血管内介入的基础知识

术前准备•患者常规备皮•过敏试验（碘）•左侧肢体建立输液通道•各种监护装配•留置导尿导管室内所需物品血管内介入的基础知识心电、呼吸监护设备氧气供给系统各类急救药品及设备镇静药、解痉药、肝素、鱼精蛋白及尿激酶等血管造影所需器械•穿刺针（套管针）•血管扩张器（血管鞘）•Y阀（二相、三相）•三通•高压输液袋•延长管•导丝（.032-.035)（泥鳅导丝，交换导丝）•造影导管Procedure-SeldingerTechnique(1)步骤-Seldinger技术•Theskinispreparedandpunctured穿刺部位备皮•Thefemoralarteryandinguinalligamentarelocated股动脉位于腹股沟韧带处•Theneedlewithstyletisangledparalleltothecourseofthefemoralartery套管针的针头倾斜平行进入到股动脉内Procedure-SeldingerTechnique(2)步骤•Arteryispunctured(doubleorsinglewalltechnique)穿刺动脉•Styletisremovedandneedlewithdrawnuntilbloodflowoccurs移动套管针将针头回撤直到看到回血•Cannularemoved移动套管•Wireinserted导丝插入•Wireisfixed&needleremoved固定导丝，针头撤出•Trackisdilated扩张通道•Catheterisintroducedoverthewire导管通过导丝进入套管针，血管鞘，三通脑血管血管造影示意图ComplicationsofAngiography并发症•Groinhematoma(leakage,bruising)mostcommon最常见腹股沟血肿•Hemorrhage出血•Allergicreactiontocontrastordrugsadministered造影剂或药物过敏反应•Arterialinjury动脉损伤•Renalfailureduetocontrastmetabolism造影剂代谢引起的肾衰•Infection感染•Stroke中风•Death死亡血管内介入治疗器械•指引导管（5Fr-9Fr）•导丝，交换导丝•球囊导管系统（扩张，封堵）•血管远端保护装置（保护伞）•捕捞器（Goosenecksnail…)•支架导管系统（球扩式，自膨式，带膜）•微导管（OTW，漂浮）•栓塞材料（Coil，Onyx，NBCA，PVA…)球囊扩张示意图球囊扩张血管成形术示意图预装球扩式支架系统自膨式支架系统远端保护装置-保护伞捕捞器-GooseNeckSnail带膜支架系统