冠狀動脈造影術(shù)

1、首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院北京市心肺血管疾病研究所北京市心肺血管疾病醫(yī)療搶救中心冠狀動脈造影技術(shù)n病人的準(zhǔn)備n血管入路的選擇n導(dǎo)管的選擇n藥物的應(yīng)用n造影劑病人的準(zhǔn)備n12導(dǎo)聯(lián)心電圖n電解質(zhì)和腎功能n血常規(guī)n出凝血時(shí)間n準(zhǔn)備行CPI者，服阿司匹林75-325mg，術(shù)前2天服抵克力得n應(yīng)用華法令者，術(shù)前2天用肝素代替血管入路的選擇n經(jīng)股動脈途徑n經(jīng)撓動脈途徑n經(jīng)弘動脈途徑藥物的應(yīng)用n鎮(zhèn)靜劑n抗凝劑n抗心肌缺血藥物TABLE 123. CHARACTERISTICS OF RADIOCONTRAST AGENTSCOMPOUNDBRANDNAMEOSMOLALITYmOsm/kg H2OVISC

2、OSITY AT37 CIODINE(mg/ml)SODIUM(mEq/liter)ADDITIVESIonic AgentsSodium diatrizoateHypaque16909.0370160Calcium disodium EDTASodium megluminediatrizoateRenografin19408.4370160Sodium citrate, disodium EDTANonionic or Low OsmolarSodium meglumine ioxaglateHexabrix6007.5320150Calcium disodium EDTAIohexalOm

3、nipaque84410.43505Tromethamine 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: Ra

4、diographic contrast agents.In Pepine C, Hill J, Lambert C (eds): Diagnostic and Therapeutic Cardiac Catheterization. Baltimore, Williams & Wilkins, 1994, pp 182194.TABLE 124. TOXICITIES ASSOCIATED WITH RADIOCONTRAST AGENTS Hypersensitivity (Anaphylactoid) Reactions Grade I: Single episode of eme

5、sis, nausea, 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 Electrophysiol

6、ogical 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 Hyperthyroidi

7、sm TABLE 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 0.140.140.170.170.080.080.170.171.851.850.240.240 00.50.51 11.51.52 2死亡率死亡率腦缺血腦缺血血腫血腫股動脈n = 6 328股動脈n = 6 328弘動脈n = 1 087弘動脈n = 1 0870.130.130.10.10.070.070.060.060.140.140.070.070.350.350.460.460 00.10.10.20.20.30.30.40.40.50.5死亡率死亡率MIMI腦卒中腦卒中血腫血腫n=3071n=3071n=222