2019年《血管通路》ppt课件.ppt
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1、如何加强血液透析患者血管通路的管理和维护,血管通路,血液透析患者的生命线,血液透析成功施行的必要条件,第一个问题 血管通路的发展进程,动静脉外瘘(Quinton-Scribner shunt),血管通路发展史上的第一个里程碑(1960年),自体动静脉內瘘(Arteriovenous Fistula),血管通路发展史上的第二个里程碑(1962年),移植血管內瘘( Arteriovenous Graft),中心静脉留置导管(central venous catheter),充足的血流量 操作简单,可反复使用 安全稳定,并发症少,理想的血管通路,第二个问题 对几种血管通路的初步认识,AVF是什么?,
2、AVG是什么?,CVC是什么,The catheter is placed in the right internal jugular vein with a smooth curve in the subcutaneous tunnel.The tip of the catheter is placed in the right atrium to achieve adequate blood flow during hemodialysis.,AVF的并发症,血管狭窄 急性血栓形成 静脉高压征 动脉瘤 高输出量心力衰竭 通路相关性缺血综合征 感染,血管狭窄,fistulogram show
3、ing a long inflow segment stenosis which was successfully balloon angioplastied. A: Pre-angioplasty. B: Waist on the balloon. C: Post-angioplasty image.,静脉高压征,Massively swollen right upper extremity from completely occluded right subclavian vein. The transposed basilic vein arteriovenous fistula is
4、patent,Extensive network of collateral veins over the right shoulder and chest area.,动脉瘤,通路相关性缺血综合征,87-year-old female with a brachiocephalic fistula created approximately 9 months prior to photograph who complained of pain and numbness over her right hand during dialysis.On examination the fingers
5、were blue and cold (A). Panel (B)compares the color of her hand to a normal pink color.,AVG的并发症,血管狭窄 感染 血栓形成 静脉高压征 假性动脉瘤 高输出量心力衰竭 血清肿,血管狭窄,Forty-five-year-old male with a right forearm loop AVG placed in 2003 has marked central vein stenosis. The collateral veins are visualized on his shoulder and c
6、hest (arrowheads).The patient has a right subclavian vein stent with recurrent stenosis as shown in next image.,假性动脉瘤,假性动脉瘤,CVC的并发症,感染 导管功能不良纤维蛋白鞘、血栓形成,Purulent secretion, erythema over the tunnel and skin changes secondary to infection in the subcutaneous tunnel.,导管功能不良,An intact fibrin sheath pull
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