ABI踝臂指數(shù)檢查

ABI踝臂指數(shù)檢查第1頁/共39頁動(dòng)脈粥樣硬化的主要臨床表現(xiàn)Cerebrovasculardisease腦血管病Coronaryarterydisease冠狀動(dòng)脈疾病Renalarterystenosis腎動(dòng)脈狹窄Visceralarterialdisease內(nèi)臟動(dòng)脈Peripheralarterialdisease周圍動(dòng)脈疾病Intermittentclaudication間歇性跛行Criticallimbischemia下肢嚴(yán)重缺血Majormanifestationsofatherosclerosis第2頁/共39頁定義PAD是動(dòng)脈粥樣硬化的一種類型,脂肪沿動(dòng)脈管壁沉積,導(dǎo)致管腔的狹窄和阻塞性病變，主要損傷下肢和足部的動(dòng)脈。流行病學(xué)有癥狀的PAD患者占55-74歲年齡段人群的4.5%，大約20%的老年人患有癥狀的或無癥狀的PAD。

——德國血管學(xué)協(xié)會(huì)和血管醫(yī)學(xué)協(xié)會(huì)周圍動(dòng)脈疾?。≒AD）第3頁/共39頁危險(xiǎn)因素糖尿病高血壓高脂血癥LevelILevelIILevelIIILevelIV血流減少功能降低潰瘍和壞死無癥狀麻木冷感雷諾氏綜合征間歇性跛行靜息痛潰瘍壞死PAD頸動(dòng)脈主動(dòng)脈腸系膜上動(dòng)脈&腹動(dòng)脈腎動(dòng)脈髂總動(dòng)脈缺血：血供減少引起疼痛和功能障礙動(dòng)脈狹窄血小板50%的直徑狹窄75%的面積狹窄60%的直徑狹窄84%的面積狹窄主要?jiǎng)用}狹窄狹窄進(jìn)展閉塞周圍動(dòng)脈疾病（PAD）第4頁/共39頁最容易的方法...多普勒+外周動(dòng)脈血壓血管功能

——無創(chuàng)檢查第5頁/共39頁ABI(踝臂指數(shù))檢查ABIAssessment第6頁/共39頁A.B.I.定義:狹窄部位以下的動(dòng)脈壓狹窄部位以上的動(dòng)脈壓踝部動(dòng)脈收縮壓

肱部動(dòng)脈收縮壓ABI:=

踝部動(dòng)脈收縮壓

肱部動(dòng)脈收縮壓第7頁/共39頁哪些人需要進(jìn)行ABI檢查？50歲以上或病史超過10年以上的糖尿病患者。有高血壓、吸煙、高血脂癥的患者。有冠心?。ɑ蛴屑易宀∈罚⑷毖宰渲惺返母呶；颊摺Ｓ新阅I功能不全血液透析的患者。不能活動(dòng)，臥床、肥胖的病人。哪些人需要ABI檢查?第8頁/共39頁解釋檢查程序

Explainandreassurepatientoftheprocedure保持室溫舒適

Ensureambienttemperatureoftheroomiscomfortable,(Moffatt1990)松解上下肢體衣褲

Removeanytightclothingfrombotharmsandstockingssocksetc.fromlegs保護(hù)潰瘍傷口

Removeanydressingsfromcurrentulcersandcoverwithaclearfilm,(Kenny1997)患者保持安靜休息15－20分鐘

Restthepatientfor15-20minutes,(Yao1993;Williams1993)患者仰臥

Positionthepatientsupine,

(Stubbing1996)患者準(zhǔn)備

PreparationofthePatient

VascularAssessmentTrainingSession-Introductory第9頁/共39頁正常靜脈血流音Soundsofnormalvein血流聲音VascularAssessmentTrainingSession-Introductory正常動(dòng)脈血流聲

Soundofnormalartery第10頁/共39頁Theposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,andthedorsalispedispulseisfeltbetweenthefirstandsecondmetatarsals.(K.RVowden,1996)足部動(dòng)脈

