【摘要】 目的探讨经桡动脉路径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)血管通路痉挛应用PCI导丝和球囊辅助跨越痉挛段血管的安全性和可行性。方法回顾性分析2014年1月至2015年6月首都医科大学附属北京朝阳医院、临汾市人民医院、晋城心脑血管病医院、临汾市第二人民医院和烟台海港医院经桡动脉路径PCI伴有桡动脉和(或)肱动脉痉挛应用PCI导丝和球囊辅助成功越过痉挛段的33例冠心病患者(A组),并与同期其他术者用常规方法处理痉挛的38例患者(B组)进行比较。观察两种方法指引导管通过痉挛段的成功率以及并发症的发生率等指标,以了解两种方法的优劣。结果两组患者痉挛部位比较,差异无统计学意义(P=0.150),但肱动脉痉挛的发生率均较桡动脉高。A组指引导管通过率显著高于B组[33例(100.0%)比15例(39.5%),P=0.000];对于指引导管成功通过痉挛段的两组患者,A组较B组所需时间更短(P=0.000),A、B组指引导管通过时间≤5 min的患者分别为30例(90.9%)和2例(13.3%),5~15 min的患者分别为3例(9.1%)和7例(46.7%),>15 min的患者分别为0和6例(40.0%)。A组患者前臂血肿发生率较B组降低[(2例(6.1%)比7例(18.4%)],但差异无统计学意义(P=0.113)。结论经桡动脉路径PCI血管痉挛应用PCI导丝和球囊辅助可非常安全有效地使指引导管跨越痉挛和(或)夹层段,较应用抗痉挛药物这一常规方法更为安全可行。更多还原

【Abstract】 Objective To explore the safety and feasibility of guiding catheter passing through spasmodic vessels in patients undergoing percutaneous coronary intervention( PCI) via radial artery access by the aid of PCI guiding wire and balloon. Methods The clinical data of 33 coronary artery disease( CAD) patients undergoing PCI via radial artery access with radial artery or( and) brachial artery spasm( group A) were retrospectively analyzed. Among all these patients,guiding catheters were delivered through the spasmodic vessels successfully by the aid of PCI guiding wires and balloons. The clinical data of other 38 CAD patients having PCI during the same period performed by other operators via radial artery or( and)brachial artery approach and experienced vessel spasm were anlysed as the control( group B). All patients in group B received conventional anti-spasm management during PCI. All vessel spasm was identified by angiography. For patients in group A,a diameter of 0. 014 inch guiding wire was chosen to pass through the spasmodic vessel segment carefully and gently. The diameter of balloon should be chosen according to the diameter of guiding catheter. A balloon diameter of 2. 0 mm and 2. 5 mm was corresponded to 6F and 7F guiding catheter respectively. The balloon was advanced to the tip of guiding catheter,keeping a half in catheter and a half in vessel followed by inflating the balloon with a pressure of 8 atm. The balloon was kept inflated the guiding catheter was pushed in vitro carefully and slowly until the catheter passed through the spasmodic vessel segment. Then the balloon was deflated and pulled out together with PCI guiding wire.Exchanged a diameter of 0. 035 inch wire and completed the positioning of guiding catheter. After finishing the PCI,radial or( and) brachial angiography was performed again to observe if spasm disappeared and to determine if there any contrast medium exudation. For patients in group B,routine approach was applied including administration of nitroglycerine, diltiazem or nitroprusside etc. to relieve vessel spasm.Results The location of vessel spasm was similar in group A and group B( P = 0. 150),and the incidence rate of spasm in brachial artery was higher than that in radial artery in both groups. The chance of guiding catheter crossing the spasmodic vessel segment was significantly higher in group A than in group B( 100%vs. 39. 5%,P = 0. 00). In patients whose guiding catheter could pass through the spasmodic vessel segment successfully,time spent in group A was shorter than in group B( P = 0. 000). The patient number which time spent was less than five minutes,five to 15 minutes and more than 15 minutes was 30 and 2( 90. 1%vs. 13. 3%),3 and 7( 9. 9% vs. 46. 7%) and 0 and 6( 0% vs. 40. 0%) in group A and in group B respectively. The incidence of forearm hematoma was lower in group A than in group B without statistical difference [6. 1%( 2 /33) vs. 18. 4%( 7 /38),P = 0. 113]. Conclusions It is safe and feasible for passing guiding catheter through spasmodic vessels during PCI via radial artery access by the aid of PCI guiding wire and balloon.更多还原