踝压 (ABI)

经证明,趾压/踝压 (TBI/ABI) 可以准确诊断踝肱指数 (ABI) 假性升高的患者是否患有外周动脉疾病 (PAD),因为脚趾血管通常不受钙化的影响。该测量程序类似于 ABI 测试,但需要小型的袖口和灵敏的探头。

Perimed 设备使用最高质量的激光多普勒 (LD) 技术进行检测,并结合独特的局部加热功能,以确保结果的可靠性和可重复性。  由于 LD 能更好地检测低压力,因此,此技术优于光电容积脉搏波描记术 (PPG)1 The usefulness of a laser Doppler in the measurement of toe blood pressures. Jurgen C. de Graaff, MD, et al. J Vasc Surg 2000;32:1172-9. Doi: 10.1067/mva.2000.108009

  • 对于患者因动脉钙化导致 ABI 值不可靠的情况,测量趾压是更佳选择2 Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220034.e1-2.
  • 趾压测量可以检测到踝关节水平以下的阻断情况。
  • 脚趾上的小血管对寒冷环境温度很敏感,可能发生血管收缩情况,因此控制脚趾温度十分重要。
  • 需要客观的血流动力学测试(包括应首选的趾压测量)才能评估 CLTI3 Conte MS, Bradbury AW, Kolh P, et. al, Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006.

ABI 仍然是对非糖尿病患者进行一线 PAD 诊断的黄金标准。执行 ABI 测量有几种不同的方法,超声是血管实验室最常用的方法,而不太精确的示波测量设备在初级保健环境中已受到欢迎4 Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Victor Aboyans, MD, PhD. 2012 Dec 11;126(24):2890-909. doi: 10.1161/CIR.0b013e318276fbcb.。 然而,对于有血管钙化风险的患者(例如,糖尿病和慢性肾脏疾病的患者),应该只相信低的 ABI 值,而正常值 (ABI > 0.9) 则应始终结合趾压进行确认。如果没有脚趾或脚趾不适合测量,则检测 tcpO2、PVR 和 SPP 是有效的替代方案5 Research: Treatment Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration. Diabetic Medecine. B. Vriens, F. D’Abate, B. A. Ozdemir , C. Fenner, W. Maynard, J. Budge, D. Carradice and R. J. Hinchliffe. DOI: 10.1111/dme.13634.,3.,6Chapter II: Diagnostic Methods. P.Caoa, H.H.Eckstein, P.De Rango, C.Setacci, J-B.Riccoe, G. Donato, F.Becker, H.Robert-Ebadi, N.Diehm, J.Schmid, M.Teraa, F.L.Moll, F.Dick, A.H.Davies, M.Lepäntalo, J.Apelqvist. doi.org/10.1016/S1078-5884(11)60010-5.

参考文献:

  1. The usefulness of a laser Doppler in the measurement of toe blood pressures. Jurgen C. de Graaff, MD, et al. J Vasc Surg 2000;32:1172-9. Doi: 10.1067/mva.2000.108009
  2. Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220034.e1-2.
  3. Conte MS, Bradbury AW, Kolh P, et. al, Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006.
  4. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Victor Aboyans, MD, PhD. 2012 Dec 11;126(24):2890-909. doi: 10.1161/CIR.0b013e318276fbcb.
  5. Research: Treatment Clinical examination and non-invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes-related foot ulceration. Diabetic Medecine. B. Vriens, F. D’Abate, B. A. Ozdemir , C. Fenner, W. Maynard, J. Budge, D. Carradice and R. J. Hinchliffe. DOI: 10.1111/dme.13634.,3.
  6. Chapter II: Diagnostic Methods. P.Caoa, H.H.Eckstein, P.De Rango, C.Setacci, J-B.Riccoe, G. Donato, F.Becker, H.Robert-Ebadi, N.Diehm, J.Schmid, M.Teraa, F.L.Moll, F.Dick, A.H.Davies, M.Lepäntalo, J.Apelqvist. doi.org/10.1016/S1078-5884(11)60010-5.

PeriFlux 6000 Combined System 介绍视频

欧洲血管外科学会 (ESVS) 培训视频 – Maarit Venermo 教授

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