无肝素冠状动脉造影术1400例临床分析

Clinical analysis of 1 400 cases of coronary artery angiography without heparin

目的评价无肝素冠状动脉造影术的可行性及安全性。方法总结分析1400例经股动脉行无肝素冠状动脉造影术的患者的临床资料并与354例普通肝素冠状动脉造影术患者进行对照。结果99.3%的病例行选择性冠脉造影成功,手术时间(从穿刺动脉到造影结束)8min￣1h,平均(17.9±11.3)min。冠心病阳性率为72.2%,多支血管病变占49.8%。皮下血肿的发生率为1.8%,假性动脉瘤和动静脉瘘发生率为0.07%,腹膜后血肿、急性心肌梗死、脑卒中及其他体循环栓塞事件发生率为0。结论无肝素冠状动脉造影术不仅安全且具有外周血管并发症少、痛苦小、住院时间短等优点。

Objective To evaluate the feasibility and safety of coronary artery angiography via femoral artery approach without heparin. Methods Totally 1 400 consecutive patients undergoing coronary artery angiography with heparin were analyzed retrospectively in comparison with the data of 354 patients for coronary artery angiography without heparin. Results Success in selective coronary artery angiography was achieved in 99.3% of the patients in the non-heparin group, with the mean operation time of 17.9±11.3 min ranging from 8 min to 1 hour. Angiography identified coronary artery stenosis in 72.2% of the patients including 49.8% with multivessel involvement. Subcutaneous hematoma occurred in 25 （1.8%） of the patients, and 1 （0.07%） patient developed arterial and venous fistula and pseudoaneurysm at the puncture site, but other complications （retroperitoneal hematoma, acute myocardial infarction, stroke and peripheral artery thrombotic events） occurred neither during nor after the procedure. In the heparin group, 18 （5.1%） patients developed subcutaneous hematoma and 1 （0.2%） had arterial and venous fistula and pseudoaneurysm at the puncture site after angiography. Conclusion Coronary artery angiography without heparin is both safe and feasible with only very low risk of complications.