IVUS操作

1BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyiLabTM操作流程及临床应用波士顿科学公司2013-12-242BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally目录•iLabTM设备及相关耗材•AtlantisSRPro超声导管连接•常规手术界面操作步骤•iLabTM在PCI的应用3BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyiLabTM设备及相关耗材•主机•MDU（驱动马达）•超声导管•一次性滑板4BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声导管连接•超声导管包装内包含：超声导管，延长管，注射针管3ml及10ml，驱动马达的无菌套•将显像核心轴完全收回到Telescoping鞘内(如箭头所示)；•连接几个导管部件。5BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声导管连接•将包装内取出的3毫升和10毫升的注射器充满肝素生理盐水并完全排气；•术中超声导管使用前后，均用3毫升注射器向显像导管内注肝素生理盐水两次。6BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声导管连接•将MDU马达装在随每个IVUS导管提供的无菌袋中,然后将MDU马达连接到一次性马达拖板上；•马达就位良好，其上方的显示屏会显示数字。7BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声导管连接•在测验马达可以正常回撤时，可按住马达上的“RELEASE”键手动在拖板上前后推移马达；•切忌在拖板上不按键蛮力推动马达，这样极易损坏马达。8BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally超声导管连接•将导管与马达连接，把超声导管近端固定在拖板的卡槽上；•术前将马达推到滑板左侧，按“RESET”键清零。9BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally常规手术界面操作步骤开关机流程建立新病例病例存档10BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally开机建立新病例•连接电源，打开总开关11BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally开机建立新病例12BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally采集片段、Review片段•1）Imaging显像2）PullbackRecord自动回撤3）ImageReview回顾。•a）显像后，b）manualRecord键，请台上术者按着马达上的c）Release键手动回撤。13BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally简单读图和测量•利用LongView，Bookmark，DynamicReview，TraceAssistant等功能，实现病变位置确认、Lumen/VesselCSA测量、病变性质说明、斑块负荷以及狭窄率的测量。14BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally简单读图和测量•利用LongView看长轴（右图），Bookmark做标记，DynamicReview动态显示该截面，通过声影强弱判断病变性质。15BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally简单读图和测量•利用TraceAssistant自动获得截面积描绘，数字显示管腔面积大小和最大最小直，利用DynamicReiew功能观察边界，手动修改，完成Lumen/VesselCSA测量、斑块负荷以及狭窄率的测量。16BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally保存病例•回撤片段Review，病变评估及测量后，在触控面板上完成存档工作。17BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally视频图片格式导出•完成病变评估后，需要将片段以JPEG,BMP,WMV格式导出储存方式，CD，DVD，移动硬盘18BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally退出系统•关机流程注意：绝不允许不走关机流程直接关电源，这对机器损伤极大。19BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyiLab指导日常PCI20BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally第1步：分析造影结果，确定“路标”D2D121BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternally第2步：测量MLAD2D2MLA2.1mm222BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyD2MLADistalreferenceProximalreference第3步：测量血管直径测量血管大小，决定支架直径23BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyProximalreferenceMLAsiteDistalreference2.6mm2.3mm“支架直径2.5mm?”第3步：测量血管直径24BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyD2根据“正常至正常”的原则，决定支架长度MLA第4步：测量病变长度25BostonScientificConfidential--ForInternalUseOnly.DoNotCopy,DisplayorDistributeExternallyMSA=4.2mm2???Pre-InterventionPost-Stent第5步：PCI后确定MSA