ABI(踝臂指数)检查.ppt

1、a,1,ABI (踝臂指数) 检查 -动脉粥样硬化无创性筛查 ABI Assessment,a,2,动脉粥样硬化的病理进程,Stable angina 稳定型心绞痛/intermittent claudication 间歇性跛行,Thrombosis 血栓,Atherosclerosis 动脉粥样硬化,unstable angina不稳定型心绞痛 MI 心梗 ischemic stroke/TIA 中风 critical limb ischemia 下肢缺血 CV death 心血管死亡,Pathologic progression to atherosclerosis,a,3,动脉粥样硬化的

2、主要临床表现,Major manifestations of atherosclerosis,a,4,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）,a,5,PAD,颈动脉,主动脉,肠系膜上动脉 Williams 1993) 患者仰卧 Position the patient supine,(Stubbing 1996),患者准备 Preparation of th

3、e Patient Vascular Assessment Training Session - Introductory,a,11,正常静脉血流音 Sounds of normal vein,血流声音 Vascular Assessment Training Session - Introductory,正常动脉血流声 Sound of normal artery,a,12,The posterior tibial pulse is located in the hollow behind the medial malleolus, and the dorsalis pedis pulse

4、is felt between the first and second metatarsals. (K.R Vowden, 1996),足部动脉Arteries of the Foot Vascular Assessment Training Session - 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,a,13,足踝血压 Ankle Pressures Vascular Assessment Trai

5、ning Session - Introductory,右足背动脉收缩压 Right DP Systolic Pressure,a,14,足踝血压 Ankle Pressures Vascular Assessment Training Session - Introductory,右胫后动脉收缩血压 Right PT Systolic Pressure,a,15,ABI检查 How to examine the ABI Vascular Assessment Training Session - Introductory,a,16,ABI计算 How to Calculate the ABI

6、 Vascular Assessment Training Session - Introductory,85,80,145,150,120,115,足背動脈 Dorsalis Pedis,後脛骨動脈 Posterior Tibial,上臂 Brachial,右ABI Right ABI,左ABI Left ABI,Normal ABI ratio is equal or greater than 0.90 but not greater than 1.3(check local policy),= 85,150,= 0.57,= 120,150,= 0.80,ABI計算法 ABI calcu

7、lations 足関節収縮期血圧最大測定値(両足) Highest ankle systolic pressure 上腕収縮期血圧最大測定値 Highest brachial systolic pressure,上臂 Brachial,後脛骨動脈 Posterior Tibial,a,17,a,18,ABI结果解释 How to interpret the ABI Vascular Assessment Training Session - Introductory,ABI 1.0 - 1.3 ABI = 0.8 - 1.0 ABI = 0.5 - 0.8 ABI 1.3 ,动脉正常 Unli

8、kely to be arterial in origin 轻度动脉疾病 Mild peripheral disease 显著动脉疾病 Significant of arterial disease 严重动脉疾病 Severe arterial disease 检测足趾血压Measure toe pressures or refer to specialist,Apply compression therapy Apply compression therapy with caution Do not compress refer to specialist Do not compress r

9、efer urgently to vascular specialist, may vary according to local protocols,a,19,ABI检查周期Repeat ABI checks Vascular Assessment Training Session - Introductory,每12周一次 It is recommended that the ABI is checked every 12 weeks (Simon 1994) however; if the patients condition changes during that time i.e.

10、pain, the procedure should be repeated as necessary If an ulcer re-occurs, repeat the Doppler assessment Do not presume it is of the same origin,a,20,影响ABI结果的因素 Factors Affecting the Accuracy of the ABI Vascular Assessment Training Session - Introductory,心律不齐 Cardiac Arrhythmias (Vowden, K.P. 1996).

