如何建设介入-外科手术室_蒋世良.ppt

如何建设介入外科手术室（杂交手术室）,中国医学科学院阜外心血管病医院放射科.蒋世良,HybridRoom,背景（1）,心血管外科和介入心脏医生在过去存在一种竞争关系，特别是在冠心病和先心病治疗领域。,背景（2）,一些获得性和先天性心血管疾病采用经导管介入治疗和配合心外科治疗，提高了治疗效果。,背景（3）,随着介入心脏病医生和心血管外科医生合作的不断加强，适合这两种治疗方法共同的手术室（杂交手术室）出现了。,杂交手术时需要的人员,介入医生心血管外科医生超声心动图医生心脏麻醉医生电生理医生护士介入手术室技术员灌注师,杂交手术室设计,房间空间要求双球管造影机需要至少80m2单球管造影机需要至少70m2,空间要求,地面预留空间给下列设施心血管造影机麻醉机超声设备体外循环设备,手术床与可移动床的结合,产品特征：三维成像的需要床可浮动、移动防震动旋转角度15头侧抬高/降低15侧面倾斜碳纤维床面,空间方面的考虑,设备垂吊或安装在墙壁上手术灯造影剂注射器可变焦照相机（摄影机）,杂交手术室显像设备,平板监视器麻醉科医生超声心动图医生介入医生,信息传输,造影图像超声图像（经胸、经食道、血管内超声和三维超声图像）生理监护仪实时录像其它图像PACS（图像存储与传输系统）,杂交方法治疗冠心病多支病变,冠脉搭桥术后（CABG）行PCI治疗多支病变,先采用CABG治疗LAD阻塞性病变，后行PCI支架治疗右冠状动脉狭窄,经导管栓塞体肺侧支血管,法乐氏四联症术前经导管栓塞体肺侧支,经导管栓塞体肺侧支血管,法乐氏四联症术前经导管栓塞体肺侧支,法乐氏四联症术前经导管栓塞体肺侧支,经导管栓塞体肺侧支血管,经导管栓塞体肺侧支血管,法乐氏四联症术后经导管栓塞体肺侧支,Thankyouforyourattention！,HowtoBuildaCath-LabOperatingRoom（HybridOperatingRoom）,DepartmentofRadiology,CardiovascularInstitute&FuwaiHospital,PekingUnionMedicalCollege&ChineseAcademyofMedicalSciencesBeijing,China,100037ShiliangJiang,MD蒋世良,HybridRoom,Background（1）,Historically,surgeonsandinterventionalistshavehadasomewhatcompetitiverelationship,especiallyincoronaryarterydiseaseandcongenitalheartdisease.,Background（2）,Themanagementofsomeacquiredandcongenitalcardiovasculardiseasesisevolvingduetoadvancesintranscathetertherapiesthatcoincidewithsurgicalstrategiestoimproveoutcomes.,Background（3）,Asthelevelofcollaborationbetweenthesurgeonandinterventionalisthasincreased,theneedforatherapeuticsuitethatiscompatiblewithbothdisciplines（hybrid）hasbecomeapparent.,StaffInvolvedInAHybridCase,InterventionalistCardiovascularSurgeonEcho-cardiographerCardiacanesthesiologistElectrophysiologistNursesCathLabTechniciansPerfusionist,HybridRoomDesign,Theroomsize:shouldbeminimumof80m2forbi-planesystems70m2forsigle-planesystems,SpaceConsiderations,Floorspacereservedfor:AngiographicsystemAnesthesiamachineEchocardiographymachineCPBmachine,IntegratedOperationTablewithfloatingtabletop,Productfeatures:Integratedtableisthepre-requisitefor3DimagingFloatingtabletopCollisionProtectionMotorizedtiltingcapabilities:15headup/Down15lateraltiltCarbonfibretabletop,SpaceConsiderations,Equipmentmountedonceiling/walls:SurgicallightContrastinjectorZoomcameramountedonthewall,HybridRoomVideoDisplay,Flatpanelmonitorsaroundtheroomfor:AnesthesiologistEcho-cardiographerInterventionalist,InformationTransport,AngiogramsEchocardiograms(TTE,TEE,IVUS,3D)PhysiologymonitoringLivevideoOthervideosources-PACS,HybridProceduresfortheTreatmentofCADwithMultipleVesselsDisease,CABGpriortoPCIforCADwithMultipleVesselsDisease,CABGpriortoPCIforCTOwithLADandRCAStenosis,PercutaneousClosureofAortopulmonaryCollaterals,PriortointracardiacoperationforTetralogyofFallot,PercutaneousClosureofAortopulmonaryCollaterals,PriortointracardiacoperationforTetralogyofFallot,PercutaneousClosureofAortopulmonaryCollaterals,Priortointracardiacoperatio