《冠状动脉造影操作过程及规范》.pptVIP

冠脉起始走向 牧羊鞭状（仅右冠） 推造影剂 视右冠大小、血流快慢 一般3—5ml 血流慢的少推，但踩X线长一点。 投照体位： 近段：LAO45°、 LAO30°+CAU 中段：RAO30° 远段：LAO30°+CRA 左前斜（LAO） 45o 造影结束，造影管缓慢的顺着出来。 左心室造影 RAO30°猪尾导管于左心室腔中部， 连续测压至升主动脉 LAO45°观察肥厚梗阻型心肌病 左室流出道梗阻 LAO60°观察室间隔穿孔、侧壁运动 左室造影 造影管：猪尾巴导管 投照体位：RAO30° 带有侧孔，不会出现心肌染色 冲泥鳅钢丝、导管→导丝进导管→进动脉鞘→钢丝先行 先送钢丝→估计到腋动脉时，踩X线透视下前走→钢丝方向向下→钢丝固定不动 →瞩患者深吸气，造影管前走→主动脉窦底→缓慢顺钟向旋转→先顶起来→使导管的弯向上→轻轻送入导管→左室。 无法进入时→可沿导引钢丝送导管到主动脉根部→使圈弯向上→后撤钢丝→导管也可跳入左室→看有没有心律失常 撤钢丝→接三连三通→抽回血 →抽肝素→排气后推回去 铺无菌巾→连接高压注射器→抽回血，保证无气体→再推回一点→开始左室造影 松开高压注射器→撤无菌巾→接三连三通→抽回血→抽肝素盐水推回去→看压力曲线→缓慢撤导管测连续压力曲线 如果颈动脉造影→就撤到升主动脉再造影 造影结束→撤导管缓慢顺着or进导丝后再撤导管 可以到走廊后拔管→叠4层纱布→先拔出1cm →让护士用弹力绷带到位后→瞩患者深吸气→拔出动脉鞘 左心室造影的分析 投照体位：RAO30°, LAO60° 室壁节段的命名 －RAO30°：前基底段、前侧壁、心尖部、隔面和后基底段 －LAO60°：间隔部和后侧壁 室壁运动功能 －运动减弱 －运动消失 －矛盾运动 * * JL (Judkins Left) The JL curve is the standard LCA guide with an open primary curve. If the aortic root is narrow, use a smaller curve. If the aortic root is dilated, use a larger JL curve. In a normal aorta, when the guide tip has an inferior orientation below the ostium, the curve is too large. When the guide tip has a superior orientation above the ostium, the guide is too small. FL (Femoral Left) The FL curve is also often a standard catheter for the LCA. It has a more acute primary curve and is more superior in its orientation than the JL series. The FL curve is often referred to as a “diagnostic” curve, since it more closely resembles a diagnostic catheter. * * JR (Judkins Right) The JR curve is the standard RCA guide, which has a relaxed tip. If the aortic root is narrow, use a smaller curve. If the aortic root is dilated, use a larger curve. When the guide tip has an inferior orientation below the ostium, the curve is too large. When the guide tip has a superior orientation above the ostium, the guide is too small. FR (Femoral Right) The FR curves have a more acute primary and secondary curve than the JR, with a more superior orientation of the tip. The FR more closely rese