ABI踝臂指数检查PPT推荐.ppt
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ABI(踝臂指数踝臂指数)检查检查-动脉粥样硬化无创性筛查ABIAssessment动脉粥样硬化的病理进程动脉粥样硬化的病理进程Stableangina稳定型心绞痛稳定型心绞痛/intermittentclaudication间歇性跛间歇性跛行行ThrombosisThrombosis血栓血栓血栓血栓AtherosclerosisAtherosclerosis动脉粥样硬化动脉粥样硬化动脉粥样硬化动脉粥样硬化unstableanginaunstableangina不稳定型心不稳定型心绞痛绞痛MIMI心梗心梗ischemicstroke/TIAischemicstroke/TIA中风中风criticallimbischemiacriticallimbischemia下肢缺下肢缺血血CVdeathCVdeath心血管死亡心血管死亡Pathologicprogressiontoatherosclerosis动脉粥样硬化的主要临床表现动脉粥样硬化的主要临床表现CerebrovasculardiseaseCerebrovasculardisease脑血管病脑血管病脑血管病脑血管病CoronaryarterydiseaseCoronaryarterydisease冠状动脉疾病冠状动脉疾病冠状动脉疾病冠状动脉疾病RenalarterystenosisRenalarterystenosis肾动脉狭窄肾动脉狭窄肾动脉狭窄肾动脉狭窄VisceralarterialdiseaseVisceralarterialdisease内脏动脉内脏动脉内脏动脉内脏动脉PeripheralarterialdiseasePeripheralarterialdisease周围动脉疾病周围动脉疾病周围动脉疾病周围动脉疾病IntermittentclaudicationIntermittentclaudication间歇性跛行间歇性跛行间歇性跛行间歇性跛行CriticallimbischemiaCriticallimbischemia下肢严重缺血下肢严重缺血下肢严重缺血下肢严重缺血Majormanifestationsofatherosclerosis定义定义PAD是动脉粥样硬化的一种类型,脂肪沿动脉管壁沉积,导致管腔的狭窄和阻塞性病变,主要损伤下肢和足部的动脉。
@#@流行病学流行病学有症状的PAD患者占55-74岁年龄段人群的4.5%,大约20%的老年人患有症状的或无症状的PAD。
@#@德国血管学协会和血管医学协会周围动脉疾病(周围动脉疾病(PADPAD)危险因素糖尿病高血压高脂血症LevelILevelIILevelIIILevelIV血流减少血流减少功能降低功能降低溃疡和坏死溃疡和坏死无症状麻木冷感雷诺氏综合征间歇性跛行静息痛溃疡坏死PAD颈动脉主动脉肠系膜上动脉&@#@腹动脉肾动脉髂总动脉缺血:
@#@缺血:
@#@血供减少引起疼痛和功能障碍动脉狭窄血小板血小板50%的直径狭窄75%的面积狭窄60%的直径狭窄84%的面积狭窄主要动脉狭窄狭窄进展闭塞周围动脉疾病(周围动脉疾病(PADPAD)最容易的方法最容易的方法.多普勒多普勒+外周动脉血压外周动脉血压血管功能无创检查ABI(踝臂指数踝臂指数)检查检查ABIAssessmentA.B.I.定义定义:
@#@狭窄部位以下的动脉压狭窄部位以下的动脉压狭窄部位以上的动脉压狭窄部位以上的动脉压踝部动脉收缩压踝部动脉收缩压肱部动脉收缩压肱部动脉收缩压ABI:
@#@=踝部动脉收缩压踝部动脉收缩压肱部动脉收缩压肱部动脉收缩压哪些人需要进行哪些人需要进行ABI检查?
@#@检查?
@#@50岁以上或病史超过10年以上的糖尿病患者。
@#@有高血压、吸烟、高血脂症的患者。
@#@有冠心病(或有家族病史)、缺血性卒中史的高危患者。
@#@有慢性肾功能不全血液透析的患者。
@#@不能活动,卧床、肥胖的病人。
@#@哪些人需要哪些人需要ABI检查检查?
