经桡动脉路径行冠状动脉造影导管打折预防方法的对比分析

Comparison of the methods for preventing a kinked catheter in transradial coronary angiography

目的 分析对比合并动脉环和(或)动脉严重迂曲患者经桡动脉路径行冠状动脉造影时,导管打折的预防方法。方法 回顾性分析2015年7月至2019年7月期间完成的经桡动脉路径行冠状动脉造影合并动脉环和(或)动脉严重迂曲的720例患者的资料,根据术中是否送入0.035in(1in=2.54cm)导丝辅助旋转分为导丝预防组(372例)和对照组(348例),比较两组的临床基线资料、实验室检查结果、手术特征、导管打折发生率及处理方法。结果 两组患者临床特征、实验室检查结果比较,差异均无统计学意义(均P>0.05),两组患者经左侧桡动脉路径、首次桡动脉穿刺、术者经验<200例、动脉环和(或)动脉严重迂曲、经右侧桡动脉造影失败、并发症发生率比较,差异均无统计学意义(均P>0.05)。对照组导管打折发生率明显高于导丝预防组(1.4%比0,P=0.020),1例发生在完成左冠状动脉造影过程中,4例发生在完成右冠状动脉造影过程中,此5例打折导管通过介入方式解除,更换导管后在0.035 in导丝辅助下完成冠状动脉造影,其中1例患者术后发生右上臂轻微肿胀,压迫后好转,顺利出院,无严重并发症发生。结论 规范操作造影导管打折的发生率低,在合并上肢动脉环、动脉严重迂曲等高危患者中,主动使用0.035 in导丝可有效预防导管打折。

Objective To explore the methods for preventing a kinked catheter of transradial coronary angiography in patients with arterial ring or severe tortuosity. Methods Between July 2015 and July 2019, the patients who participated in the transradial coronary angiography were divided into two groups according to the preventive methods [(0.035 inch(1 inch = 2.54 cm)guidewire usage], as the guidewire preventive group and the control group. The clinical, laboratory and interventional characteristics, the incidence and treatment of kinked catheter were retrospectively analyzed and compared between groups. Results A total of 720 patients were included in the study,of which 372 cases were classifi ed in the guidewire preventive group and 348 cases in the control group. There were no signifi cant dif ferences in clinical characteristics and laboratory results. The proportion of left and right radial artery,the experience of doctors, the proportion of vascular rings and severe tortuosity were similar. The proportion of kinked catheters in the control group was higher(1.4% vs. 0,P=0.020), and 1 case and 4 cases occurred in the process of left and right coronary angiography respectively. All 5 cases of kinked catheters were removed by interventional method. Coronary angiography was completed with the assistance of 0.035 inch guidewire and another catheter. Only one patient endured slight swelling of right upper arm after operation, and was discharged after compression without serious complications. Conclusions The incidence of kinked catheters in standard operation is low. In high-risk patients with arterial ring or severe tortuosity, active use of 0.035 inch guidewire can ef fectively prevent kinked catheter.