如何建设介入－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放射科.蒋世良HybridRoom背景（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领域。背景（2）•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，提高了治疗效果。背景（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（杂交手术室）出现了。杂交手术时需要的人员•介入医生•心血管外科医生•超声心动图医生•心脏麻醉医生•电生理医生•护士•介入手术室技术员•灌注师杂交手术室设计•房间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空间要求•地面预留空间给下列设施心血管造影机麻醉机超声设备体外循环设备手术床与可移动床的结合产品特征：–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15°侧面倾斜–碳纤维床面空间方面的考虑•设备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）杂交手术室显像设备•平板监视器麻醉科医生超声心动图医生介入医生信息传输•造影图像•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）杂交方法治疗冠心病多支病变冠脉搭桥术后（CABG）行PCI治疗多支病变先采用CABG治疗LAD阻塞性病变，后行PCI支架治疗右冠状动脉狭窄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后经导管栓塞体肺侧支Thankyouforyourattention！HowtoBuildaCath-LabOperatingRoom（HybridOperatingRoom）DepartmentofRadiology,CardiovascularInstitute&FuwaiHospital,PekingUnionMedicalCollege&ChineseAcademyofMedicalSciencesBeijing,China,100037ShiliangJiang,MD蒋世良HybridRoomBackground（1）•Historically,surgeonsandinterventionalistshavehadasomewhatcompetitiverelationship,especiallyincoronaryarterydiseaseandcongenitalheartdisease.Background（2）•Themanagementofsomeacquiredandcongenitalcardiovasculardiseasesisevolvingduetoadvancesintranscathetertherapiesthatcoincidewithsurgicalstrategiestoimproveoutcomes.Background（3）•Asthelevelofcollaborationbetweenthesurgeonandinterventionalisthasincreased,theneedforatherapeuticsuitethatiscompatiblewithbothdisciplines（hybrid）hasbecomeapparent.StaffInvolvedInAHybridCase•Interventionalist•CardiovascularSurgeon•Echo-cardiographer•Cardiacanesthesiologist•Electrophysiologist•Nurses•CathLabTechnicians•PerfusionistHybridRoomDesign•Theroomsize:shouldbeminimumof80m2forbi-planesystems70m2forsigle-planesystemsSpaceConsiderations•Floorspacereservedfor:AngiographicsystemAnesthesiamachineEchocardiographymachineCPBmachineIntegratedOperationTablewithfloatingtabletopProductfeatures:–Integratedtableisthepre-requisitefor3Dimaging–Floatingtabletop–CollisionProtection–Motorizedtiltingcapabilities:15°headup/Down15°lateraltilt–CarbonfibretabletopSpaceConsiderations•Equipmentmountedonceiling/walls:SurgicallightContrastinjectorZoomcameramountedonthewallHybridRoomVideoDisplay•Flatpanelmonitorsaroundtheroomfor:AnesthesiologistEcho-cardiographerInterventionalistInformationTransport•Angiograms•Echocardiograms(TTE,TEE,IVUS,3D)•Physiologymonitoring•Livevideo•Othervideosources-PACSHybridProceduresfortheTreatmentofCADwithMultipleVesselsDiseaseCABGpriortoPCIforCADwithMultipleVesselsDiseaseCABGpriortoPCIforCTOwithLADandRCAStenosisPercutaneousClosureofAortopulmonaryCollateralsPriortointracardiacoperationforTetralogyofFallotPercutaneousClosureofAortopulmonaryCollateralsPriortointracardiacoperationforTetralogyofFallotPercutaneousClosureofAortopulmonaryCollateralsPriortointracardiacoperationforTetralogyofFallotPercutaneousClosureofAortopulmonaryCollateralsPosteriortointracardiacoperationforTetralogyofFallotThankyouforyourattention！
