摘要
引言冠状动脉病变的诊疗技术在不断更新发展。最初时股动脉作为冠状动脉造影(coronary arteriography,CAG)及经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的入径选择,后续得益于鞘管技术的发展,目前桡动脉入径(transradial access,TRA)已经被证实优于股动脉入径[1-2]。相比于股动脉入径,TRA能显著降低出血等血管并发症的发生[3],甚至能降低急性冠状动脉综合征患者的死亡率[4],更为重要的是可增加患者的舒适度[2]。因此,目前我国90%以上的CAG及PCI手术由TRA完成[5-6]。
Objective:To assess the feasibility of distal transradial access in the anatomical Hegu acupoint for coronary angiography and interventions.Subjects:This study enrolled 153 consecutive patients undergoing percutaneous coronary angiography and interventional therapy through right distal transradial access in the anatomical Hegu acupoint between March 1,2019 and March 31,2019 in Shenzhen People's Hospital.One hundred and twenty-four patients were selected,while the other 29 patients were excluded due to the lack of pulsation or weak pulsation at the anatomical location of right.Interventions:The puncture of right distal transradial access in the anatomical Hegu acupoint was performed,and the sheath of 6 F TerumoTalmao radial artery was inserted along the guidewire to complete the puncture.Main Outcomes and Measurements:The age,height,weight,body mass index,puncture time,and VAS pain score were obtained observed,and Student's t-test was used for the comparison between the enrolled group and the unenrolled group,the successful group and the unsuccessful group.The gender,hypertension,diabetes,hyperlipidemia,smoking history,atrial fibrillation,chronic renal insufficiency,heart failure,nature of the surgery,discharge diagnosis,and type of surgery were compared using Chi-square test between the enrolled group and the unenrolled group,the successful group and the unsuccessful group.P<0.05 was considered statistically significant.Results:Among the 124 patients enrolled,93 were males,accounting for 75%,with the age of(60.2±11.6)years old,the height of(165.7±7.2)cm,and the weight of(68.2±11.7)kg,showing no statistical significance(P>0.05)compared with the 25 patients not enrolled.The distal transradial access in the anatomical Hegu acupoint was achieved in 99 patients with a success rate of 79.84%.In 8 patients,arterial puncture failed,while in 17 others,despite successful arterial puncture the wire could not be advanced towards the forearm part of the radial artery.The mean puncture time was(1.49±1.06)min,and the mean visual analogue scale was(1.81±0.99).Thirteen patients completed coronary angiography alone,35 patients completed coronary angiography plus left cardiac catheterization,and 51 patients completed coronary angiography plus coronary intervention.No radial artery occlusion,subcutaneous hematoma or compartment fascia syndrome occurred.Conclusion:Distal transradial access in the anatomical Hegu acupoint is feasible,safe,and comfortable for patients undergoing coronary angiography or interventions.
作者
孙鑫
宋坤青
王能
张峰
董少红
吴炯仁
Sun Xin;Lin Yaowang;Tong Ling;Zhang Chuanshou;Zhang Zhuanzhuan;Luo Linjie;Li Jun;Qin Yingjie;Jiang Liman;Luo Yingping;Liu Huadong;Dong Shaohong(Department of Cardiology,Shenzhen People’s Hospital(the Second Clinical Medical College of Jinan University,the First Affiliated Hospital of Southern University of Science and Technology),Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center,Shenzhen 518020,China)
作者简介
通信作者:吴炯仁,Email:cvcjwu@gmail.com
