如何建设介入-外科手术室-蒋世良PPT课件.ppt

如何建设介入外科手术室如何建设介入外科手术室（杂交手术室）（杂交手术室）中国医学科学院阜外心血管病医院中国医学科学院阜外心血管病医院放射科放射科.蒋世良蒋世良1Hybrid Room2背景（背景（1）心血管外科和介入心脏医生在过去存在一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种竞争关系，特别是在冠心病和先心病治疗领域。疗领域。3背景（背景（2）一些获得性和先天性心血管疾病采用经导一些获得性和先天性心血管疾病采用经导管介入治疗和配合心外科治疗，提高了治管介入治疗和配合心外科治疗，提高了治疗效果。疗效果。4背景（背景（3）随着介入心脏病医生和心血管外科医生合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作的不断加强，适合这两种治疗方法共同的手术室（杂交手术室）出现了。的手术室（杂交手术室）出现了。5杂交手术时需要的人员杂交手术时需要的人员介入医生介入医生心血管外科医生心血管外科医生 超声心动图医生超声心动图医生心脏麻醉医生心脏麻醉医生电生理医生电生理医生护士护士介入手术室技术员介入手术室技术员灌注师灌注师 6杂交手术室设计杂交手术室设计 房间空间要求房间空间要求 双球管造影机需要至少双球管造影机需要至少80m2 单球管造影机需要至少单球管造影机需要至少70m27空间要求空间要求地面预留空间给下列设施地面预留空间给下列设施 心血管造影机心血管造影机 麻醉机麻醉机 超声设备超声设备 体外循环设备体外循环设备8手术床与可移动床的结合手术床与可移动床的结合产品特征：产品特征：三维成像的需要三维成像的需要床可浮动、移动床可浮动、移动防震动防震动 旋转角度旋转角度 15 头侧抬高头侧抬高/降低降低 15 侧面倾斜侧面倾斜 碳纤维床面碳纤维床面 9空间方面的考虑空间方面的考虑设备垂吊或安装在墙壁上设备垂吊或安装在墙壁上 手术灯手术灯 造影剂注射器造影剂注射器 可变焦照相机（摄影机）可变焦照相机（摄影机）10杂交手术室显像设备杂交手术室显像设备平板监视器平板监视器 麻醉科医生麻醉科医生 超声心动图医生超声心动图医生 介入医生介入医生11信息传输信息传输造影图像造影图像超声图像超声图像（经胸、经食道、血管内超声和三维超声图像）（经胸、经食道、血管内超声和三维超声图像）生理监护仪生理监护仪实时录像实时录像其它图像其它图像PACS（图像存储与传输系统）（图像存储与传输系统）12杂交方法治疗冠心病多支病变杂交方法治疗冠心病多支病变冠脉搭桥术后（冠脉搭桥术后（CABG）行行PCI治疗多支病变治疗多支病变13先采用先采用CABG治疗治疗LAD阻塞性病变，阻塞性病变，后行后行PCI支架治疗右冠状动脉狭窄支架治疗右冠状动脉狭窄 14经导管栓塞体肺侧支血管经导管栓塞体肺侧支血管 法乐氏四联症术前经导管栓塞体肺侧支法乐氏四联症术前经导管栓塞体肺侧支 15经导管栓塞体肺侧支血管经导管栓塞体肺侧支血管 法乐氏四联症术前经导管栓塞体肺侧支法乐氏四联症术前经导管栓塞体肺侧支 16法乐氏四联症术法乐氏四联症术前前经导管栓塞体肺侧支经导管栓塞体肺侧支 经导管栓塞体肺侧支血管经导管栓塞体肺侧支血管 17经导管栓塞体肺侧支血管经导管栓塞体肺侧支血管 法乐氏四联症术法乐氏四联症术后后经导管栓塞体肺侧支经导管栓塞体肺侧支 18Thank you for your attention！19How 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蒋世良蒋世良20Hybrid Room21Background（1）Historically,surgeons and interventionalists have had a somewhat competitive relationship,especially in coronary artery disease and congenital heart disease.22Background（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.23Background（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.24Staff Involved In A Hybrid CaseInterventionalistCardiovascular Surgeon Echo-cardiographerCardiac anesthesiologistElectrophysiologistNursesCath Lab TechniciansPerfusionist 25Hybrid Room Design The room size:should be minimum of 80 m2 for bi-plane systems 70 m2 for sigle-plane systems26Space ConsiderationsFloor space reserved for:Angiographic system Anesthesia machine Echocardiography machine CPB machine27Integrated 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 28Space ConsiderationsEquipment mounted on ceiling/walls:Surgical light Contrast injector Zoom camera mounted on the wall29Hybrid Room Video DisplayFlat panel monitors around the room for:Anesthesiologist Echo-cardiographer Interventionalist 30Information TransportAngiogramsEchocardiograms(TTE,TEE,IVUS,3D)Physiology monitoringLive videoOther video sources-PACS31Hybrid Procedures for the Treatment of CAD with Multiple Vessels DiseaseCABG prior to PCI for CAD with Multiple Vessels Disease32CABG prior to PCI for CTO withLAD and RCA Stenosis 33Percutaneous Closure of Aortopulmonary Collaterals Prior to intracardiac operation for Tetralogy of Fallot 34Percutaneous Closure of Aortopulmonary CollateralsPrior to intracardiac operation for Tetralogy of Fallot 35Percutaneous Closure of Aortopulmonary Collaterals Prior to intracardiac operation for Tetralogy of Fallot 36Percutaneous Closure of Aortopulmonary CollateralsPosterior to intracardiac operation for Tetralogy of Fallot 37Thank you for your attention！38