基于欧洲专家共识的硬化治疗围手术期管理.pptx

基于欧洲专家共识的硬化治疗围手术期管理ATX 市场部依据2012年欧洲专家共识的细则:注射用针头与针筒注射部位选择硬化治疗后的管理Sclerolounge: injection: needles and syringes针对隐静脉或复发性静脉曲张的注射为了避免疏忽导致的静脉旁注射或者动脉内注射，针对不可见静脉我们推荐超声下引导进行泡沫或液体的硬化治疗 (GRADE 1C)为了不降低泡沫的质量，治疗大静脉时，注射所选择的针头不能低于25G硬化治疗前的诊断1我们推荐诊断性评估包括病史采集，体格检查和超声检查。针对毛细血管扩张和网状静脉曲张彩超可以替代双能超声检查(GRADE 1C)硬化治疗前的诊断2针对已经治疗过的静脉曲张患者和静脉血管畸形的患者在硬化治疗前进行双能超声的检查(GRADE 1B)治疗前注射部位的标记硬化治疗的计划:Tegernsseer Kompaktsklerotherapiekurs硬化治疗的策略：Munich Compact Sclerotherapy Course首先治疗反流的大血管和隐静脉（手术或泡沫硬化剂的治疗）分支静脉（如必须）网状静脉曲毛细血管扩张11 mm16 mmInjectionPost injection2. InjectionSpasm 在患者腿部抬升30°时进行硬化剂的注射，并在注射后维持5分钟注射前注射后J:Vasc:Surg2008:Hill. et al Assessment of techniques to reduce sclerosant foam migration during ultrasound-guided sclerotherapy of the great saphenous vein Ultrasound-guided sclerotherapy of the great saphenous vein using foam sclerosants is best performed with the leg elevated and no occlusive pressure at the saphenofemoral junction in order to reduce the risk of gas embolization to the central nervous system. Further study is needed to assess the midterm success of this technique and to confirm the effect of using foam produced from physiologic gases 下肢侧枝血栓切除术治疗前侧枝静脉曲张0.5%安束喜泡沫治疗血管观察治疗后硬化治疗后的管理偏心压迫弹力袜压迫采用棉花和胶布进行偏心压迫采用3M绷带条增加偏心压力压力物料:共识: 术后压力弹力绷带与弹力袜在硬化治疗后的治疗效果差异性不大为了尽可能减少局部血栓，绝大多数专家建议术后进行压迫疗法共识: 术后压力 绝大多数专家赞成需要采用压力疗法不需要采用压力疗法需要采用压力疗法GSV15%85%SSV12%88%Lateral branches12%88%Recurrent varices12%88%Perforating veins15%85%Reticular veins36%64%Telangiectasias50%50%Venous malformations6%94%压力疗法材料压迫绷带弹力袜： 使用三周23-32mmHg的袜子有助于曲张静脉的消失Kern P.: Compression after sclerotherapy for telangiectasia and reticular leg veins: a randomized controlled study (J Vasc Surg 2007)Efficacy of graduated compression stockings for an additional 3 weeks after sclerotherapy treatment of reticular and telangiectatic leg veins(Pavan K Nootheti: Dermatol Surg 2009)衬垫、绷带与弹力袜联合用于硬化剂的术后压迫疗法硬化剂术后建议:术后迅速在就诊区域内快速行走20-30分钟。在术后当日20分钟行走2次以上术后24消失可以脱掉压力绷带，然后更换为2级压力弹力袜在最后一次注射疗程后保持压力疗法大约3周。术后管理中，我们同样推荐如下（1）:仔细观察任何不良反应的发生(GRADE 1B)硬化治疗后给予患者医