应用4F导管经肱动脉行冠状动脉造影的可行性

Safety and efficacy of percutaneous coronary angiography using the brachial approach and 4 French catheters

目的探讨应用4FJL4.0和JR4.0造影导管经肱动脉行冠状动脉造影的可行性,为进一步的随机对照研究做准备。方法选择住院行择期冠状动脉造影术的病人120名。手术时穿刺肱动脉送入4F动脉鞘管,经鞘管注入普通肝素2000IU抗凝,应用4FJL4.0和JR4.0造影导管按常规行冠状动脉造影检查。术后即刻拔除动脉鞘,局部压迫止血20分钟,术侧上肢制动并加压包扎6小时。止血结束后患者即刻可以下床活动。观察手术成功率、手术时间及术后7天内发生的死亡、心肌梗塞和各种外周血管并发症。结果共有120人完成了研究,总体手术成功率为92.5%,平均手术时间17.7±4.0分钟。术后90%的患者步行返回病房。总体并发症发生率为1.6%,无死亡及心肌梗塞。结论应用4FJL4.0和JR4.0造影导管经肱动脉行冠状动脉造影具有较高的手术成功率和较低的并发症发生率,手术时间未明显增加,不影响术后病人活动,因此是安全、可行的。

Objective This study was designed to evaluate the efficacy and safety of coronary angiography using the brachial approach and 4 French catheters. Methods One hundred and twenty patients undergoing selective coronary angiography were enrolled. The brachial approach and 4 French catheters were used. A single intra-arterial bolus of heparin(2000u) was administered after insertion of the arterial access sheath. Coronary angiography was performed using standard techniques. Sheaths were removed immediately after the procedure. Hemostasis was achieved by manual compression for 20. minutes. End points: success rate, procedural time, and death, myocardial infarction or local complication at one-week follow-up. Results In the 120 patients, the overall primary success rate was 92.5%; the mean procedure time was 17.7±4.0 minutes. The overall complication rate was 1.6%. There were no death or myocardial infarction. Conclusions coronary angiography using the brachial approach and 4 French catheters is technically feasible.