冠状动脉造影术优选课件.ppt

1、n北京市心肺血管疾病医疗抢救中心2020/10/1812020/10/1822020/10/1832020/10/1842020/10/1852020/10/1862020/10/1872020/10/188冠状动脉造影技术n病人的准备n血管入路的选择n导管的选择n药物的应用n造影剂2020/10/189病人的准备n12导联心电图n电解质和肾功能n血常规n出凝血时间n准备行CPI者，服阿司匹林75-325mg，术前2天服抵克力得n应用华法令者，术前2天用肝素代替2020/10/1810血管入路的选择n经股动脉途径n经挠动脉途径n经弘动脉途径2020/10/1811药物的应用n镇静剂n抗凝剂n抗

2、心肌缺血药物2020/10/1812TABLE 123.CHARACTERISTICS OF RADIOCONTRAST AGENTSCOMPOUNDBRANDNAMEOSMOLALITYmOsm/kg H2OVISCOSITY AT37 CIODINE(mg/ml)SODIUM(mEq/liter)ADDITIVESIonic AgentsSodium diatrizoateHypaque16909.0370160Calcium disodium EDTASodium megluminediatrizoateRenografin19408.4370160Sodium citrate,diso

3、dium EDTANonionic or Low OsmolarSodium meglumine ioxaglateHexabrix6007.5320150Calcium disodium EDTAIohexalOmnipaque84410.43505Tromethamine calcium disodium EDTAIopamidolIsovue7909.43702Tromethamine calcium disodium EDTAIoversolOptiray7025.83202Tromethamine calcium disodium EDTAIodixanolVisipaque2901

4、1.832019Tromethamine calcium disodium EDTA+0.15 mEq/L calciumModified from Hill J,Lambert C,Pepine C:Radiographic contrast agents.In Pepine C,Hill J,Lambert C(eds):Diagnostic and Therapeutic Cardiac Catheterization.Baltimore,Williams&Wilkins,1994,pp 182194.2020/10/1813TABLE 124.TOXICITIES ASSOCIATED

5、 WITH RADIOCONTRAST AGENTS Hypersensitivity(Anaphylactoid)Reactions Grade I:Single episode of emesis,nausea,sneezing,or vertigoGrade II:Hives,multiple episodes of emesis,fevers,or chillsGrade III:Clinical shock,bronchospasm,laryngospasm or edema,loss of consciousness,hypotension,hypertension,cardiac

6、 arrhythmias,angioedema,or pulmonary edema Cardiovascular Toxicity Electrophysiological Bradycardia(asystole,heart block)Tachycardia(sinus,ventricular)Ventricular fibrillation Hemodynamic Hypotension(cardiac depression,vasodilatation)Heart failure(cardiac depression,increased intravascular volume)Ne

7、phrotoxicity Discomfort Nausea,vomitingHeat and flushing Hyperthyroidism 2020/10/1814TABLE 126.RISK OF CARDIAC CATHETERIZATION SCAI REGISTRY(%)Mortality 0.11 Myocardial infarction 0.05 Cerebrovascular accident 0.07 Arrhythmias 0.38 Vascular complications 0.43 Contrast reaction 0.37 Hemodynamic compl

8、ications 0.26 Perforation of heart chamber 0.03 Other complications 0.28 Total of major complications 1.70 2020/10/18150.140.140.170.170.080.080.170.171.851.850.240.240 00.50.51 11.51.52 2死亡率死亡率脑缺血脑缺血血肿血肿股动脉n=6 328股动脉n=6 328弘动脉n=1 087弘动脉n=1 0872020/10/18160.130.130.10.10.070.070.060.060.140.140.070.

9、070.350.350.460.460 00.10.10.20.20.30.30.40.40.50.5死亡率死亡率MIMI脑卒中脑卒中血肿血肿n=3071n=3071n=222553n=2225532020/10/18170.550.550.30.30.290.290 00.10.10.20.20.30.30.40.40.50.50.60.6左主干左主干LVEF30%LVEF30%NYHA IV级NYHA IV级死亡率(%)死亡率(%)2020/10/1818：2020/10/18192020/10/1820谢谢您的聆听与观看THANK YOU FOR YOUR GUIDANCE.感谢阅读！为了方便学习和使用，本文档的内容可以在下载后随意修改，调整和打印。欢迎下载！汇报人：XXX日期：20XX年XX月XX日