。因此，在服用毛地黃時，應監測脈搏，並定期檢查血鉀水平。
Digoxin is an inotrope that can be used to treat heart failure caused by myocarditis. Side effects of digoxin include arrhythmias and hypokalemia. Therefore, patients should monitor their heart rate and have their blood potassium levels checked regularly while taking digoxin.
在心肌炎康復期，病患可以在醫生的指導下進行適當的運動，以幫助恢復心臟功能。
During the recovery phase of myocarditis, patients can engage in appropriate exercise under the guidance of their doctor to help restore heart function.
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