踝臂指數(shù)檢查

ABI(踝臂指數(shù))檢查-------動脈粥樣硬化無創(chuàng)性篩查ABIAssessment1精選ppt

動脈粥樣硬化的病理進(jìn)程Stableangina穩(wěn)定型心絞痛/intermittentclaudication間歇性跛行Thrombosis血栓Atherosclerosis動脈粥樣硬化

unstableangina不穩(wěn)定型心絞痛

MI心梗ischemicstroke/TIA中風(fēng)criticallimbischemia下肢缺血CVdeath心血管死亡Pathologicprogressiontoatherosclerosis2精選ppt動脈粥樣硬化的主要臨床表現(xiàn)Cerebrovasculardisease腦血管病Coronaryarterydisease冠狀動脈疾病Renalarterystenosis腎動脈狹窄Visceralarterialdisease內(nèi)臟動脈Peripheralarterialdisease周圍動脈疾病Intermittentclaudication間歇性跛行Criticallimbischemia下肢嚴(yán)重缺血Majormanifestationsofatherosclerosis3精選ppt定義PAD是動脈粥樣硬化的一種類型,脂肪沿動脈管壁沉積,導(dǎo)致管腔的狹窄和阻塞性病變，主要損傷下肢和足部的動脈。流行病學(xué)有病癥的PAD患者占55-74歲年齡段人群的4.5%，大約20%的老年人患有病癥的或無病癥的PAD?！聡軐W(xué)協(xié)會和血管醫(yī)學(xué)協(xié)會周圍動脈疾病〔PAD〕4精選ppt危險因素糖尿病高血壓高脂血癥LevelILevelIILevelIIILevelIV血流減少功能降低潰瘍和壞死無癥狀麻木冷感雷諾氏綜合征間歇性跛行靜息痛潰瘍壞死PAD頸動脈主動脈腸系膜上動脈&腹動脈腎動脈髂總動脈缺血：血供減少引起疼痛和功能障礙動脈狹窄血小板50%的直徑狹窄75%的面積狹窄60%的直徑狹窄84%的面積狹窄主要動脈狹窄狹窄進(jìn)展閉塞周圍動脈疾病〔PAD〕5精選ppt最容易的方法...多普勒+外周動脈血壓血管功能

——無創(chuàng)檢查6精選pptABI(踝臂指數(shù))檢查ABIAssessment7精選pptA.B.I.定義:狹窄部位以下的動脈壓狹窄部位以上的動脈壓踝部動脈收縮壓

肱部動脈收縮壓ABI:=

踝部動脈收縮壓

肱部動脈收縮壓8精選ppt哪些人需要進(jìn)行ABI檢查？50歲以上或病史超過10年以上的糖尿病患者。有高血壓、吸煙、高血脂癥的患者。有冠心病〔或有家族病史〕、缺血性卒中史的高危患者。有慢性腎功能不全血液透析的患者。不能活動，臥床、肥胖的病人。哪些人需要ABI檢查?9精選ppt解釋檢查程序

Explainandreassurepatientoftheprocedure保持室溫舒適

Ensureambienttemperatureoftheroomiscomfortable,(Moffatt1990)松解上下肢體衣褲

Removeanytightclothingfrombotharmsandstockingssocksetc.fromlegs保護(hù)潰瘍傷口

Removeanydressingsfromcurrentulcersandcoverwithaclearfilm,(Kenny1997)患者保持安靜休息15－20分鐘

Restthepatientfor15-20minutes,(Yao1993;Williams1993)患者仰臥

Positionthepatientsupine,

(Stubbing1996)患者準(zhǔn)備

PreparationofthePatient

VascularAssessmentTrainingSession-Introductory10精選ppt正常靜脈血流音Soundsofnormalvein血流聲音VascularAssessmentTrainingSession-Introductory正常動脈血流聲

Soundofnormalartery11精選pptTheposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,andthedorsalispedispulseisfeltbetweenthefirstandsecondmetatarsals.(K.RVowden,1996)足部動脈

