2022年医学专题—如何建设介入-外科手术室-蒋世良(1).ppt

如何建设(jinsh)介入外科手术室（杂交手术室）,中国医学科学院阜外心血管病医院(yyun)放射科.蒋世良,第一页，共三十九页。,Hybrid Room,第二页，共三十九页。,背景(bijng)（1）,心血管外科和介入心脏医生在过去存在一种竞争关系，特别是在冠心病和先心病治疗(zhlio)领域。,第三页，共三十九页。,背景(bijng)（2）,一些获得性和先天性心血管疾病采用经导管介入治疗(zhlio)和配合心外科治疗(zhlio)，提高了治疗(zhlio)效果。,第四页，共三十九页。,背景(bijng)（3）,随着介入心脏病医生和心血管外科医生合作的不断加强，适合这两种治疗方法共同的手术室（杂交(zjio)手术室）出现了。,第五页，共三十九页。,杂交手术时需要(xyo)的人员,介入医生心血管外科医生 超声心动图医生心脏(xnzng)麻醉医生电生理医生护士介入手术室技术员灌注师,第六页，共三十九页。,杂交(zjio)手术室设计,房间(fngjin)空间要求 双球管造影机需要至少80m2 单球管造影机需要至少70m2,第七页，共三十九页。,空间(kngjin)要求,地面预留空间(kngjin)给下列设施 心血管造影机 麻醉机 超声设备 体外循环设备,第八页，共三十九页。,手术床与可移动(ydng)床的结合,产品特征：三维成像的需要床可浮动、移动防震动 旋转角度 15 头侧抬高/降低(jingd)15 侧面倾斜 碳纤维床面,第九页，共三十九页。,空间(kngjin)方面的考虑,设备(shbi)垂吊或安装在墙壁上 手术灯 造影剂注射器 可变焦照相机（摄影机）,第十页，共三十九页。,杂交(zjio)手术室显像设备,平板监视器 麻醉科医生(yshng)超声心动图医生 介入医生,第十一页，共三十九页。,信息(xnx)传输,造影图像(t xin)超声图像（经胸、经食道、血管内超声和三维超声图像）生理监护仪实时录像其它图像PACS（图像存储与传输系统）,第十二页，共三十九页。,杂交(zjio)方法治疗冠心病多支病变,冠脉搭桥术后（CABG）行PCI治疗(zhlio)多支病变,第十三页，共三十九页。,先采用CABG治疗LAD阻塞性病变，后行PCI支架治疗右冠状动脉(gunzhung-dngmi)狭窄,第十四页，共三十九页。,经导管栓塞(shuns)体肺侧支血管,法乐氏四联症术前经导管(dogun)栓塞体肺侧支,第十五页，共三十九页。,经导管栓塞(shuns)体肺侧支血管,法乐氏四联症术前经导管(dogun)栓塞体肺侧支,第十六页，共三十九页。,法乐(f l)氏四联症术前经导管栓塞体肺侧支,经导管栓塞(shuns)体肺侧支血管,第十七页，共三十九页。,经导管(dogun)栓塞体肺侧支血管,法乐氏四联症术后经导管(dogun)栓塞体肺侧支,第十八页，共三十九页。,Thank you for your attention！,第十九页，共三十九页。,How to Build a Cath-Lab Operating Room（Hybrid Operating Room）,Department of Radiology,Cardiovascular Institute&Fuwai Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences Beijing,China,100037Shiliang Jiang,MD蒋世良,第二十页，共三十九页。,Hybrid Room,第二十一页，共三十九页。,Background（1）,Historically,surgeons and interventionalists have had a somewhat competitive relationship,especially in coronary artery disease and congenital heart disease.,第二十二页，共三十九页。,Background（2）,The management of some acquired and congenital cardiovascular diseases is evolving due to advances in transcatheter therapies that coincide with surgical strategies to improve outcomes.,第二十三页，共三十九页。,Background（3）,As the level of collaboration between the surgeon and interventionalist has increased,the need for a therapeutic suite that is compatible with both disciplines（hybrid）has become apparent.,第二十四页，共三十九页。,Staff Involved In A Hybrid Case,InterventionalistCardiovascular Surgeon Echo-cardiographerCardiac anesthesiologistElectrophysiologistNursesCath Lab TechniciansPerfusionist,第二十五页，共三十九页。,Hybrid Room Design,The room size:should be minimum of 80 m2 for bi-plane systems 70 m2 for sigle-plane systems,第二十六页，共三十九页。,Space Considerations,Floor space reserved for:Angiographic system Anesthesia machine Echocardiography machine CPB machine,第二十七页，共三十九页。,Integrated Operation Table with floating table top,Product features:Integrated table is the pre-requisite for 3D imagingFloating table topCollision Protection Motorized tilting capabilities:15 head up/Down 15 lateral tilt Carbon fibre table top,第二十八页，共三十九页。,Space Considerations,Equipment mounted on ceiling/walls:Surgical light Contrast injector Zoom camera mounted on the wall,第二十九页，共三十九页。,Hybrid Room Video Display,Flat panel monitors around the room for:Anesthesiologist Echo-cardiographer Interventionalist,第三十页，共三十九页。,Information Transport,AngiogramsEchocardiograms(TTE,TEE,IVUS,3D)Physiology monitoringLive videoOther video sources-PACS,第三十一页，共三十九页。,Hybrid Procedures for the Treatment of CAD with Multiple Vessels Disease,CABG prior to PCI for CAD with Multiple Vessels Disease,第三十二页，共三十九页。,CABG prior to PCI for CTO withLAD and RCA Stenosis,第三十三页，共三十九页。,Percutaneous Closure of Aortopulmonary Collaterals,Prior to intracardiac operation for Tetralogy of Fallot,第三十四页，共三十九页。,Percutaneous Closure of Aortopulmonary Collaterals,Prior to intracardiac operation for Tetralogy of Fallot,第三十五页，共三十九页。,Percutaneous Closure of Aortopulmonary Collaterals,Prior to intracardiac operation for Tetralogy of Fallot,第三十六页，共三十九页。,Percutaneous Closure of Aortopulmonary Collaterals,Posterior to intracardiac operation for Tetralogy of Fallot,第三十七页，共三十九页。,Thank you for your attention！,第三十八页，共三十九页。,内容(nirng)总结,如何建设介入外科手术室（杂交手术室）。如何建设介入外科手术室（杂交手术室）。随着介入心脏病医生和心血管外科医生合作的不断加强，适合(shh)这两种治疗方法共同的手术室（杂交手术室）出现了。超声图像（经胸、经食道、血管内超声和三维超声图像）。Shiliang Jiang,MD。Echocardiograms(TTE,TEE,IVUS,3D)。Live video。Other video sources-PACS,第三十九页，共三十九页。,