冠状动脉造影术ppt课件

1、北京市心肺血管疾病医疗抢救中心1.23456789冠状动脉造影技术n病人的准备n血管入路的选择n导管的选择n药物的应用n造影剂10病人的准备n12导联心电图n电解质和肾功能n血常规n出凝血时间n准备行CPI者，服阿司匹林75-325mg，术前2天服抵克力得n应用华法令者，术前2天用肝素代替11血管入路的选择n经股动脉途径n经挠动脉途径n经弘动脉途径12药物的应用n镇静剂n抗凝剂n抗心肌缺血药物13TABLE 123. CHARACTERISTICS OF RADIOCONTRAST AGENTSCOMPOUNDBRANDNAMEOSMOLALITYmOsm/kg H2OVISCOSITY AT

2、37 CIODINE(mg/ml)SODIUM(mEq/liter)ADDITIVESIonic AgentsSodium diatrizoateHypaque16909.0370160Calcium disodium EDTASodium megluminediatrizoateRenografin19408.4370160Sodium citrate, disodium EDTANonionic or Low OsmolarSodium meglumine ioxaglateHexabrix6007.5320150Calcium disodium EDTAIohexalOmnipaque8

3、4410.43505Tromethamine calcium disodium EDTAIopamidolIsovue7909.43702Tromethamine calcium disodium EDTAIoversolOptiray7025.83202Tromethamine calcium disodium EDTAIodixanolVisipaque29011.832019Tromethamine calcium disodium EDTA + 0.15 mEq/L calciumModified from Hill J, Lambert C, Pepine C: Radiograph

4、ic contrast agents.In Pepine C, Hill J, Lambert C (eds): Diagnostic and Therapeutic Cardiac Catheterization. Baltimore, Williams & Wilkins, 1994, pp 182194.14TABLE 124. TOXICITIES ASSOCIATED WITH RADIOCONTRAST AGENTS Hypersensitivity (Anaphylactoid) Reactions Grade I: Single episode of emesis, n

5、ausea, sneezing, or vertigoGrade II: Hives, multiple episodes of emesis, fevers, or chillsGrade III: Clinical shock, bronchospasm, laryngospasm or edema, loss of consciousness, hypotension, hypertension, cardiac arrhythmias, angioedema, or pulmonary edema Cardiovascular Toxicity Electrophysiological

6、 Bradycardia (asystole, heart block) Tachycardia (sinus, ventricular) Ventricular fibrillation Hemodynamic Hypotension (cardiac depression, vasodilatation)Heart failure (cardiac depression, increased intravascular volume)Nephrotoxicity Discomfort Nausea, vomitingHeat and flushing Hyperthyroidism 15T

7、ABLE 126. RISK OF CARDIAC CATHETERIZATION SCAI REGISTRY(%) Mortality 0.11 Myocardial infarction 0.05 Cerebrovascular accident 0.07 Arrhythmias 0.38 Vascular complications 0.43 Contrast reaction 0.37 Hemodynamic complications 0.26 Perforation of heart chamber 0.03 Other complications 0.28 Total of major complications 1.70 160.140.140.170.170.080.080.170.171.851.850.240.240 00.50.51 11.51.52 2死亡率死亡率脑缺血脑缺血血肿血肿股动脉n = 6 328股动脉n = 6 328弘动脉n = 1 087弘动脉n = 1 087170.130.130.10.10.070.070.060.060.140.140.070.070.350.350.460.460 00.10.10.20.20.30.30.40.40.50.5死亡率死亡率MIMI脑卒中脑卒中血肿血肿n=3071n=3071n=222553n=22