正確認(rèn)識(shí)股動(dòng)脈途徑以及閉合股動(dòng)脈穿刺口PPT參考幻燈片

正確認(rèn)識(shí)股動(dòng)脈途徑,中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院冠心病診治中心戴軍,1,討論,橈動(dòng)脈與股動(dòng)脈途徑比較股動(dòng)脈并發(fā)癥原因的分析贊成血管閉合設(shè)備的觀點(diǎn)AngioSeal裝置的正確使用,2,3,急性橈動(dòng)脈與股動(dòng)脈局部并發(fā)癥,橈動(dòng)脈4-6%股動(dòng)脈5-6%,4,橈動(dòng)脈特點(diǎn),橈動(dòng)脈是三級(jí)動(dòng)脈，屬肌性動(dòng)脈。橈動(dòng)脈壁厚，其中膜層500m。橈動(dòng)脈無穿支血管供應(yīng)，靠從腔內(nèi)滲透，容易出現(xiàn)由缺血引起的中膜增生。拇指和食指橈側(cè)完全由橈動(dòng)脈供，,5,動(dòng)脈搭橋材料特有的解剖學(xué)基礎(chǔ),橈動(dòng)脈的管徑與冠狀動(dòng)脈相似，其長度8.931.86cm足以達(dá)到任何靶血管。橈動(dòng)脈遠(yuǎn)端口內(nèi)徑2.450.32mm乳內(nèi)動(dòng)脈1.40.01mm胃網(wǎng)膜動(dòng)脈1.60.1mm,6,橈動(dòng)脈移植應(yīng)用,冠脈橋血管材料前臂橈動(dòng)脈皮瓣提供美容皮膚材料以及舌缺如修復(fù)材料前臂皮瓣進(jìn)行全鼻再造,7,介入后橈動(dòng)脈狀態(tài),6%12%橈動(dòng)脈閉塞15%橈動(dòng)脈波動(dòng)消失,8,9,股動(dòng)脈并發(fā)癥原因分析,血液溢出血管：出血、血腫、假性動(dòng)脈瘤、腹膜后血腫動(dòng)靜脈瘺股神經(jīng)以及側(cè)支損傷感染遠(yuǎn)端栓塞,10,正確的股動(dòng)脈穿刺技術(shù),股動(dòng)脈穿刺位置正確是減少并發(fā)癥決定因素對(duì)于強(qiáng)化抗血小板治療以及肝素化的病人不易反復(fù)穿刺術(shù)后應(yīng)該股動(dòng)脈造影，評(píng)價(jià)股動(dòng)脈解剖、鞘管位置、血管直徑，以及出現(xiàn)并發(fā)癥的風(fēng)險(xiǎn),11,Figure2:OptimalFemoralPunctureZone,Figure2:OptimalFemoralPunctureZone,髂前上棘,腹股溝韌帶,恥骨聯(lián)合,股深動(dòng)脈,股淺動(dòng)脈,股總動(dòng)脈,股靜脈,隱靜脈,腹股溝韌帶下動(dòng)脈穿刺區(qū)域,12,13,14,Figure1:Puncturesiteanatomy,Figure1:Puncturesiteanatomy,腹股溝韌帶,髂外動(dòng)脈,恥骨,股總動(dòng)脈,股深動(dòng)脈,股淺動(dòng)脈,正確,不正確,不正確,15,TooptimizeHemostasisDeviceresultsintermsof:,PatientcomfortTimetoambulationVascularcomplications,16,工欲善其事必先利其器古代名言,17,Ameta-analysisofpercutaneousvascularclosuredevicesafterdiagnosticcatheterizationandpercutaneouscoronaryintervention,16prospective,randomizedclinicaltrials5,0485,048patientsincluded.ThepooledORwas0.89(95%confidenceinterval),indicatingasignificantdecreaseinriskbydevicesAngio-Sealwasassociatedwithasignificantreductioninrisk(OR,0.51)Perclosehadaneutralresult(OR,1.0),Vasosealhadanincreasedriskofcomplications(OR,1.18).JInvasiveCardiol.2004May;16(5):243-6.,18,Angio-SealTMDeviceProvidesHemostasisby,“Activeclosure”whichmechanicallysealsthearteriotomyutilizingthreebio-absorbablecomponents:,AnchorIntravascularpulledupagainstthevesselwallCollagenplugExtravascularSutureSandwichesthevesselwallbetweentheanchorandcollagen,19,20,21,22,23,24,25,總結(jié),股動(dòng)脈始終為最可靠、便捷、安全介入途徑，尤其在緊急情況下。正確的穿刺部位是減少并發(fā)癥