@#@解释检查程序Explainandreassurepatientoftheprocedure保持室温舒适Ensureambienttemperatureoftheroomiscomfortable,(Moffatt1990)松解上下肢体衣裤Removeanytightclothingfrombotharmsandstockingssocksetc.fromlegs保护溃疡伤口Removeanydressingsfromcurrentulcersandcoverwithaclearfilm,(Kenny1997)患者保持安静休息1520分钟Restthepatientfor15-20minutes,(Yao1993;@#@Williams1993)患者仰卧Positionthepatientsupine,(Stubbing1996)患者准备患者准备PreparationofthePatientVascularAssessmentTrainingSession-Introductory正常静脉血流音Soundsofnormalvein血流声音血流声音VascularAssessmentTrainingSession-Introductory正常动脉血流声SoundofnormalarteryTheposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,andthedorsalispedispulseisfeltbetweenthefirstandsecondmetatarsals.(K.RVowden,1996)足部动脉足部动脉ArteriesoftheFootVascularAssessmentTrainingSession-Introductory足動脈前面後脛骨動脈後腓骨動脈貫通枝腓骨動脈前脛骨動脈弓状動脈外側内側足根動脈足背動脈外側内側足底動脈足底動脈弓貫通枝(深足底枝)後脛骨動脈内果後方部流、触診検査行適前腓骨動脈貫通枝足足踝踝血血压压AnklePressuresVascularAssessmentTrainingSession-Introductory右足背右足背动脉收缩压动脉收缩压RightDPSystolicPressure足足踝踝血血压压AnklePressuresVascularAssessmentTrainingSession-Introductory右胫后动脉收缩血压压RightPTSystolicPressureABI检查检查HowtoexaminetheABIVascularAssessmentTrainingSession-IntroductoryABI计算计算HowtoCalculatetheABIVascularAssessmentTrainingSession-Introductory8580145150120115足背動脈DorsalisPedis後脛骨動脈PosteriorTibial上臂Brachial右右ABIRightABI左左ABILeftABINormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3(checklocalpolicy)=85150=0.57=120150=0.80ABI計算法計算法ABIcalculations足関節収縮期血圧最大測定値(両足)Highestanklesystolicpressure上腕収縮期血圧最大測定値Highestbrachialsystolicpressure上臂Brachial後脛骨動脈PosteriorTibialABI结果解释结果解释HowtointerprettheABIVascularAssessmentTrainingSession-IntroductoryABI1.0-1.3ABI=0.8-1.0ABI=0.5-0.8ABI1.3动脉正常Unlikelytobearterialinorigin轻度动脉疾病Mildperipheraldisease显著动脉疾病Significantofarterialdisease严重动脉疾病Severearterialdisease检测足趾血压MeasuretoepressuresorrefertospecialistApplycompressiontherapyApplycompressiontherapywithcautionDonotcompressrefertospecialistDonotcompressreferurgentlytovascularspecialistmayvaryaccordingtolocalprotocolsABI检查周期检查周期RepeatABIchecksVascularAssessmentTrainingSession-Introductory每12周一次ItisrecommendedthattheABIischeckedevery12weeks(Simon1994)however;@#@ifthepatientsconditionchangesduringthattimei.e.pain,theprocedureshouldberepeatedasnecessaryIfanulcerre-occurs,repeattheDopplerassessmentDonotpresumeitisofthesameorigin影响影响ABI结果的因素结果的因素FactorsAffectingtheAccuracyoftheABIVascularAssessmentTrainingSession-Introductory心律不齐CardiacArrhythmias(Vowden,K.P.1996).Moredifficulttoassessthesound准备不足Inadequatepreparationi.e.roomtemperature血管收缩Vasoconstriction患者焦虑Patientandcliniciananxiousandunrelaxed血压升高Resultingintoincreasedbloodpressure患者体位不舒服IncorrectpositioningofpatientFalselyelevatedanklepressures超声耦合剂不足InappropriateGel空气气泡Interferenceduetoairbubbles血压袖带不合适Incorrectsizeofsphygcuff血压测量不准Incorrectpressuremeasurements多普勒探头不对InappropriateDopplerprobeUltrasoundcannotpenetratetodepthofvessel探头位置不正确IncorrectpositionofDopplerprobeovervessel血压测量不正确Incorrectpressure