《ABI踝臂指数检查》由会员分享，可在线阅读，更多相关《ABI踝臂指数检查（39页珍藏版）》请在金锄头文库上搜索。
1、ABI (踝臂指数) 检查-动脉粥样硬化无创性筛查ABI Assessment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ThrombosisThrombosis 血栓血栓AtherosclerosisAtherosclerosis 动脉粥样硬化动脉粥样硬化 unstable anginaunstable angina不稳定型心不稳定型心 绞痛绞痛 MI MI 心梗心梗 ischemic stroke/TIA ischemic stroke/TIA 中风中风 critical limb ischemia crit
2、ical limb ischemia 下肢缺下肢缺 血血 CV death CV death 心血管死亡心血管死亡Pathologic progression to atherosclerosis动脉粥样硬化的主要临床表现Cerebrovascular disease Cerebrovascular disease 脑血管病脑血管病Coronary artery disease Coronary artery disease 冠状动脉疾病冠状动脉疾病Renal artery stenosis Renal artery stenosis 肾动脉狭窄肾动脉狭窄Visceral arterial d
3、isease Visceral arterial disease 内脏动脉内脏动脉Peripheral arterial disease Peripheral arterial disease 周围动脉疾病周围动脉疾病 Intermittent claudication Intermittent claudication 间歇性跛行间歇性跛行 Critical limb ischemia Critical limb ischemia 下肢严重缺血下肢严重缺血Major manifestations of atherosclerosis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
4、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Level ILevel IILevel IIILevel IV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 Williams 1993)患者仰卧 Position the patient supine, (Stubbing 1996)患者准备 Preparation of
5、the PatientVascular Assessment Training Session - Introductory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 arteryThe posterior tibial pulse is located in the hollow behind the medial malleolus, and the dorsalis pedis pulse is felt betwe
6、en the first and second metatarsals. (K.R Vowden, 1996)足部动脉 Arteries of the FootVascular 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足踝血压 Ankle PressuresVascular Assessment Training Session - Introductory
7、右足背动脉收缩压 Right DP Systolic Pressure足踝血压 Ankle PressuresVascular Assessment Training Session - Introductory 右胫后动脉收缩血压 Right PT Systolic PressureABI检查 How to examine the ABIVascular Assessment Training Session - IntroductoryABI计算 How to Calculate the ABIVascular Assessment Training Session - Introduct
8、ory8580145150120115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 = 0.80ABI計算法 ABI calculations 足関節収縮期血圧最大測定値(両足) Highest ankle systolic pressure 上腕収縮期
9、血圧最大測定値 Highest brachial systolic pressure上臂 Brachial後脛骨動脈 Posterior TibialABI结果解释 How to interpret the ABIVascular Assessment Training Session - IntroductoryABI 1.0 - 1.3ABI = 0.8 - 1.0ABI = 0.5 - 0.8ABI 1.3 动脉正常 Unlikely to be arterial in origin轻度动脉疾病 Mild peripheral disease显著动脉疾病 Significant of a
10、rterial disease严重动脉疾病 Severe arterial disease检测足趾血压 Measure toe pressures or refer to specialistApply compression therapyApply compression therapy with cautionDo not compress refer to specialistDo not compress refer urgently to vascular specialist may vary according to local protocolsABI检查周期 Repeat
11、ABI checksVascular 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. pain, the procedure should be repeated as necessaryIf an ulcer re-occurs, repeat the Doppler asses
12、smentDo not presume it is of the same origin影响ABI结果的因素 Factors Affecting the Accuracy of the ABIVascular Assessment Training Session - Introductory心律不齐 Cardiac Arrhythmias (Vowden, K.P. 1996).More difficult to assess the sound 准备不足 Inadequate preparation i.e. room temperature血管收缩 Vaso constriction 患
13、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 patientFalsely elevated ankle pressures 超声耦合剂不足 Inappropriate Gel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 measurement
14、s 多普勒探头不对 Inappropriate Doppler probeUltrasound cannot penetrate to depth of vessel 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 rapidlyRisk
15、 of missing systolic pressure point 血管加压时间过长 Prolonged inflation of the cuff/re-inflationHyperemic effect on limb 血管反复加压 Mid procedure/repeated inflation (Vowden K. P. 1996)Hyperemic 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
16、procedure (Anderson 1995)practical skill requiring assessment by peers影响ABI结果的因素 Factors Affecting the Accuracy of the ABIVascular Assessment Training Session - Introductory多普勒波形和声音Doppler waveforms and sounds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多普勒波形和声音 Doppler Waveforms & Sounds 正常三时相波形 Triphasic Wa
