ABI(踝臂指數(shù))檢查-------動(dòng)脈粥樣硬化無創(chuàng)性篩查ABIAssessment

動(dòng)脈粥樣硬化的病理進(jìn)程Stableangina穩(wěn)定型心絞痛/intermittentclaudication間歇性跛行Thrombosis血栓Atherosclerosis動(dòng)脈粥樣硬化

unstableangina不穩(wěn)定型心絞痛MI心梗ischemicstroke/TIA中風(fēng)criticallimbischemia下肢缺血CVdeath心血管死亡Pathologicprogressiontoatherosclerosis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）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ABI(踝臂指數(shù))檢查ABIAssessmentA.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-IntroductoryTheposteriortibialpulseislocatedinthehollowbehindthemedialmalleolus,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)脈貫通枝足踝血壓

AnklePressures

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

RightPTSystolicPressureABI檢查

HowtoexaminetheABI

VascularAssessmentTrainingSession-IntroductoryABI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(cè)定値(両足)Highestanklesystolicpressure上腕収縮期血圧最大測(cè)定値Highestbrachialsystolicpressure上臂

Brachial後脛骨動(dòng)脈PosteriorTibialABI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(cè)足趾血壓

MeasuretoepressuresorrefertospecialistApplycompressiontherapyApplycompressiontherapywithcaution

Donotcompress–refertospecialist

Donotcompress–referurgentlytovascularspecialist

mayvaryaccordingtolocalprotocols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(cè)量不準(zhǔn)Incorrectpressuremeasurements

多普勒探頭不對(duì)

InappropriateDopplerprobe

Ultrasoundcannotpenetratetodepthofvessel

探頭位置不正確

IncorrectpositionofDopplerprobeovervessel血壓測(cè)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(cè)過程中探頭移動(dòng)

MovingDopplerduringmeasurementIncorrectpressuremeasurement

檢測(cè)經(jīng)驗(yàn)不足

Inexperienceoftheprocedure

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

FactorsAffectingtheAccuracyoftheABI

VascularAssessmentTrainingSession-Introductory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多普勒波形和聲音

DopplerWaveforms&Sounds

正常三時(shí)相波形

TriphasicWaveform-NormalVideoclipofTriphasicwaveform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足趾動(dòng)脈PPG檢查MeasuringToepressuresandTBPI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。PPG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足趾血壓和TBI檢查TBIusingArterialPPG足趾血壓

DiabeticsandToePressuresABPI>1.3時(shí)，需進(jìn)行足趾血壓測(cè)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)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(cè)腳趾血壓比多普勒操作簡單得多

EasierthanDopplertomeasuretoepressures

消除通過聲音探測(cè)脈搏恢復(fù)

Eliminatestheneedtoaudiblydetectthereturnofthepulse

探頭容易連接手指和腳趾

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

Cuffsshouldbedeflatedat2-3mmHg/sec(BHS,2000)足趾血壓

DiabeticsandToePressures

PPG檢測(cè)足趾血壓

ToePressuresusingPPG135140