ArteriesoftheFoot

VascularAssessmentTrainingSession-Introductory足の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狀動脈外側(cè)?內(nèi)側(cè)足根動脈足背動脈外側(cè)?內(nèi)側(cè)足底動脈足底動脈弓貫通枝〔深足底枝〕後脛骨動脈が內(nèi)果後方部を流れているため、觸診や検査を行うのに適している前腓骨動脈貫通枝12精選ppt足踝血壓

AnklePressures

VascularAssessmentTrainingSession-Introductory

右足背動脈收縮壓

RightDPSystolicPressure13精選ppt足踝血壓

AnklePressures

VascularAssessmentTrainingSession-Introductory右脛后動脈收縮血壓

RightPTSystolicPressure14精選pptABI檢查

HowtoexaminetheABI

VascularAssessmentTrainingSession-Introductory15精選pptABI計算

HowtoCalculatetheABI

VascularAssessmentTrainingSession-Introductory8580145150120115足背動脈DorsalisPedis後脛骨動脈PosteriorTibial上臂

Brachial右ABI

RightABI左ABI

LeftABI

NormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3(checklocalpolicy)=85150=0.57=120150=0.80ABI計算法ABIcalculations足関節(jié)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PosteriorTibial16精選ppt17精選pptABI結(jié)果解釋

HowtointerprettheABI

VascularAssessmentTrainingSession-IntroductoryABI>1.0-1.3ABI=0.8-1.0ABI=0.5-0.8ABI<0.5ABI>1.3

動脈正常

Unlikelytobearterialinorigin

輕度動脈疾病

Mildperipheraldisease

顯著動脈疾病

Significantofarterialdisease

嚴(yán)重動脈疾病Severearterialdisease檢測足趾血壓

MeasuretoepressuresorrefertospecialistApplycompressiontherapyApplycompressiontherapywithcaution

Donotcompress–refertospecialist

Donotcompress–referurgentlytovascularspecialist

mayvaryaccordingtolocalprotocols18精選pptABI檢查周期

RepeatABIchecks

VascularAssessmentTrainingSession-Introductory每12周一次

ItisrecommendedthattheABIischeckedevery12weeks(Simon1994)however;

ifthepatientsconditionchangesduringthattimei.e.pain,theprocedureshouldberepeatedasnecessary

Ifanulcerre-occurs,repeattheDopplerassessmentDonotpresumeitisofthesameorigin19精選ppt影響ABI結(jié)果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory心律不齊CardiacArrhythmias(Vowden,K.P.1996).Moredifficulttoassessthesound準(zhǔn)備缺乏Inadequatepreparationi.e.roomtemperature血管收縮Vasoconstriction患者焦慮Patientandcliniciananxiousandunrelaxed血壓升高Resultingintoincreasedbloodpressure患者體位不舒服IncorrectpositioningofpatientFalselyelevatedanklepressures超聲耦合劑缺乏InappropriateGel空氣氣泡Interferenceduetoairbubbles血壓袖帶不適宜Incorrectsizeofsphygcuff血壓測量不準(zhǔn)Incorrectpressuremeasurements多普勒探頭不對InappropriateDopplerprobe

Ultrasoundcannotpenetratetodepthofvessel20精選ppt探頭位置不正確IncorrectpositionofDopplerprobeovervessel血壓測量不正確Incorrectpressuremeasurements對血管施壓過大Excessivepressureonvesselduringprocedure血管擠壓Collapsesvessels血圧袖帶放氣過快Releasingsphygcufftoorapidly

Riskofmissingsystolicpressurepoint血管加壓時間過長Prolongedinflationofthecuff/re-inflation