11、 More difficult to assess the sound 准备不足 Inadequate preparation i.e. room temperature 血管收缩 Vaso constriction 患者焦虑 Patient and clinician anxious and unrelaxed 血压升高 Resulting into increased blood pressure 患者体位不舒服 Incorrect positioning of patient Falsely elevated ankle pressures 超声耦合剂不足 Inappropriate G

12、el 空气气泡 Interference due to air bubbles 血压袖带不合适Incorrect size of sphyg cuff 血压测量不准 Incorrect pressure measurements 多普勒探头不对 Inappropriate Doppler probe Ultrasound cannot penetrate to depth of vessel,a,21,探头位置不正确 Incorrect position of Doppler probe over vessel 血压测量不正确 Incorrect pressure measurements 对

13、血管施压过大 Excessive pressure on vessel during procedure 血管挤压Collapses vessels 血圧袖带放气过快Releasing sphyg cuff too rapidly Risk of missing systolic pressure point 血管加压时间过长Prolonged inflation of the cuff/re-inflation Hyperemic effect on limb 血管反复加压Mid procedure/repeated inflation (Vowden K. P. 1996) Hyperem

14、ic effect on limb 检测过程中探头移动Moving Doppler during measurement Incorrect pressure measurement 检测经验不足Inexperience of the procedure(Anderson 1995) practical skill requiring assessment by peers,影响ABI结果的因素 Factors Affecting the Accuracy of the ABI Vascular Assessment Training Session - Introductory,a,22,多

15、普勒波形和声音 Doppler waveforms and sounds,a,23,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Doppler Waveforms & Sounds,a,24,多普勒波形和声音Doppler Waveforms & Sounds,正常三时相波形Triphasic Waveform - Normal,Video clip of Triphasic waveform,a,25,单相波形异常Monophasic Waveform2 - Abnormal,多普勒波形和声音Doppler Waveform

16、s & Sounds,a,26,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,Mild obstruction 轻度梗阻,Moderate obstruction 中度梗阻,Severe Obstruction 严重梗阻,波峰消失,多普勒波形和声音Doppler Waveforms & Sounds,a,27,足趾动脉PPG检查 Measuring Toe pressures and TBPI,a,28,光电容积PPG原理PPG Shift Explained Vascular Assessment Training Session - Introductor

17、y,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。,a,29,影响PPG检查的因素Factors affecting APPG measurements,室内温度应保持在2024摄氏度。The room temperature should be between 20 - 24C 检查前足趾不应裸露在外。Always keep toes covered until tests are started 患者检查局部的温度会影响波形（如凉手、凉足） Patient temperature - c

18、old hands and feet will alter the waveform 吸烟-尼古丁会影响波形。Smoking - nicotine will distort the waveform 患者肢体运动检测过程中应保持不动。 Patient movement - patients should remain still during the examination,a,30,PPG波形解释APPG Waveform Interpretation,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

19、幅减小,a,31,足趾血压和TBI检查 TBI using Arterial PPG,a,32,足趾血压Diabetics and Toe Pressures,ABPI1.3时，需进行足趾血压测定和TBPI检查。Undertake toe pressures and TBPI when ABPI1.3 (Brooks, 2001) 动脉血管中层钙化很少发生在趾端动脉Calcification rarely extends to digital arteries (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。“In patients with

20、Diabetes Mellitus additional care should be taken and further arterial investigations undertaken such as toe pressures” (ETRS guideline 2003),a,33,足趾血压Diabetics and Toe Pressures,动脉PPG是检查足趾血压的最佳手段。Arterial PPG is the preferred technique to measure toe pressures (Vowden, 2002) 检测脚趾血压比多普勒操作简单得多Easier than Doppler to measure toe pressures 消除通过声音探测脉搏恢复Eliminates the need to audibly detect the return of the pulse 探头容易连接手指和脚趾Sensors easily attach to fingers & toes 血压测定时，充气袖带放气速度应为23mmHg/秒Cuffs should be deflated at 2-3mmHg/sec (BHS, 2000),a,34,足趾血压Diabetics and