冠脉CTA，冠脉造影到底哪家强？

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                    <section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.jpg" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section><span>关注</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section data-tools="gulangu" data-id="97917"><section><section><section data-bgless="spin" data-bgopacity="30%"><br  /></section><p><p><img src="image/20201014/0019257acc629680f19444cbe0edb04a_2.jpg" /></p></p><p><br  /></p><p><span>有两种检查可以选择，</span></p><p><span>1、冠脉CTA，</span></p><p><span>2、冠脉造影。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/3e6912c04d1423e732e25d1edfd41644_3.jpg" /></p></p><p><br  /></p><p><span>对于选择的问题，还是大致分为三点。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/802c86c7af15ada394505ca89df8ecc8_4.jpg" /></p></p><p><br  /></p><p><span>首先，</span></p><p><span>了解一下冠脉狭窄的概念：</span></p><p><span>冠状动脉的粥样硬化导致管腔狭窄，</span></p><p><span>从而引起心肌供血不足，</span></p><p><span>产生心悸、胸痛、胸闷、呼吸困难等症状。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/59e1768c033b4891db0cfc676824d740_5.jpg" /></p></p><p><span>&nbsp;</span></p><p><span>其次，</span></p><p><span>从二者优缺点开始讲，</span></p><p><span>冠脉CTA属于无创检查，</span></p><p><span>简单来说就是在前臂静脉扎一个留置针，</span></p><p><span><br  /></span></p><p><span>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;&nbsp;</span><p><img src="image/20201014/a9ba14b4498dbc82613a2a7e3aaf4803_6.jpg" /></p></p><p><br  /></p><p><span>用高压注射器将造影剂快速注射入血管，</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/5855b9aa8e1ab23209d931b255b62b84_7.jpg" /></p></p><p><br  /></p><p><span>等造影剂在冠状动脉达到峰值的同时</span></p><p><span>启动CT扫描，</span></p><p><span>通过重建技术</span></p><p><span>获得比较清晰的冠脉影像。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/643a1fd5f03b3b511dc8e5008d283926_8.jpg" /></p></p><p><br  /></p><p><span>优点是：</span></p><p><span>检查便捷、无创伤、</span></p><p><span>&nbsp;费用相对较低、</span></p><p><span>阴性诊断率高</span></p><p><span>（就是CTA检查结果说你没问题，那基本就没什么问题），</span></p><p><span>对造成管腔狭窄的斑块结构显示较清晰。</span></p><p><span><br  /></span></p><p><br  /></p><p><br  /></p><p><p><img src="image/20201014/ff901383c8dc56b581811c2ca13c72dd_9.jpg" /></p></p><p><br  /></p><p><span>缺点是：</span></p><p><span>影响因素较多</span></p><p><span>（心律、呼吸配合、身体移动、钙化等），</span></p><p><span>评价狭窄程度不够精确，</span></p><p><span>发现问题后还需冠脉造影进一步确诊并治疗。</span></p><p><span><br  /></span></p><p><br  /></p><p><span>&nbsp; &nbsp; &nbsp;</span><p><img src="image/20201014/316b39486b2cbd3c20e7cfb3d0e81135_10.jpg" /></p></p><p><br  /></p><p><span>冠脉造影属于微创检查，</span></p><p><span>在桡动脉或者股动脉处穿刺</span></p><p><span>并置入导管直至心脏冠状动脉，</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/c6910b46c3d28e41d0a63c6654705928_11.jpg" /></p></p><p><br  /></p><p><span>对冠状动脉注射造影剂并实时动态观察，</span></p><p><span>从而获得比较直观的影像资料。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/618b701d708a8227beafdc46a689d8ed_12.jpg" /></p></p><p><br  /></p><p><span>优点是：</span></p><p><span>准确性高，</span></p><p><span>诊断冠心病的金标准，</span></p><p><span>诊断与治疗可以同步进行。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/0ea47f56e540e86c82de165159d548ed_13.jpg" /></p></p><p><br  /></p><p><p><img src="image/20201014/d825d7d6b03c3fe79f6118b0c142f0e1_14.jpg" /></p></p><p><span>&nbsp;</span></p><p><span>缺点是：</span></p><p><span>对于造成管腔狭窄斑块结构无法显示，</span></p><p><span>尽管微创，但还是有创伤；</span></p><p><span>尽管风险低，仍然需要术前谈话、签字；</span></p><p><span>费用相对较高。