ABI(踝臂指数)检查.ppt

ABI(踝臂指数)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,Stableangina稳定型心绞痛/intermittentclaudication间歇性跛行,Thrombosis血栓,Atherosclerosis动脉粥样硬化,unstableangina不稳定型心绞痛MI心梗ischemicstroke/TIA中风criticallimbischemia下肢缺血CVdeath心血管死亡,Pathologicprogressiontoatherosclerosis,动脉粥样硬化的主要临床表现,Majormanifestationsofatherosclerosis,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（PAD）,PAD,颈动脉,主动脉,肠系膜上动脉Williams1993)患者仰卧Positionthepatientsupine,(Stubbing1996),患者准备PreparationofthePatientVascularAssessmentTrainingSession-Introductory,正常静脉血流音Soundsofnormalvein,血流声音VascularAssessmentTrainingSession-Introductory,正常动脉血流声Soundofnormalartery,Theposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,andthedorsalispedispulseisfeltbetweenthefirstandsecondmetatarsals.(K.RVowden,1996),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,足踝血压AnklePressuresVascularAssessmentTrainingSession-Introductory,右足背动脉收缩压RightDPSystolicPressure,足踝血压AnklePressuresVascularAssessmentTrainingSession-Introductory,右胫后动脉收缩血压RightPTSystolicPressure,ABI检查HowtoexaminetheABIVascularAssessmentTrainingSession-Introductory,ABI计算HowtoCalculatetheABIVascularAssessmentTrainingSession-Introductory,85,80,145,150,120,115,足背動脈DorsalisPedis,後脛骨動脈PosteriorTibial,上臂Brachial,右ABIRightABI,左ABILeftABI,NormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3(checklocalpolicy),=85,150,=0.57,=120,150,=0.80,ABI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PosteriorTibial,ABI结果解释HowtointerprettheABIVascularAssessmentTrainingSession-Introductory,ABI1.0-1.3ABI=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Measuretoepressuresorrefertospecialist,ApplycompressiontherapyApplycompressiontherapywithcautionDonotcompressrefertospecialistDonotcompressreferurgentlytovascularspecialist,mayvaryaccordingtolocalprotocols,ABI检查周期RepeatABIchecksVascularAssessmentTrainingSession-Introductory,每12周一次ItisrecommendedthattheABIischeckedevery12weeks(Simon1994)however;ifthepatientsconditionchangesduringthattimei.e.pain,theprocedureshouldberepeatedasnecessaryIfanulcerre-occurs,repeattheDopplerassessmentDonotpresumeitisofthesameorigin,影响ABI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Incorrectpressuremeasurements对血管施压过大Excessivepressureonvesselduringprocedure血管挤压Collapsesvessels血圧袖带放气过快ReleasingsphygcufftoorapidlyRiskofmissingsystolicpressurepoint血管加压时间过长Prolongedinflationofthecuff/re-inflationHyperemiceffectonlimb血管反复加压Midprocedure/repeatedinflation(VowdenK.P.1996)Hyperemiceffectonlimb检测过程中探头移动MovingDopplerduringmeasurementIncorrectpressuremeasurement检测经验不足Inexperienceoftheprocedure(Anderson1995)practicalskillrequiringassessmentbypeers,影响ABI结果的因素FactorsAffectingtheAccuracyoftheABIVascularAssessmentTrainingSession-Introductory,多普勒波形和声音Dopplerwaveformsandsounds,心脏收缩期迅速升高的血流速,心脏舒张期前期血液回流,心脏舒张期后期血液顺流,下肢动脉血流波形图,多普勒波形和声音DopplerWaveforms&Sounds,多普勒波形和声音DopplerWaveforms&Sounds,正常三时相波形TriphasicWaveform-Normal,VideoclipofTriphasicwaveform,单相波形异常MonophasicWaveform2-Abnormal,多普勒波形和声音DopplerWaveforms&Sounds,失去多相波单元,单向波波峰圆钝,Normal正常,坚锐的上升支三相波单元,Mildobstruction轻度梗阻,Moderateobstruction中度梗阻,SevereObstruction严重梗阻,波峰消失,多普勒波形和声音DopplerWaveforms&Sounds,足趾动脉PPG检查MeasuringToepressuresandTBPI,光电容积PPG原理PPGShiftExplainedVascularAssessmentTrainingSession-Introductory,光电容积描记仪发射并接收红外线，红外线遇到组织时出现散射，遇到红细胞时则被其吸收。肢体的皮下微循环内血容量增加时被反射的红外线密度减少；反之则增大。,影响PPG检查的因素FactorsaffectingAPPGmeasurements,室内温度应保持在2024摄氏度。Theroomtemperatureshouldbebetween20-24C检查前足趾不应裸露在外。Alwayskeeptoescovereduntiltestsarestarted患者检查局部的温度会影响波形（如凉手、凉足）Patienttemperature-coldhandsandfeetwillalterthewaveform吸烟-尼古丁会影响波形。Smoking-nicotinewilldistortthewaveform患者肢体运动检测过程中应保持不动。Patientmovement-patientsshouldremainstillduringtheexamination,PPG波形解释APPGWaveformInterpretation,正常Normal,异常Abnormal,下降坡,重搏切迹,尖峰,基线,重搏切迹消失，下降支轻度上弓,上升支轻度下弓,上升支延迟,波峰园钝,波幅减小,足趾血压和TBI检查TBIusingArterialPPG,足趾血压DiabeticsandToePressures,ABPI1.3时，需进行足趾血压测定和TBPI检查。UndertaketoepressuresandTBPIwhenABPI1.3(Brooks,2001)动脉血管中层钙化很少发生在趾端动脉Calcificationrarelyextendstodigitalarteries(Vowden,1999)对于糖尿病患者应给予更加关注，需进行特殊的动脉检查，如足趾血压检查。“InpatientswithDiabetesMellitusadditionalcareshouldbetakenandfurtherarterialinvestigationsundertakensuchastoepressures”(ETRSguideline2003),足趾血压DiabeticsandToePressures,动脉PPG是检查足趾血压的最佳手段。ArterialPPGisthepreferredtechniquetomeasuretoepressures(Vowden,2002)检测脚趾血压比多普勒操作简单得多EasierthanDopplertomeasuretoepressures消除通过声音探测脉搏恢复Eliminatestheneedtoaudiblydetectthereturnofthepulse探头容易连接手指和脚趾Sensorseasilyattachtofingers&toes血压测定时，充气袖带放气速度应为23mmHg/秒Cuffsshouldbedeflatedat2-3mmHg/sec(BHS,2000),足趾血压DiabeticsandToePressures,