ABI踝臂指数检查

ABI踝臂指数检查ABI踝臂指数

检查-------动脉粥样硬化无创性筛查ABIAssessment文档附赠有可编辑的3D小人素材

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Cerebrovasculardisease脑血管病Coronaryarterydisease冠状动脉疾病Renalarterystenosis肾动脉狭窄Visceralarterialdisease内脏动脉Peripheralarterialdisease周围动脉疾病Intermittentclaudication间歇性跛行Criticallimbischemia下肢严重缺血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危险因素糖尿病高血压高脂血症LevelILevelIILevelIIILevelIV血流减少功能降低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：血供减少引起疼痛和功能障碍动脉狭窄血小板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PAD最容易的方法...多普勒+外周动脉血压血管功能

——无创检查ABI踝臂指数

检查ABIAssessmentA.B.I.定义:狭窄部位以下的动脉压狭窄部位以上的动脉压踝部动脉收缩压

肱部动脉收缩压ABI:=

踝部动脉收缩压

肱部动脉收缩压哪些人需要进行ABI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ABI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15－20分钟

Restthepatientfor15-20minutes,Yao1993;Williams1993患者仰卧

Positionthepatientsupine,

Stubbing1996患者准备

PreparationofthePatient

VascularAssessmentTrainingSession-Introductory正常静脉血流音Soundsofnormalvein血流声音VascularAssessmentTrainingSession-Introductory正常动脉血流声

SoundofnormalarteryTheposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,andthedorsalispedispulseisfeltbetweenthefirstandsecondmetatarsals.

K.RVowden,1996足部动脉

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が内果後方部を流れているため、触診や検査を行うのに適している前腓骨動脈貫通枝足踝血压

AnklePressures

VascularAssessmentTrainingSession-Introductory

右足背动脉收缩压

RightDPSystolicPressure足踝血压

AnklePressures

VascularAssessmentTrainingSession-Introductory右胫后动脉收缩血压

RightPTSystolicPressureABI检查

HowtoexaminetheABI

VascularAssessmentTrainingSession-IntroductoryABI计算

HowtoCalculatetheABI

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

Brachial右ABI

RightABI左ABI

LeftABI

NormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3checklocalpolicy=85150=0.57=120150=0.80ABI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

HowtointerprettheABI

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

ApplycompressiontherapyApplycompressiontherapywithcaution

Donotcompress–refertospecialist

Donotcompress–referurgentlytovascularspecialist

mayvaryaccordingtolocalprotocolsABI检查周期

RepeatABIchecks

VascularAssessmentTrainingSession-Introductory每12周一次

ItisrecommendedthattheABIischeckedevery12weeksSimon1994however;

ifthepatientsconditionchangesduringthattimei.e.pain,theprocedureshouldberepeatedasnecessary

Ifanulcerre-occurs,repeattheDopplerassessmentDonotpresumeitisofthesameorigin影响ABI结果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-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

InappropriateDopplerprobe

Ultrasoundcannotpenetratetodepthofvessel

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

Releasingsphygcufftoorapidly

Riskofmissingsystolicpressurepoint

血管加压时间过长

Prolongedinflationofthecuff/re-inflation

Hyperemiceffectonlimb

血管反复加压

Midprocedure/repeatedinflationVowdenK.P.1996Hyperemiceffectonlimb

检测过程中探头移动

MovingDopplerduringmeasurementIncorrectpressuremeasurement

检测经验不足

Inexperienceoftheprocedure

Anderson1995practicalskillrequiringassessmentbypeers影响ABI结果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-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-NormalVideoclipofTriphasicwaveform

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

PPGShiftExplained

VascularAssessmentTrainingSession-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

FactorsaffectingAPPGmeasurementsPPG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

DiabeticsandToePressuresABPI>1.3时,需进行足趾血压测定和TBPI检查。

UndertaketoepressuresandTBPIwhenABPI>1.3Brooks,2001动脉血管中层钙化很少发生在趾端动脉

CalcificationrarelyextendstodigitalarteriesVowden,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。

InpatientswithDiabetesMellitusadditionalcareshouldbetakenandfurtherarterialinvestigationsundertakensuchastoepressuresETRSguideline2003足趾血压

DiabeticsandToePressures

动脉PPG是检查足趾血压的最佳手段。ArterialPPGisthepreferredtechniquetomeasuretoepressuresVowden,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2－3mmHg/秒

Cuffsshouldbedeflatedat2-3mmHg/secBHS,2000足趾血压

DiabeticsandToePressures

PPG检测足趾血压

ToePressuresusin