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/40fc429fdb4aae1d6c7a68ecc8aad58f_15.jpg" /></p></p><p><br  /></p><p><span>第三，</span></p><p><span>根据患者个体差异、症状、病史等进行选择。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/aad285707ce004c9c30221c652cb0923_16.jpg" /></p></p><p><br  /></p><p><span>冠脉CTA适用于症状不典型患者、</span></p><p><span>心前区不适但其他检查不支持患者</span></p><p><span>及易患冠心病高危人群的筛查，</span></p><p><span>非心脏外科手术前排除冠心病，</span></p><p><span>冠状动脉畸形的检查，</span></p><p><span>冠状动脉桥血管的检查等。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/9ad115d4898aa0e6de9f657a74ce76ad_17.jpg" /></p></p><p><br  /></p><p><span>冠脉造影适用于反复发作心绞痛、</span></p><p><span>胸闷等高度可疑患者，</span></p><p><span>经临床确诊患者，</span></p><p><span>拟行冠脉手术治疗的患者，</span></p><p><span>因心律不可控、</span></p><p><span>呼吸无法配合、</span></p><p><span>过于肥胖等原因</span></p><p><span>无法行冠脉CTA检查的患者。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/2a0619e51a9cada14f2990e0160ff7ff_18.jpg" /></p></p><p><br  /></p><p><span>简而言之：</span></p><p><span>轻症、不典型、需排查患者优先选择冠脉CTA。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/56532baeb11293d6d01ceafc166c1b41_19.jpg" /></p></p><p><br  /></p><p><span>为什么会出现做完CTA之后，</span></p><p><span>又去做冠脉造影？</span></p><p><span>是医生选择的错误吗？</span></p><p><br  /></p><p><br  /></p><p><br  /></p><p><br  /></p><p><br  /></p><p><br  /></p><p><br  /></p><p><span>其一，</span></p><p><span>个别患者临床表现不显著，</span></p><p><span>但冠脉狭窄程度较重，</span></p><p><span>所以，</span></p><p><span>在首选冠脉CTA排查时发现问题，</span></p><p><span>需冠脉造影进一步检查及造影中治疗。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/5700c85f6666b12e10b8c8c02f79ac21_20.jpg" /></p></p><p><br  /></p><p><br  /></p><p><br  /></p><p><span>其二，</span></p><p><span>患者心情易紧张，</span></p><p><span>冠脉CTA过程中，</span></p><p><span>心率控制欠佳，</span></p><p><span>导致图像质量较差，</span></p><p><span>不能排除冠脉狭窄，</span></p><p><span>需冠脉造影进一步检查。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/b759a07eb51710f05c587bed29f73830_21.jpg" /></p></p><p><br  /></p><p><span>小科普：</span></p><p><span>支架是怎么放进冠状动脉的。</span></p><p><br  /></p><p><span>第一步，导管进入冠脉。</span></p><p><span><br  /></span></p><p><p><img src="image/20201014/c2c849f4497ac69d4c9bcc67ef810c60_22.jpg" /></p></p><p><br  /></p><p><span>第二步，支架进入冠脉狭窄段。<br  /></span></p><p><span><br  /></span></p><p><p><img src="image/20201014/81f6009d877f9e07a2ff6ddc41338c56_23.jpg" /></p></p><p><br  /></p><p><span>第三步，气囊充气，支架撑起。<br  /></span></p><p><span><br  /></span></p><p><p><img src="image/20201014/0efb445520ac59f7f023f07b7fbedf89_24.jpg" /></p></p><p><br  /></p><p><span>第四步，气囊放气，抽离。<br  /></span></p><p><span><br  /></span></p><p><p><img src="image/20201014/374538a1b1026daba33e0389ceff2cb3_25.jpg" /></p></p><p><br  /></p><p><br  /></p><p><br  /></p><p><p><img src="image/20201014/aa96d1521e93b7b1fbb26237e5e6350e_26.jpg" /></p></p><p><br  /></p><p><p><img src="image/20201014/d93de233b0ef1b02d2566346952a8a4d_27.jpg" /></p></p><p><br  /></p></section></section></section><section data-role="outer" label="Powered by gulangu"><section data-role="paragraph" data-color="#757576"><section data-role="paragraph"><section><section><section data-brushtype="text"><strong>相关阅读</strong></section></section></section><section><section><br  /></section></section><section data-width="100%"><section><section><section><section data-width="100%"><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"><section><p><img src="image/20201014/2aac877ff9233ba5a66e7a5ff3a4febf_28.gif" /></p></section><section 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