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经皮穿刺桡动脉冠状动脉造影182例经验总结(摘要)
http://www.100md.com 《中国循环杂志》 1999年第0期
     作者:魏盟 严卫 樊冰 王齐冰 潘翠珍 戎卫海 何梅先 蔡乃绳 陈灏珠

    单位:上海市,上海医科大学中山医院 上海市心血管病研究所 心内科(200032)

    关键词:

    目的 目的:评价国人经皮穿刺桡动脉冠状动脉造影的可行性。

    方法:选择从我院1998年5月至1999年2月间欲行冠状动脉造影的201例病人中选出182例病人,其中男性155例,女性27例,平均年龄为66.7±9.6(31~81)岁。冠状动脉造影主要采用Judkins技术,均以右桡动脉为穿刺血管。有135例及76例分别于术前、术后用彩色多普勒二维超声检测右桡动脉的内径及平均血流速度。

    结果:术前男性(117例)的桡动脉内径为0.15~0.41 cm,平均0.270±0.036 cm,女性(18例)为0.18~0.30 cm,平均0.230±0.038 cm。术前男性的桡动脉平均血流速度为23~111 cm/s,平均55.92±18.50 cm/s,女性为29.1~87.0 cm/s,平均51.87±15.53 cm/s。术后男性(61例)的桡动脉直径为0.21~0.39 cm,平均0.290±0.046 cm,女性(15例)为0.17~0.30 cm,平均0.250±0.026 cm;术后男性的桡动脉平均血流速度为22.4~100 cm/s,平均57.87±27.14 cm/s,女性为24.3~79.0 cm/s,平均55.27±37.79 cm/s,术前与术后相比,男性及女性的桡动脉内径及平均血流速度之间均无明显差别(P>0.05)。手术成功率为96.7%(176/182)。6例不成功,其中5例发生在前50例。失败的原因,3例为穿刺失败,3例为导管无法进入升主动脉,其中2例为血管严重痉挛,1例为血管严重粥样硬化及扭曲。并发症两例,右冠状动脉夹层分离造成非Q性心肌梗塞,1例为导丝误入右冠引起,1例为导管进入过深造成近端斑块破裂引起。术后未见桡动脉闭塞及血管并发症。
, 百拇医药
    结论:经皮穿刺桡动脉冠状动脉造影易于掌握,成功率高,并发症少,病人痛苦少,恢复快,是选择性冠状动脉造影的又一理想穿刺途径。

    Experience of Transradial Coronary Angiography in 182 Chinese Patients (Abstract)

    epartment of Cardiology, Zhong Shan Hospital of Shanghai Medical University, Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)

    Wei Meng, Yan Wei, Fan Bing, et al.

    Objective: To gain experiences of coronary angiography through the radial artery on Chinese population and evaluate its safety and feasibility.
, 百拇医药
    Methods: One hundred and eighty two out of 201 patients were selected from May 1998 to February 1999 undergoing coronary angiography via radial artery in Zhong Zhan Hospital, Shanghai. The average age of these patients was 66.7±9.6 (31~81), male patients were 155, female patients were 27. According to the results of our prior experiment, transradial coronary angiography was easier performed on right radial artery with Judkins technique. Inner diameters and average blood velocity of the right radial artery were measured with color Doppler echocardiogram in 117 male and 18 female patients before coronary angiography and in 61 male and 15 female patients after coronary angiography.
, http://www.100md.com
    Results: Before coronary angiography, the diameters of the right radial artery in men were 0.15~0.41 cm (average 0.270±0.036 cm), and in women 0.18~0.30 cm (average 0.230±0.038 cm), the average blood velocities in men were 23~111 cm/s (average 55.92±18.50 cm/s), and in women 29.1~87.0 cm/s (average 51.87±15.53 cm/s). After coronary angiography, the diameters of the right radial artery in men were 0.21~0.39 cm (average 0.290±0.046 cm), and in women 0.17~0.30 cm (average 0.250±0.026 cm); the average blood velocities in men were 22.4~100.0 cm/s (average 57.87±27.14 cm/s), and in women 24.3~79.0 cm/s (average 55.27±37.79 cm/s). The differences in the inner diameter and the average blood velocity of the right radial artery between before and after coronary angiography were insignificant in both men and women patients (p>0.05). Transradial coronary angiography was successfully performed in 96.7% (176/182) cases. In 6 case, it was unsuccessful. Five of the six cases were among the initial fifty cases in this study. The causes were failure to puncture in 3 cases, failure to move the catheters into the ascending aorta in 3 cases with severe vessel spasm (2 cases) and diffusive atherosclerosis with severe tortuosity (1 case). There were 2 cases with complication of the right coronary artery dissection, one was due to guide wire entering inadvertently the right coronary artery, the other was the catheter tip deeply engaged in the right coronary artery. These two cases were treated successfully with intracoronary stents, and non-Q myocardial infarction was confirmed in the two cases later on. Follow-up showed no occlusion of the right radial arteries, no ischemia of the right hands and puncture-site vessel complications.

    Conclusion: Transradial coronary angiography is a safe and practical alternative approach for interventional procedure in our Chinese patients., 百拇医药