选择性冠状动脉造影术中并发心室颤动的原因及防止对策

目的分析选择性冠状动脉造影(SCA)术中发生心室颤动(VF)的原因及其预防措施。方法回顾性分析3 028例SCA术中发生VF病例。结果用5F Terumo TIG造影导管VF发生率1.26%,高于使用其它造影导管VF的发生率。SCA术中,23例发生VF,三支CA病变5例、双支CA病变2例、RCA近端重度狭窄4例、左主干单支病变5例、RCA发育细小2例、CA无异常1例、前降支重度狭窄并AMI 2例、RCA单支完全闭塞2例。导管超选择进入圆锥支8例、导管插入过深4例、导管在RCA口操作时间较长2例、左主干病变导管在左主干操作时间过长2例、无诱因6例,RCA单支重度狭窄、前降支注入气泡1例。16患者发生VF前首先表现为CA内压力下降,7例发生VF前无CA内压力下降。结论冠脉病变特点器材选择及操作不当是SCA中VF发生的主要原因,充分认识并避免之可防止VF发生。

The reason and precaution of ventricular fibrillation undergoing selective coronary angiography

Objective To discuss the reason and precaution of ventricular fibrillation(VF) undergoing selective coronary angiography(SCA). Methods o analysis some correlated factories of VF during SCA retrospectively and discuss the preventive measures.Results The morbidity rate of VF using 5F Termao TIG is 1.26%,It's higher than using other catheters.There were 23 cases with VF undergoing SCA,including 5 cases with triple vessels disease,2 cases with double vessels disease,4 cases with severe llesion at the proximal part of right coronary artery(RCA).5 cases with left main coronary artery(LM) lesion,2 cases wit small RCA,1 case without coronary artery abnormality,2 cases accompanied acute myocardial infarction with severe stenosis of left anterior descending branch(LAD),2 cases accompanied acute myocardial infarction with severe stenosis of left anterior descending branch(LAD),2 cases with RCA occluded completely.Of 23 cases,8 cases with catheter fit-into conus artery ultraselectively,4 cases with catheter inserting to deeply,2 cases with operation time too long in RCA,2 cases with operation time too long for LM lesion,6 cases without any reason,1 case with RCA sever stenosis and LAD influxes bubble.The pressure of CA decreased before VF in 16 cases of the 23 cases.Conclusion The pathological feature of the coronary arteries,unsuitable equipment and operation should be the main reason that VF happens in SCA.Sufficient understand for the reason should be necessary to avoid VF.