ArteriesoftheFoot

VascularAssessmentTrainingSession-Introductory足の動(dòng)脈前面後脛骨動(dòng)脈後腓骨動(dòng)脈貫通枝腓骨動(dòng)脈前脛骨動(dòng)脈弓狀動(dòng)脈外側(cè)?內(nèi)側(cè)足根動(dòng)脈足背動(dòng)脈外側(cè)?內(nèi)側(cè)足底動(dòng)脈足底動(dòng)脈弓貫通枝（深足底枝）後脛骨動(dòng)脈が內(nèi)果後方部を流れているため、觸診や検査を行うのに適している前腓骨動(dòng)脈貫通枝第11頁/共39頁足踝血壓

AnklePressures

VascularAssessmentTrainingSession-Introductory

右足背動(dòng)脈收縮壓

RightDPSystolicPressure第12頁/共39頁足踝血壓

AnklePressures

VascularAssessmentTrainingSession-Introductory右脛后動(dòng)脈收縮血壓

RightPTSystolicPressure第13頁/共39頁ABI檢查

HowtoexaminetheABI

VascularAssessmentTrainingSession-Introductory第14頁/共39頁ABI計(jì)算

HowtoCalculatetheABI

VascularAssessmentTrainingSession-Introductory8580145150120115足背動(dòng)脈DorsalisPedis後脛骨動(dòng)脈PosteriorTibial上臂

Brachial右ABI

RightABI左ABI

LeftABI

NormalABIratioisequalorgreaterthan0.90butnotgreaterthan1.3(checklocalpolicy)=85150=0.57=120150=0.80ABI計(jì)算法ABIcalculations足関節(jié)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(dòng)脈PosteriorTibial第15頁/共39頁第16頁/共39頁ABI結(jié)果解釋

HowtointerprettheABI

VascularAssessmentTrainingSession-IntroductoryABI>1.0-1.3ABI=0.8-1.0ABI=0.5-0.8ABI<0.5ABI>1.3動(dòng)脈正常

Unlikelytobearterialinorigin

輕度動(dòng)脈疾病

Mildperipheraldisease

顯著動(dòng)脈疾病

Significantofarterialdisease

嚴(yán)重動(dòng)脈疾病Severearterialdisease檢測足趾血壓

MeasuretoepressuresorrefertospecialistApplycompressiontherapyApplycompressiontherapywithcaution

Donotcompress–refertospecialist

Donotcompress–referurgentlytovascularspecialist

mayvaryaccordingtolocalprotocols第17頁/共39頁ABI檢查周期

RepeatABIchecks

VascularAssessmentTrainingSession-Introductory每12周一次

ItisrecommendedthattheABIischeckedevery12weeks(Simon1994)however;

ifthepatientsconditionchangesduringthattimei.e.pain,theprocedureshouldberepeatedasnecessary

Ifanulcerre-occurs,repeattheDopplerassessmentDonotpresumeitisofthesameorigin第18頁/共39頁影響ABI結(jié)果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory心律不齊

CardiacArrhythmias

(Vowden,K.P.1996).Moredifficulttoassessthesound準(zhǔn)備不足

Inadequatepreparationi.e.roomtemperature血管收縮Vasoconstriction患者焦慮

Patientandcliniciananxiousandunrelaxed血壓升高Resultingintoincreasedbloodpressure

患者體位不舒服

IncorrectpositioningofpatientFalselyelevatedanklepressures

超聲耦合劑不足

InappropriateGel空氣氣泡Interferenceduetoairbubbles

血壓袖帶不合適

Incorrectsizeofsphygcuff血壓測量不準(zhǔn)Incorrectpressuremeasurements

多普勒探頭不對(duì)

InappropriateDopplerprobe

Ultrasoundcannotpenetratetodepthofvessel第19頁/共39頁

探頭位置不正確

IncorrectpositionofDopplerprobeovervessel血壓測量不正確

Incorrectpressuremeasurements

對(duì)血管施壓過大

Excessivepressureonvesselduringprocedure血管擠壓

Collapsesvessels

血圧袖帶放氣過快

Releasingsphygcufftoorapidly

Riskofmissingsystolicpressurepoint

血管加壓時(shí)間過長

Prolongedinflationofthecuff/re-inflation

Hyperemiceffectonlimb

血管反復(fù)加壓

Midprocedure/repeatedinflation(VowdenK.P.1996)Hyperemiceffectonlimb

檢測過程中探頭移動(dòng)

