ABI(踝臂指数)检查课件

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-IntroductoryTheposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,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

NormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3(checklocalpolicy)=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

MeasuretoepressuresorrefertospecialistApplycompressiontherapyApplycompressiontherapywithcaution

Donotcompress–refertospecialist

Donotcompress–referurgentlytovascularspecialist

mayvaryaccordingtolocalprotocols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/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

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory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。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

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

UndertaketoepressuresandTBPIwhenABPI>1.3(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2－3mmHg/秒

Cuffsshouldbedeflatedat2-3mmHg/sec(BHS,2000)足趾血压

DiabeticsandToePressures

PPG检测足趾血压

ToePressuresusingPPG135140