“A弯法”在心腔内超声导管无阻力通过左侧髂静脉过程的临床应用

Clinical application of"bend A method"in course of intracardiac echocardiographic catheter passing left iliac vein without resistance

目的探讨“A弯法”在心腔内超声(ICE)导管无阻力通过左侧髂静脉过程中的有效性和安全性。方法选取2020年1月至2021年8月于胜利油田中心医院拟行ICE引导下经导管心脏射频消融术且合并左侧股静脉入路盲送ICE导管遭遇阻力的患者25例。其中11例通过X线下造影或导丝引导方法尝试通过髂静脉将ICE导管送至右心房(对照组);另14例采用ICE引导下“A弯法”尝试将ICE导管送至右心房(实验组);比较两组患者经ICE导管通过髂静脉的成功率、通过时间、X线曝光时间及并发症的发生率。结果实验组无阻力通过左侧髂静脉的成功率高于对照组(100%vs.90.91%,P=0.44),但无统计学差异。对照组中1例放弃左侧股静脉入路,改为右侧股静脉入路,视为不成功;实验组无阻力通过左侧髂静脉的时间较对照组明显缩短(0.82±0.28 min vs.1.37±0.58 min,P<0.05),实验组X线曝光时间为零;两组均无并发症发生。结论与X线透视下推送ICE导管的传统方式相比,“A弯法”在ICE导管无阻力通过左侧髂静脉过程中的临床应用效果更好。

Objective To discuss the efficacy and safety of“bend A method”in course of intracardiac echocardiographic(ICE)catheter passing left iliac vein without resistance.Methods The patients(n=25)planed to receive ICE-guided transcatheter cardiac radiofrequency catheter ablation(RFCA)combined with blind ICE catheter passing left femoral vein with resistance were chosen from Central Hospital of Shengli Oilfield from Jan.2020 to Aug.2021.ICE catheter was tried to send to right atrium passing left iliac vein by using radiography or wire guiding method guided by X-ray in 11 patients(control group),and ICE catheter was tried to send to right atrium by using“bend A method”guided by ICE in 14 patients(test group).The success rate and passing time of ICE catheter passing left iliac vein,X-ray exposure time and incidence rates of complications were compared between 2 groups.Results The success rate of passing left iliac vein without resistance was higher in test group than that in control group(100%vs.90.91%,P=0.44).In control group,left femoral vein passage was given up and right femoral vein passage was taken in 1 case,which was regarded as unsuccessful.The time passing left iliac vein without resistance was significantly shorter in test group than that in control group(0.82±0.28 min vs.1.37±0.58 min,P<0.05).the X-ray exposure time was zero in test group.There were no complications occurred in 2 groups.Conclusion Compared with the traditional method of pushing ICE catheter guided by X-ray,“bend A method”has a higher clinical effect in the course of ICE catheter passing through left iliac vein without resistance.