心脏冠脉介入术后拔鞘致迷走神经反射临床分析

The Clinical Analysis of Pulling Out Sheath induced Vagovagal Reflexes after Heart Coronary Intervention

目的:探讨心脏冠脉介入术后拔鞘致迷走神经反射发生原因及其防治。方法:本院接受择期冠状动脉造影、冠状动脉腔内成形及冠状动脉支架术共3 518例。分为单纯冠脉造影组,PCI介入组,高龄组、低龄组,男性组及女性组,再根据不同穿刺途径分为股动脉途径组及桡动脉途径组。比较各组的迷走反射发生率。结果:术后拔鞘过程中发生血管迷走反射52例,其中48例发生于拔股动脉鞘时,4例发生在拔桡动脉鞘时。所有病例迷走反射总发生率为1.48%,经股动脉途径发生率为3.82%,经桡动脉途径为0.18%。经股动脉途径发生率明显高于桡动脉。经桡动脉途径各组血管迷走反射发生率无显著性差异。经股动脉途径PCI介入组血管迷走反射发生率高于单纯造影组,高龄组血管迷走反射发生率高于低龄组。结论:股动脉穿刺途径、PCI手术治疗、高龄能增加迷走反射发生率。其中股动脉途径可能是最主要的因素。

Objective：To explore the causes and prevention of vascular vagovagal reflexes （VVRs） occuring in the process of pulling out the scabbard after cardiac intervention operation. Methods：A total of 3 518 patients with elective coronary angiography, percutaneous transluminal coronary angioplasty and Coronary artery stenting. They were divided into pure coronary angiography group and PCI group, the aged group and young group, the male group and the female group. According to the different puncture way into the femoral artery approach group and the radial artery approach group. The groups were compared on the incidence of vascular vagovagal reflexes. Results ：52 patients with vascular vagovagal refle- xes occur in the process of pulling out the scabbard after cardiac intervention operation, including 48 patients of occur- rence during pulling out the femoral artery scabbard and 4 patients during pulling out the radial artery scabbard. The total incidence of Vagal reflex in all cases was 1.48% , through the femoral artery approach incidence was 3.82% , the radial artery was 0.18%. The incidence through the femoral artery approach was significantly higher than that of the radial ar- tery. There was no significant difference in the transradial vasovagal incidence. The vasovagal reflx incidence of PCI in- tervention group was higher than that of simple angiography group ; aged group vasovagal incidence was higher than that of the younger age groups. Conclusion：The femoral artery approach, PCI and age can increase the incidence of vascular vagovagal reflexes. The femoral artery approach might be the main factor.