醫(yī)學(xué)專題如何建設(shè)介入-外科手術(shù)室-蔣世良

1、如何建設(shè)介入外科手術(shù)室（雜交手術(shù)室）中國(guó)醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院放射科.蔣世良2021/7/19 星期一1Hybrid Room2021/7/19 星期一2背景（1）心血管外科和介入心臟醫(yī)生在過去存在一種競(jìng)爭(zhēng)關(guān)系，特別是在冠心病和先心病治療領(lǐng)域。2021/7/19 星期一3背景（2）一些獲得性和先天性心血管疾病采用經(jīng)導(dǎo)管介入治療和配合心外科治療，提高了治療效果。2021/7/19 星期一4背景（3）隨著介入心臟病醫(yī)生和心血管外科醫(yī)生合作的不斷加強(qiáng)，適合這兩種治療方法共同的手術(shù)室（雜交手術(shù)室）出現(xiàn)了。2021/7/19 星期一5雜交手術(shù)時(shí)需要的人員介入醫(yī)生心血管外科醫(yī)生 超聲心動(dòng)圖醫(yī)生心臟麻醉

2、醫(yī)生電生理醫(yī)生護(hù)士介入手術(shù)室技術(shù)員灌注師 2021/7/19 星期一6雜交手術(shù)室設(shè)計(jì) 房間空間要求 雙球管造影機(jī)需要至少80m2 單球管造影機(jī)需要至少70m22021/7/19 星期一7空間要求地面預(yù)留空間給下列設(shè)施 心血管造影機(jī) 麻醉機(jī) 超聲設(shè)備 體外循環(huán)設(shè)備2021/7/19 星期一8手術(shù)床與可移動(dòng)床的結(jié)合產(chǎn)品特征：三維成像的需要床可浮動(dòng)、移動(dòng)防震動(dòng) 旋轉(zhuǎn)角度 15 頭側(cè)抬高 / 降低 15 側(cè)面傾斜 碳纖維床面 2021/7/19 星期一9空間方面的考慮設(shè)備垂吊或安裝在墻壁上 手術(shù)燈 造影劑注射器 可變焦照相機(jī)（攝影機(jī)）2021/7/19 星期一10雜交手術(shù)室顯像設(shè)備平板監(jiān)視器 麻醉科醫(yī)

3、生 超聲心動(dòng)圖醫(yī)生 介入醫(yī)生2021/7/19 星期一11信息傳輸造影圖像超聲圖像（經(jīng)胸、經(jīng)食道、血管內(nèi)超聲和三維超聲圖像）生理監(jiān)護(hù)儀實(shí)時(shí)錄像其它圖像PACS（圖像存儲(chǔ)與傳輸系統(tǒng)）2021/7/19 星期一12雜交方法治療冠心病多支病變冠脈搭橋術(shù)后（CABG） 行PCI治療多支病變2021/7/19 星期一13先采用CABG治療LAD阻塞性病變，后行PCI支架治療右冠狀動(dòng)脈狹窄 2021/7/19 星期一14經(jīng)導(dǎo)管栓塞體肺側(cè)支血管 法樂氏四聯(lián)癥術(shù)前經(jīng)導(dǎo)管栓塞體肺側(cè)支 2021/7/19 星期一15經(jīng)導(dǎo)管栓塞體肺側(cè)支血管 法樂氏四聯(lián)癥術(shù)前經(jīng)導(dǎo)管栓塞體肺側(cè)支 2021/7/19 星期一16法樂氏四

4、聯(lián)癥術(shù)前經(jīng)導(dǎo)管栓塞體肺側(cè)支 經(jīng)導(dǎo)管栓塞體肺側(cè)支血管 2021/7/19 星期一17經(jīng)導(dǎo)管栓塞體肺側(cè)支血管 法樂氏四聯(lián)癥術(shù)后經(jīng)導(dǎo)管栓塞體肺側(cè)支 2021/7/19 星期一18Thank you for your attention ！2021/7/19 星期一19How to Build a Cath-Lab Operating Room （Hybrid Operating Room）Department of Radiology, Cardiovascular Institute & Fuwai Hospital,Peking Union Medical College & Chinese A

5、cademy of Medical Sciences Beijing, China, 100037Shiliang Jiang, MD蔣世良2021/7/19 星期一20Hybrid Room2021/7/19 星期一21Background（1）Historically, surgeons and interventionalists have had a somewhat competitive relationship, especially in coronary artery disease and congenital heart disease. 2021/7/19 星期一22B

6、ackground（2）The management of some acquired and congenital cardiovascular diseases is evolving due to advances in transcatheter therapies that coincide with surgical strategies to improve outcomes.2021/7/19 星期一23Background（3）As the level of collaboration between the surgeon and interventionalist has

7、 increased, the need for a therapeutic suite that is compatible with both disciplines（hybrid）has become apparent. 2021/7/19 星期一24Staff Involved In A Hybrid CaseInterventionalistCardiovascular Surgeon Echo-cardiographerCardiac anesthesiologistElectrophysiologistNursesCath Lab TechniciansPerfusionist

8、2021/7/19 星期一25Hybrid Room Design The room size : should be minimum of 80 m2 for bi-plane systems 70 m2 for sigle-plane systems2021/7/19 星期一26Space ConsiderationsFloor space reserved for: Angiographic system Anesthesia machine Echocardiography machine CPB machine2021/7/19 星期一27Integrated Operation T

9、able with floating table top Product features :Integrated table is the pre-requisite for 3D imagingFloating table topCollision Protection Motorized tilting capabilities: 15 head up/Down 15 lateral tilt Carbon fibre table top 2021/7/19 星期一28Space ConsiderationsEquipment mounted on ceiling/walls: Surg

10、ical light Contrast injector Zoom camera mounted on the wall2021/7/19 星期一29Hybrid Room Video DisplayFlat panel monitors around the room for: Anesthesiologist Echo-cardiographer Interventionalist 2021/7/19 星期一30Information TransportAngiogramsEchocardiograms(TTE,TEE,IVUS,3D)Physiology monitoringLive v

11、ideoOther video sources-PACS2021/7/19 星期一31Hybrid Procedures for the Treatment of CAD with Multiple Vessels DiseaseCABG prior to PCI for CAD with Multiple Vessels Disease2021/7/19 星期一32CABG prior to PCI for CTO withLAD and RCA Stenosis 2021/7/19 星期一33Percutaneous Closure of Aortopulmonary Collaterals Prior to intracardiac operation for Tetralogy of Fallot 2021/7/19 星期一34Percutaneous Closure of Aortopulmonary CollateralsPrior to intracardiac operation for Tetralogy of Fallot 2021/7/19 星期一35Percutaneous Closure of Aortopulmonary Collaterals Prior to intracardiac operation for Tetralogy of Fal