老年冠心病患者经桡动脉途径同时接受冠状动脉、肾动脉和下肢动脉造影的安全性及有效性探讨

Investigation on safety and feasibility of angiographies of coronary and renal and lower extremity artery in elderly patients with coronary heart disease by transradial approach at the same time

目的探讨老年冠心病患者经桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影的方法并分析其安全性及有效性。方法收集可疑冠心病伴外周动脉粥样硬化的老年患者275例（年龄≥60岁）行选择性冠脉造影同时行肾动脉及下肢动脉造影。按介入途径分为左桡动脉组（124例）及右桡动脉组（151例）,各组再按年龄段分为三个不同亚组：低龄老年亚组（60～69岁）,中龄老年亚组（70～79岁）,高龄老年亚组（≥80岁）,分别以左、右桡动脉途径运用TIG共用造影管（100cm）及MP A1造影管（125cm）依次行冠脉、双侧下肢动脉和肾动脉造影,比较桡动脉穿刺成功率、造影操作时间、对比剂用量、X线曝光时间及造影完成率等,并分析这些指标与年龄的相关性。结果左、右桡动脉组的穿刺成功率及对比剂用量差异无统计学意义,而左桡动脉组造影操作时间、X线暴露时间均低于右桡动脉组,造影完成率亦明显高于右桡动脉组;左、右桡动脉组造影操作时间均与年龄呈正相关,而X线曝光时间与年龄无相关性。结论老年患者经左桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影完成率高,安全有效,可作为首选路径。

Objective To investigate the methods of angiographies of coronary and renal and lower extremity artery in elderly patients with coronary heart disease by transradial approach at the same time, and to analyze the safety and feasibility. Methods Two hundred and seventy five elderly patients （age≥60 years） with suspected coronary heart disease complicated with peripheral artery atherosclerosis were performed with selective angiography of coronary and renal and lower extremity artery. Those patients were divided randomly into left radial artery group and right radial artery group, then each group were divided into three subgroups according to ages： lower-elderly subgroup （60-69 years）, middle-elderly subgroup （70-79 years） and high-elderly group （≥80 years）. The angiography of coronary and kidney and lower extremity artery were performed with TIG common angiography catheter （100 cm） and MP A1 angiography tube （125 cm） by left and right transradial approach. The success rate of radial artery puncture, angiographic procedure time, the amount of con- trast agent, X-ray exposure time and angiography completion rate were compared between the two groups. The correlations between those indexes and ages were analyzed. Results There was no significance difference in success rate of radial artery puncture and the amount of contrast agent between left and right artery subgroups. The operating time of angiography and X-ray exposure time in left radial artery group were much less than those of right radial artery group, and the angiographic completion rate was also significantly higher than that of the right radial artery group. There was significant positive correlation between age and angiography operating time in left and right radial artery group, but no correlation between age and X-ray exposure time in right and left radial artery group. Conclusion The angiographies of coronary artery, lower artery and renal artery through radial artery approach at the same time can reach a high success rate, which is safe and feasible.