Hyperemiceffectonlimb血管反復(fù)加壓Midprocedure/repeatedinflation(VowdenK.P.1996)Hyperemiceffectonlimb檢測過程中探頭移動MovingDopplerduringmeasurementIncorrectpressuremeasurement檢測經(jīng)驗缺乏Inexperienceoftheprocedure(Anderson1995)practicalskillrequiringassessmentbypeers影響ABI結(jié)果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory21精選ppt多普勒波形和聲音Dopplerwaveformsandsounds22精選ppt心臟收縮期迅速升高的血流速心臟舒張期前期血液回流心臟舒張期后期血液順流下肢動脈血流波形圖多普勒波形和聲音

DopplerWaveforms&Sounds23精選ppt多普勒波形和聲音

DopplerWaveforms&Sounds

正常三時相波形

TriphasicWaveform-NormalVideoclipofTriphasicwaveform24精選ppt

單相波形－異常

MonophasicWaveform2-Abnormal

多普勒波形和聲音

DopplerWaveforms&Sounds25精選ppt失去多相波單元單向波波峰圓鈍Normal

正常堅銳的上升支三相波單元Mildobstruction輕度梗阻Moderateobstruction中度梗阻SevereObstruction嚴(yán)重梗阻波峰消失多普勒波形和聲音

DopplerWaveforms&Sounds26精選ppt足趾動脈PPG檢查MeasuringToepressuresandTBPI27精選ppt光電容積PPG原理

PPGShiftExplained

VascularAssessmentTrainingSession-Introductory光電容積描記儀發(fā)射并接收紅外線，紅外線遇到組織時出現(xiàn)散射，遇到紅細(xì)胞時那么被其吸收。肢體的皮下微循環(huán)內(nèi)血容量增加時被反射的紅外線密度減少；反之那么增大。28精選ppt影響PPG檢查的因素

FactorsaffectingAPPGmeasurements室內(nèi)溫度應(yīng)保持在20－24攝氏度。Theroomtemperatureshouldbebetween20-24C檢查前足趾不應(yīng)裸露在外。Alwayskeeptoescovereduntiltestsarestarted患者檢查局部的溫度會影響波形〔如涼手、涼足〕

Patienttemperature-coldhandsandfeetwillalterthewaveform吸煙-尼古丁會影響波形。Smoking-nicotinewilldistortthewaveform患者肢體運(yùn)動－檢測過程中應(yīng)保持不動。

Patientmovement-patientsshouldremainstillduringtheexamination29精選pptPPG波形解釋

APPGWaveformInterpretation正常

Normal異常

Abnormal下降坡重搏切跡尖峰基線重搏切跡消失，下降支輕度上弓上升支輕度下弓上升支延遲波峰園鈍波幅減小30精選ppt足趾血壓和TBI檢查TBIusingArterialPPG31精選ppt足趾血壓

DiabeticsandToePressuresABPI>1.3時，需進(jìn)行足趾血壓測定和TBPI檢查。

UndertaketoepressuresandTBPIwhenABPI>1.3(Brooks,2001)動脈血管中層鈣化很少發(fā)生在趾端動脈

Calcificationrarelyextendstodigitalarteries(Vowden,1999)對于糖尿病患者應(yīng)給予更加關(guān)注，需進(jìn)行特殊的動脈檢查，如足趾血壓檢查。

“InpatientswithDiabetesMellitusadditionalcareshouldbetakenandfurtherarterialinvestigationsundertakensuchastoepressures〞(ETRSguideline2003)32精選ppt足趾血壓

DiabeticsandToePressures動脈PPG是檢查足趾血壓的最正確手段。ArterialPPGisthepreferredtechniquetomeasuretoepressures(Vowden,2002)檢測腳趾血壓比多普勒操作簡單得多EasierthanDopplertomeasuretoepressures消除通過聲音探測脈搏恢復(fù)Eliminatestheneedtoaudiblydetectthereturnofthepulse探頭容易連接手指和腳趾Sensorseasilyattachtofingers&toes血壓測定時，充氣袖帶放氣速度應(yīng)為2－3mmHg/秒

Cu