ABI(踝臂指数)检查

50%的直径狭窄 75%的面积狭窄
血小板
60%的直径狭窄 84%的面积狭窄
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血管功能 ——无创检查
最容易的方法 ...
多普勒 + 外周动脉血压
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ABI (踝臂指数) 检查
ABI Assessment
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A.B.I. 定义: 狭窄部位以下的动脉压 狭窄部位以上的动脉压
A B I: =
Apply compression therapy Apply compression therapy with caution
Do not compress – refer to specialist
Do not compress – refer urgently to vascular specialist
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影响ABI结果的因素 Factors Affecting the Accuracy of the ABI
Vascular Assessment Training Session - Introductory
• 探头位置不正确 Incorrect position of Doppler probe over vessel
Vascular Assessment Training Session - Introductory
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• 右胫后动脉收缩血压 Right PT Systolic Pressure
足踝血压 Ankle Pressures
Vascular Assessment Training Session - Introductory
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周围动脉疾病（PAD）
定义
PAD是动脉粥样硬化的一种类型,脂肪沿动脉管 壁沉积,导致管腔的狭窄和阻塞性病变，主要损伤 下肢和足部的动脉。
流行病学
有症状的PAD患者占55-74岁年龄段人群的4.5%， 大约20%的老年人患有症状的或无症状的PAD。
——德国血管学协会和血管医学协会
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however; if the patients condition changes during that time i.e. pain, the procedure should be repeated as necessary
If an ulcer re-occurs, repeat the Doppler assessment Do not presume it is of the same origin
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ABI结果解释 How to interpret the ABI
Vascular Assessment Training Session - Introductory
ABI > 1.0 - 1.3 ABI = 0.8 - 1.0 ABI = 0.5 - 0.8 ABI < 0.5 ABI > 1.3
右ABI
Right ABI
上臂
Brachial
145
= 85 150
= 0.57
ABI计算 How to Calculate the ABI
Vascular Assessment Training Session - Introductory
上臂
Brachial
150
左ABI Left
ABI
= 120 150
• 血压袖带不合适 Incorrect size of sphyg cuff
血压测量不准 Incorrect pressure measurements
• 多普勒探头不对 Inappropriate Doppler probe
Ultrasound cannot penetrate to depth of vessel
血压升高 Resulting into increased blood pressure
• 患者体位不舒服 Incorrect positioning of patient
Falsely elevated ankle pressures
• 超声耦合剂不足 Inappropriate Gel
空气气泡 Interference due to air bubbles
• 患者保持安静休息15－20分钟 Rest the patient for 15-20 minutes,
(Yao
1993; Williams 1993)
• 患者仰卧 Position the patient supine, (Stubbing 1996)
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血流声音
Vascular Assessment Training Session - Introductory
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may vary according to local protocols
ABI检查周期 Repeat ABI checks
Vascular Assessment Training Session - Introductory
每12周一次 (Simon 1994) It is recommended that the ABI is checked every 12 weeks
踝部动脉收缩压 肱部动脉收缩压
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踝部动脉收缩压 肱部动脉收缩压
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哪些人需要ABI 检查?
哪些人需要进行ABI检查？
• 50岁以上或病史超过10年以上的糖尿病患者。 • 有高血压、吸烟、高血脂症的患者。 • 有冠心病（或有家族病史）、缺血性卒中史的高危患者。 • 有慢性肾功能不全血液透析的患者。 • 不能活动，卧床、肥胖的病人。
腓骨動脈 前脛骨動脈
前腓骨動脈貫通枝 外側･内側足根動脈 弓状動脈 足背動脈
足底動脈弓
後脛骨動脈 後腓骨動脈貫通枝
The posterior tibial pulse is located in the hollow behind the medial malleolus, and the dorsalis pedis pulse is felt between the first and
动脉正常
Unlikely to be arterial in origin
轻度动脉疾病 Mild peripheral disease
显著动脉疾病
Significant of arterial disease
严重动脉疾病
Severe arterial disease
检测足趾血压
Measure toe pressures or refer to specialist
= 0.80
後脛骨動脈
Posterior Tibial
80
後脛骨動脈
Posterior Tibial
120
85
115
足感背谢動下载脈 Dorsalis Pedis
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Normal ABI ratio is equal or greater than 0.90 but not greater than 1.3(check local policy)
ABI (踝臂指数) 检查
-------动脉粥样硬化无创性筛查
ABI Assessment
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Pathologic progression to atherosclerosis
