经桡动脉4F导管行冠状动脉造影的可行性与安全性研究

The safety and feasibility of 4F catheter in transradial coronary angiography

目的评价4F造影导管经桡动脉途径行冠状动脉造影的可行性与安全性。方法入选2008年5月至2009年5月于安贞医院就诊初次行冠状动脉造影的患者947例,使用随机数字表随机分为4F导管组和5F导管组。比较两组间造影成功率、造影图像质量、手术时间、对比剂用量、压迫止血时间、单导管完成率、导管打结率、桡动脉痉挛发生率以及术中和术后不良心血管事件,分别于术前24h,术后24h,术后4周行右桡动脉彩色多普勒超声。结果 4F导管组和5F导管组在造影成功率、造影图像质量、手术时间、对比剂用量、单导管完成率、导管打结率、桡动脉痉挛发生率等方面差异均无统计学意义,压迫止血时间4F组显著短于5F组(4.62±0.98)h比(6.36±0.93)h,P<0.001。除5F组一例患者于术中出现心室颤动外,两组患者均未出现院内、院外死亡、急性血栓事件、严重出血事件、前臂大血肿等;4F组桡动脉闭塞、桡动脉内膜增厚率均显著少于5F组(分别为0.60%比2.30%,P=0.038;1.10%比4.10%,P=0.003)。结论 4F造影导管经桡动脉行冠状动脉造影术安全、可行,同时对桡动脉损伤小,血管并发症少,术后压迫止血时间短,舒适度更高。

Objective To investigate the safety and feasibility of transradial approach for diagnostic coronary angiography with 4F catheter.Methods From May 2008 to May 2009,947 patients who received transradial coronary angiography in Anzhen hospital were randomized to 4F or 5F catheters.The procedure success rate,image quality,duration of operation,contrast volume,hemostasis duration,percentage of procedures completed with single catheter,catheter knotting,radial artery spasm,and adverse cardiovascular events during and after procedures between the two groups were compared.Diameters of the radial artery were measured with color Doppler ultrasound before,24 hours and 4 weeks after the procedures.Results No significant differences were observed between the 4F and 5F in the procedure success rate,image quality,duration of operation,contrast volume,percentage of procedures completed with single catheter,catheter knotting,radial artery spasm.The hemostasis duration of 4F group was significantly shorter than 5F group（4.62±0.98）h vs.（6.36±0.93） h,P〈0.001.No death,acute myocardial infarction or upper limb haematoma occurred in both groups,except 1 ventricular fibrillation in the 5F group.The incidences of radial artery occlusion and intima-media thickening were both significantly lower in 4F group than 5F group（0.60% vs..2.30%,P=0.038;1.10% vs.4.10%,P=0.003）.Conclusions Diagnostic transradial coronary angiography with 4F catheter is safe and feasible.Moreover,4F catheter can lead to less radial damage,vascular related complications,hemostasis duration and more comfort.