MovingDopplerduringmeasurementIncorrectpressuremeasurement

檢測經(jīng)驗(yàn)不足

Inexperienceoftheprocedure

(Anderson1995)practicalskillrequiringassessmentbypeers影響ABI結(jié)果的因素

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory第20頁/共39頁多普勒波形和聲音Dopplerwaveformsandsounds第21頁/共39頁心臟收縮期迅速升高的血流速心臟舒張期前期血液回流心臟舒張期后期血液順流下肢動(dòng)脈血流波形圖多普勒波形和聲音

DopplerWaveforms&Sounds第22頁/共39頁多普勒波形和聲音

DopplerWaveforms&Sounds

正常三時(shí)相波形

TriphasicWaveform-NormalVideoclipofTriphasicwaveform第23頁/共39頁

單相波形－異常

MonophasicWaveform2-Abnormal

多普勒波形和聲音

DopplerWaveforms&Sounds第24頁/共39頁失去多相波單元單向波波峰圓鈍Normal

正常堅(jiān)銳的上升支三相波單元Mildobstruction輕度梗阻Moderateobstruction中度梗阻SevereObstruction嚴(yán)重梗阻波峰消失多普勒波形和聲音

DopplerWaveforms&Sounds第25頁/共39頁足趾動(dòng)脈PPG檢查MeasuringToepressuresandTBPI第26頁/共39頁光電容積PPG原理

PPGShiftExplained

VascularAssessmentTrainingSession-Introductory光電容積描記儀發(fā)射并接收紅外線，紅外線遇到組織時(shí)出現(xiàn)散射，遇到紅細(xì)胞時(shí)則被其吸收。肢體的皮下微循環(huán)內(nèi)血容量增加時(shí)被反射的紅外線密度減少；反之則增大。第27頁/共39頁影響PPG檢查的因素

FactorsaffectingAPPGmeasurements

室內(nèi)溫度應(yīng)保持在20－24攝氏度。Theroomtemperatureshouldbebetween20-24C

檢查前足趾不應(yīng)裸露在外。

Alwayskeeptoescovereduntiltestsarestarted

患者檢查局部的溫度會(huì)影響波形（如涼手、涼足）

Patienttemperature-coldhandsandfeetwillalterthewaveform

吸煙-尼古丁會(huì)影響波形。

Smoking-nicotinewilldistortthewaveform

患者肢體運(yùn)動(dòng)－檢測過程中應(yīng)保持不動(dòng)。

Patientmovement-patientsshouldremainstillduringtheexamination第28頁/共39頁P(yáng)PG波形解釋

APPGWaveformInterpretation正常

Normal異常

Abnormal下降坡重搏切跡尖峰基線重搏切跡消失，下降支輕度上弓上升支輕度下弓上升支延遲波峰園鈍波幅減小第29頁/共39頁足趾血壓和TBI檢查TBIusingArterialPPG第30頁/共39頁足趾血壓

DiabeticsandToePressuresABPI>1.3時(shí)，需進(jìn)行足趾血壓測定和TBPI檢查。

UndertaketoepressuresandTBPIwhenABPI>1.3(Brooks,2001)動(dòng)脈血管中層鈣化很少發(fā)生在趾端動(dòng)脈

Calcificationrarelyextendstodigitalarteries(Vowden,1999)

對(duì)于糖尿病患者應(yīng)給予更加關(guān)注，需進(jìn)行特殊的動(dòng)脈檢查，如足趾血壓檢查。

“InpatientswithDiabetesMellitusadditionalcareshouldbetakenandfurtherarterialinvestigationsundertakensuchastoepressures”(ETRSguideline2003)第31頁/共39頁足趾血壓

DiabeticsandToePressures

動(dòng)脈PPG是檢查足趾血壓的最佳手段。ArterialPPGisthepreferredtechniquetomeasuretoepressures(Vowden,2002)

檢測腳趾血壓比多普勒操作簡單得多

EasierthanDopplertomeasuretoepressures

消除通過聲音探測脈搏恢復(fù)

Eliminatestheneedtoaudiblydetectthereturnofthepulse

探頭容易連接手指和腳趾

Sensorseasilyattachtofingers&toes血壓測定時(shí)，充氣袖帶放氣速度應(yīng)為2－3mmHg/秒

Cuffsshouldbedeflatedat2-3mmHg/sec(BHS,2000)第32頁/共39頁足趾血壓

DiabeticsandToe