卫生部心血管疾病介入诊疗技术培训教材

XXX5000-7500XXXXX1XXXmAkVXXX2X1X2X3X45XX1X2X1234X5678ALARAAsLowAsReasonablyAchievable.XXXDSAXXCUCL+CXX1.2.3.X1.2.X3.XXX1X234567UAP20min20minAPAPAP20minTGAPST1mm22APMVAPTS32CCSQST1mm6512380g/L45678912%Seldinger1/321AllenAllen30-6010Allen8FBuergerIMA217022%2-3cm32cm211cm45430-50cm0.02554-5F0.036J6-7F63619090%1-31%60+3037%78%22%1-31-2++250%2-3cm1132cm4cm6cm10cm4JudkinsAmplatz1Judkins3.54.04.55.06.0Judkins4.0JudkinsJudkinsJudkins4-6mL3-5mL2AmplatzJudkinsAmplatzAmplatzAmplatz360AmplatzAmplatzAmplatzValsalvaAmplatzAmplatzAmplatzAmplatzAmplatz3130Judkins--JudkinsJudkins452JudkinsJudkinsJudkinsJudkinsJudkins9010430130245-6020-30:45301/360302/350%75%50%75%85%50%50%90%ACC/AHAABCBB1B2BB12BB2ACC/AHAABC10mm10~20mm20mm4590459033IVUSXABCDABCDDIVUS100-200ug1-2min90%41%26%17%3%1%0.6%~1.3%25%1.3%1.2.50%3.4.CT24-481mL2000-3000U12000UXcontrast-inducednephropathyCINCIN25%0.5mg/dLCIN1%5.5%5CIN10%-15%50%-70%24-485~77~10MehranCINCIN16CIN57.3%12.6%CIN5IABP557.5%0.04%CHF57556~1014%0.12%4311-1626.1%1.09%100ml1Cr1.5mg/dL41657.3%12.6%eGFR60ml/(min*1.73m2)240-60420-40620CIN1.0.9%0.45%0.5-1ml/Kg/h3-66-122.N-3.coronaryintravascularultrasound,IVUS20608090,360IVUSIVUSprobeacousticimpedancescatteringreflectionIVUS3601-2IVUSIVUSultrasoundcatheterpullbacksystemimagingconsoleIVUS2.63.5F0.871.17mm()2.63.2F0.871.07mmresolutionpenetration2045MHzaxiallateralresolution100120200250820mm(9MHz)IVUSmechanicallyrotatingtransducerelectronicallyswitchedmulti-elementarraytransducer1-11-1IVUSAB1-2IVUSAtlantisSRPro1-3IVUSAtlantisSRPro1.1800/30BostonScientificClearViewGALAXY2iLAB1-21-40.014non-uniformrotationaldistortion,NURDguide-wireartifact2.64VALCANO(Endosonics)1-5NURDring-downartifactIVUSVirtualHistologyVH0.51.0mm/s1-5123IVUS0.5-2mm0.51.0mm/s0.5mm/s1-71-81IVUS0.014guidewireIVUSPTCA2serialstudiesHausmann2207IVUSIVUSLMLADLCXLADLCX9LCXLAD3LAD8-122-8LCX12-6IVUS3IVUS0.5-1mm/sIVUSYIVUS200ug3000u1.IVUSPTCA2.IVUSIVUS3.IVUS4.IVUS11-11-11.intimainternalelasticmembraneatheroma2.mediaexternalelasticmembrane,EEM3.adventitiaperiadventitialtissues5603022040250200IVUS10050%2IVUSIVUS1IVUSIVUSIVUSIVUSIVUSIVUSIVUS-VirtualHistologyVH2IVUSIVUSExternalElasticMembraneEEMLumenCrosssectionalAreaLCSAExternalElasticMembraneCrosssectionalAreaEEMCSAIVUSEEMCSALCSA+EEM=EEMCSA-LCSA=EEMCSA-LCSA/EEMCSA(Plaqueburden)=/EEMCSA*100%EEMCSAIVUSRemodelingIndexRIEEMCSAEEMCSA10mmEEMCSAEEMCSARI1RI101-9091-180181-270271-3603IVUSIVUSIVUS4IVUS1IVUS140%IVUSIVUS26.0mm23.0mm4.0mm2IVUS3IVUS1mm220%0.7mmIVUSACSACSVH-IVUS