缺血预处理预防经桡动脉冠状动脉造影外周血管并发症的效果

Effect of ischemic preconditioning on preventing complications induced by transradial coronary angiography

目的探讨缺血预处理预防经桡动脉冠状动脉造影外周血管并发症的效果。方法选择2016年3月至2017年6月在广西中医学院第一附属医院择期经桡动脉冠状动脉造影的150例患者为研究对象。按随机数字表法将患者为两组:试验组(75例)用血压计袖带缠绕于右上臂并充气达200 mmHg(1 mmHg=0.133 kPa),持续5 min后放气,重复3次,每次间隔5 min,然后送入导管室行经桡动脉冠状动脉造影术;对照组(75例)不作预处理,按常规送入导管室行经桡动脉冠状动脉造影术。术后穿刺点加压包扎6 h。术前和术后1周,用彩色多普勒超声评估右桡动脉远端。统计术中和术后1周内外周血管并发症的发生率。结果术中和术后1周内,两组患者均未发生前臂张力性血肿、腕管综合征和前臂骨筋膜室综合征。两组桡动脉闭塞和局部出血的发生率比较,差异无统计学意义[1.3%(1/75)vs. 11.3%(1/75),P>0.05;12.0%(9/75)vs. 17.3%(13/75),P>0.05]。试验组桡动脉痉挛、狭窄和迷走神经反射的发生率比对照组减少,差异有统计学意义[4.0%(3/75)vs. 14.7%(11/75),P<0.05;34.7%(26/75)vs. 52.0%(39/75),P<0.05;2.7%(2/75)vs. 12.0%(9/75),P<0.05]。结论缺血预处理可预防经桡动脉冠状动脉造影外周血管并发症。

Objectives To explore the effects of ischemic preconditioning on preventing complications induced by tran?sradial coronary angiography.Methods Totally150patients who received elective transradial coronary angiography from March2016to June2017in The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine were randomly divided into two groups:treatment and control groups.In treatment group(n=75),the patients were wrapped around the right upper arm with a cuff of sphygmomanometer and inflated up to200mmHg(1mmHg=0.133kPa),which lasted for5minutes then deflated.The above operation was repeated3times,each time interval of5minutes,then the patients were sent to the cath lab for the transradial coronary angiography.In control group(n=75),the patients were sent to the cath lab for the transradial coronary angiography without ischemic preconditioning.The puncture points of the two groups after transradial coronary angiography were pressurized for6hours.Before and1week after transradial coronary angiography,the changes of distal radial artery were observed with color doppler ultrasound.Incidences of complications induced by transradial coronary angiography were counted.Results No tension hematoma of forearm,carpal tunnel syndrome and forearm compartment syndrome were found in the two groups.There were no significant differences in incidences of radial artery occlusion and local hemorrhage of the two group[1.3%(1/75)vs.11.3%(1/75),P>0.05;12.0%(9/75)vs.17.3%(13/75),P>0.05].Incidence of radial artery spasm,stenosis and vagus reflex of treatment group were significantly less than those of control group[4.0%(3/75)vs.14.7%(11/75),P<0.05;34.7%(26/75)vs.52.0%(39/75),P<0.05;2.7%(2/75)vs.12.0%(9/75),P<0.05].Conclusions Ischemic preconditioning can prevent complications induced by transradial coronary angiography.