国人经皮穿刺桡动脉冠状动脉造影182例分析

Experience of transradial coronary angiography in 182 Chinese patients

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 :从该院 1 998年 5月～ 1 999年 2月间欲行冠状动脉造影的 2 0 1例患者中选出 1 82例 ,采用 Judkins技术 ,均以右桡动脉为穿刺血管。其中有 1 35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 :术前与术后相比 ,男性与女性的桡动脉内径及平均血流速度之间均无显著性差异 (P >0 .0 5 )。手术成功率为 96 .7% (1 76 / 1 82 ) ,6例失败 ,其中 5例发生在前 5 0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。2例为并发症 ,右冠状动脉夹层分离造成非 Q波心肌梗死 ,1例为导丝误入右冠状动脉引起 ,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。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 ,患者痛苦少 ,恢复快 。

Objective:To get experiences of coronary angiography through the radial artery on Chinese population and evaluate its safety and possibility. Method:182 out of 201 patientswere selected February 1999 to be undertaken coronary angiography via the right radial artery with Judkins technique.Inner diameters and average blood velocity of the right radial artery were measured with color Doppler echocardiogram 135 patients before coronary angiography and in 76 patients after coronary angiography.Result:The differences in the inner diameter and the average blood velocity of the right radial artery between pre and post coronary angiography were insignificant in both men and women patients (P> 0.05 ).Transradial coronary angiographies were successfully performed in 176 cases ( 96.7 %).Six cases were unsuccessful.Five of the six cases occurred within the initial fifty cases.The causes were failure to puncture in 3 cases,failure to move the catheters into the asccending aorta in 3 cases because of severe vessel spasm (2 cases) and diffusive atherosclerosis with severe tortuosity (1 case).There were 2 cases of complication of right coronary artery dissection,one was due to guide wire entering the right coronary artery,the other was the catheter tip engaged too deep causing break of proximal site atherome.These two cases were treated successfully with intracoronary stents, and non Q myocardial infarction was confirmed in the two cases later.Follow up showed no occlusion of the right radial arteries,no ischemia of the right hands and access vessel complications.Conclusion:Transradial coronary angiography is a safe and practical alternative approach for interventional procedure in our Chinese population.