动脉粥样硬化的病理进程
Atherosclerosis 动脉粥样硬化
Thrombosis 血栓
• unstable angina不稳定型心绞
血压测量不正确 Incorrect pressure measurements
• 对血管施压过大 Excessive pressure on vessel during procedure
血管挤压 Collapses vessels
• 血圧袖带放气过快 Releasing sphyg cuff too rapidly
roomtemperature血管收缩vasoconstriction患者焦虑patientcliniciananxiousunrelaxed血压升高resultingincreasedbloodpressure患者体位不舒服incorrectpositioningpatientfalselyelevatedanklepressures超声耦合剂不足inappropriategel空气气泡interferencedueairbubbles血压袖带不合适incorrectsizesphygcuf血压测量不准incorrectpressuremeasurements多普勒探头不对inappropriatedopplerprobeultrasoundcannotpenetrate探头位臵不正确incorrectpositiondopplerprobeovervessel血压测量不正确incorrectpressuremeasurements对血管施压过大excessivepressurevesselduringprocedure血管挤压collapsesvessels血圧袖带放气过快releasingsphygcuftoorapidlyriskmissingsystolicpressurepoint血管加压时间过长prolongedinflationreinflationhyperemiceffect血管反复加压midprocedurerepeatedinflationvowden1996hyperemiceffect检测过程中探头移动movingdopplerduringmeasurementincorrectpressuremeasurement检测经验不足inexperienceprocedureanderson1995practicalskillrequiringassessmentpeers影响abi结果的因素factorsaffectingabivascularassessmenttrainingsession22dopplerwaveforms23心脏收缩期迅速升高的血流速心脏舒张期前期血液回流心脏舒张期后期血液顺流下肢动脉血流波形图多普勒波形和声音dopplerwaveforms24多普勒波形和声音dopplerwaveforms正常三时相波形triphasicwaveformnormalvideocl
• 正常动脉血流声
Sound of normal artery
• 正常静脉血流音
Sounds of normal vein
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足の動脈 前面
足部动脉 Arteries of the Foot
Vascular Assessment Training Session - Introductory
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ABI检查 How to examine the ABI
Vascular Assessment Training Session - Introductory
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ABI計算法 ABI calculations
足関節収縮期血圧最大測定値(両足) Highest ankle systolic pressure 上腕収縮期血圧最大測定値 Highest brachial systolic pressure
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患者准备 Preparation of the Patient
Vascular Assessment Training Session - Introductory
• 解释检查程序 Explain and reassure patient of the procedure
• 保持室温舒适 (Moffatt 1990) Ensure ambient temperature of the room is comfortable,
痛Hale Waihona Puke • MI 心梗 • ischemic stroke/TIA 中风 • critical limb ischemia 下肢缺血 • CV death 心血管死亡
Stable angina 稳定型心绞痛/intermittent claudication 间歇性跛行
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Major manifestations of atherosclerosis
second metatarsals. (K.R Vowden, 1996)
後脛骨動脈が内果後方部を流れているため、触診や検査を行うのに適している 外側･内側足底動脈
貫通枝（深足底枝）
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• 右足背动脉收缩压 Right DP Systolic Pressure
足踝血压 Ankle Pressures
周围动脉疾病（PAD）
PAD
颈动脉
主动脉
肠系膜上动脉&腹动脉 肾动脉
髂总动脉
危险因素
糖尿病 高血压 高脂血症
Level I
血流减少
Level II Level III Level IV
功能降低 溃疡和坏死
无症状 麻木冷感 雷诺氏综合征
间歇性 跛行
静息痛
溃疡 坏死
主要动脉狭窄
狭窄进展
闭塞
动脉狭窄
缺血： 血供减少引起疼 痛和功能障碍
• 松解上下肢体衣裤 Remove any tight clothing from both arms and stockings socks etc. from legs
• 保护溃疡伤口 (Kenny 1997) Remove any dressings from current ulcers and cover with a clear film,
动脉粥样硬化的主要临床表现
Cerebrovascular disease 脑血管病
Coronary artery disease 冠状动脉疾病
Renal artery stenosis 肾动脉狭窄
Visceral arterial disease 内脏动脉
Peripheral arterial disease 周围动脉疾病 – Intermittent claudication 间歇性跛行 – Critical limb ischemia 下肢严重缺血
More difficult to assess the sound
• 准备不足 Inadequate preparation i.e. room temperature
血管收缩 Vaso constriction
• 患者焦虑 Patient and clinician anxious and unrelaxed
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影响ABI结果的因素 Factors Affecting the Accuracy of the ABI
Vascular Assessment Training Session - Introductory
•心律不齐 Cardiac Arrhythmias (Vowden, K.P. 1996).
Risk of missing systolic pressure point
• 血管加压时间过长
Hyperemic effect on limb
Prolonged inflation of the cuff/re-inflation