动脉硬化检测课件.ppt

病在腿上，险在心上 下肢动脉粥样硬化患者，随访十年，存活率60％ ，75％因心肌梗死死亡，因下肢血栓截肢的不到3％。 下肢动脉粥样硬化患者，男性60％首发是心梗或猝死，女性40％首发是心梗或猝死。 (Toe Brachial pressure Index) 脚趾上臂血压指数 TBI * TBI检测 糖尿病周围血管病变 选配件 TBI （评估末梢血管阻塞） 糖尿病患者末梢血管病变 通过检测脚趾血压来测得TBI TBI≧0.7 TBI＜0.7　　　 TP≧40mmHg TP≦30mmHg 正常 异常 有自然治愈的可能性 重症 （＊介入性治療不可缺） TBI 计算方法和评价标准 评价标准 TASCⅡ（跨大西洋多学会外周动脉疾病诊疗共识） 2006年标准 TASK : Management of Peripheral Arterial Disease J.Vasc Surg 2000 足趾最高血压(收缩压) 上臂最高血压(左右中高侧) ＴＢＩ＝ 脚趾上臂血压指数 TBI预测心血管事件 HR 2.92 [95% CI 1.04–8.19] HR 3.83 [95% CI 1.45–10.1] TBI低值组（＜0.6）vs正常组 足趾血压低值组（＜50mmHg）vs正常组 81例急性冠脉综合征的糖尿病患者，平均随访44个月 Diabetes Care 2015;38:e53–e54 Page ? * ABI/PWV全面检查 Figure 1. (A) Kaplan-Meier curves for event-free survival in the high-brachial–ankle pulse wave velocity (baPWV) and low-baPWV groups. The end-point was re-admission because of exacerbation of heart failure. The patients with high baPWV were significantly more likely than the patients with low baPWV to reach the endpoint (P0.05 by log-rank test). (B) Kaplan-Meier curves for event-free survival in the high-baPWV and low-baPWV groups. The endpoint was cardiac death. The patients with high baPWV were significantly more likely than the patients with low baPWV to reach the endpoint (P0.05 by log-rank test). * In a study of 1592 men and women whose age ranged from 55 through 74 years and who were selected randomly from 11 general practices in Edinburgh, Scotland, the risk of a coronary heart disease, or CHD, event, defined as a myocardial infarction, or MI, was found to increase with decreases in the ankle-brachial index, or ABI. In those with an ABI of 1.1 or more, the annual MI rate was 1.2% In those with an ABI of 1.0 through 0.91, it was 1.8% In those with an ABI of 0.9 through 0.71, it was 2.6% In those with an ABI of 0.7 or less, it was 3.8% The 5-year risk of an MI increased from 13% to 19% with a decrease in ABI from 0.9 through 0.71 to 0.7 or less Keywords: women, coronary heart disease, CHD, myocardial infarction, MI, ankle-brac