10%40%;45672123IVUSCAS0.80.7CTO45lateacquiredincompletestentappositionLAISAlatestentmalappositionLSMLSMEEMCSA+LSMLSMDESlatelatestentthrombosis.67IVUSIVUSIVUSIVUS1IVUS2Baxter-Edwards20008F0.01445-901234OCTOCTOCTIVUSOCT1320nm360OCTOCTOCTIVUSOCT10-15um110um10OCTOCTOCTOCTLightLabImagingLLI15mmXOver-the-wireOCTOCT0.355mmOCT30/OCTOCTOCTOCT71-96%90-98%OCTOCTOCTOCTOCTOCT4.0mm30%80%30%~70%IVUSACC/AHA2005PCI400um400um40um100-400um100um5um285%-90%75%NO33-5ACoronaryFlowReserveCFR4~6BRelativeCoronaryFlowReserverCFR1CFractionalFlowReserveFFR111PTCA240-80cm/s10-20cm/s15-20%/1.8CFR33FFRFFRFFR=/PapdFFRnyo=Pd/Pa;FFRa.b.c.FFRd.e.f.+=FFRFFRFFRFFRFFRFFRFFR1FFR0.75PTCAFFR0.90FFR0.95CFR3-4cmCFRCFR100-200ugrCFRDopplerFFR1FFR10mmHg1~2mmHg2FFR3~5cmPaPdFFRPd/Pa6F7FFFRY2~3CFRFFR112-15mg8-10mg30-6030-60QTT2A2ATP20-40ug15-20ug105-1530FFR40ug60ugFFR20-30ug150ugATPATPP2ATP3ATP1-21140-180ug/(kg.min)3-6min10%-15%ATP40.56mg/kg40.75mg/kg201CFRFFRCFRCFR3-6FFRFFR1FFR0.94-1.02FFR0.7575%FFR0.7588%100%100%88%93%FFR0.75FFR0.7512%70%MLD1.8mmMLA4.0mm210mmFFR0.75CFRPCIFFRPCIFFR0.95PwPw/Pa=0.30FFRFameFFRPCI1FFRPCIMACEMICABGPCIFFRQCA75%FFR0.7575%20%FFRFFRIVUSFFRIVUSFFRFFRAMIFFRFFRFFR=0.7585%87%FFR75%81%77%FFR0.75FFRFFRFFRFFRCFR2.0rCFR0.8P/D1.7DSVR1.8diastolic/systolicflowvelocityratioFFR0.752005ACC/AHAPCI30%-70%a/BPCIb/Cb/CSwan-GanzCatherSwan-Ganz1ICG234112345621233CVP4455-12cmH2O0.392-1.177KPaCVP6Swan-GanzCVPAPmmHg51-1025/515-30/0-823/915-30/5-15PA1510-10PCWP105-15SwanGanzPAPPCWP110cm10cmlmm08lml13mmlml30cm4cm45%SwanGanz12PVR341acvapRcaVT234a.b.c.1-2mmHg.5.4%(CardiacIndexCI)=/CI2.8-3.2L/min*m2CI2.0-2.2L/min*m2CI1.8-2.0L/min*m2Seldinger1.11.5-215mL1840J5-10min4-65mL181cm1/330310.5-2mLSeldingerX2X41acvxy215-30mmHg2-5mmHg31/32.Seldinger(1)SeldingerX206242123456315-10mmHga280-130mmHg5-10mmHg70-95mmHg380-130mmHg60-90mmHg3.4.FFR5.IABPleftventricularassistdevice,LVAD3.10.6mm2.80.6mm6F7FAllen8F15-20cm2-3cm1%-2%1-2mL2125cm0.01911cm6F30-602-4mm100-200ug0.5-1.0mgPCIAngioseal1/32-3cm2%10-20mL0.035~0.0382cmSingle-wall2.5mm2.3mm6F1H/F4-62018-24PCIAPTTAPTT1.5-2.020-301kg4-618-244-6104-6TRITRI(Bp90/60mmHg)(0.9IV)()6024-48()()--1280mmol/L5722398%0.5%2%AcutekidneyinjuryAKI230.5mg/dl44mol/l;25%577101%3%5.5%50%1.2.3.4.1.2.3.4.5.6.7.728.9.10.11.12.eGFRSCrNGALC120mol/L1.36mg/dl1.120mol/L1.36mg/dL2.370N-300-370mg/mLGFR60ml/(min1.73m2)100mL=5mL(Kg)/(mg/dL)GFReGFR=(140-)(Kg)0.85()/(72mg/dL)2007ACC/AHA/SCAIIa1~1.5mL/(kgh)3-126-246AKI4-818241.DPCPX2.3.CE14.N-600mgBID245.6.1.2.3.4.AKIPCI8-112-4um1um6.8~13.5flgluc