经桡动脉途径进行冠状动脉造影

目的:评价经桡动脉途径进行冠状动脉造影的可行性、安全性。方法:经桡动脉途径对12 8例患者行冠状动脉造影检查,观察其成功率和血管并发症。结果:手术成功率90 .6% ,并发桡动脉夹层、桡动脉撕裂、前臂血肿各1例。结论:经桡动脉途径进行冠状动脉造影检查是可行的,只要适应症和患者选择恰当,该途径成功率高,并发症少。     

橡皮擦用于经桡动脉行冠状动脉介入术后穿刺点止血

经桡动脉行冠状动脉造影／介入治疗因并发症少、痛苦小而广泛应用于临床。因穿刺易损伤桡动脉,且术后使用抗凝药物,若穿刺点处理不当,穿刺部位易出现渗血、前臂血肿。给患者带来心理压力,影响治疗效果。2008年1～12月我科将橡皮擦用于566例经桡动脉行冠状动脉介入治疗患者,以预防穿刺部位出血,效果较好,介绍如下。     

经桡动脉冠状动脉介入治疗100例临床分析

目的探讨经桡动脉行冠状动脉介入治疗的特点和优势。方法回顾性分析经桡动脉冠状动脉介入检查及治疗的100例患者的临床资料。结果 100例患者中90例手术成功;10例未成功,其中6例改为左桡动脉入路,4例经右股动脉成功。术中发生桡动脉痉挛8例,前臂血肿2例,术后桡动脉闭塞2例,锁骨下动脉夹层1例。结论经桡动脉行冠状动脉介入治疗损伤小、痛苦小、微创、安全。     

橡皮擦用于经桡动脉行冠状动脉介入术后穿刺点止血

经桡动脉行冠状动脉造影/介入治疗因并发症少、痛苦小而广泛应用于临床.因穿刺易损伤桡动脉,且术后使用抗凝药物,若穿刺点处理不当,穿刺部位易出现渗血、前臂血肿,给患者带来心理压力,影响治疗效果.     

经桡动脉冠状动脉造影术围术期的综合护理

目的探讨综合护理在经桡动脉冠状动脉造影术围术期中的应用效果。方法回顾性分析96例于西平县人民医院行经桡动脉冠状动脉造影术患者的临床资料。术前加强心理护理及做好术前准备,术中密切配合、预防桡动脉痉挛,术后加强穿刺口及并发症的观察等围术期综合护理措施。结果本组96例患者均一次置管及造影成功,顺利完成手术。术后4例出现穿刺部位皮下血肿,经对症处理后均消失。术中及术后未发生心室颤动、冠脉穿孔、穿刺口感染、静脉回流障碍、动脉闭塞等其他并发症。结论术前做好心理护理及各项准备工作,术中密切配合、预防桡动脉痉挛,术后加强穿刺口及术侧肢体的观察和护理。能提高经桡动脉冠脉造影术的成功率,减少术后并发症风险。     

六步手指操改善经桡动脉介入术后患者肢体症状的效果评价

目的探讨六步手指操对经桡动脉行经皮冠状动脉介入(PCI)术后患者肢体症状改善的效果。方法将经桡动脉行PCI术的101例患者随机分为对照组(50例)和观察组(51例),对照组采用常规护理方案,观察组采用六步手指操进行康复锻炼,比较两组术后术侧肢体疼痛、肿胀程度和出血情况。结果观察组术后4h和24h术侧肢体疼痛程度和肿胀程度显著轻于对照组(均P0.01);两组术后出血情况无明显差异。结论六步手指操可有效改善经桡动脉行PCI术后患者患侧肢体疼痛和肿胀情况,可有效提升术后患者舒适度。     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点,为针对性护理提供依据.方法 119例老年冠心病患者中57例经桡动脉途径置管(桡动脉组)、62例经股动脉途径置管(股动脉组),比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间.结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间,桡动脉组显著优于股动脉组(均P＜0.01);两组一次置管成功率比较,差异无显著性意义(P＞0.05).结论 经桡动脉与股动脉穿刺均安全、有效、可行;桡动脉组术后治疗性损害相对较轻,更适合老年患者.     

冠状动脉造影和血管成形术诊治老年冠心病:经桡动脉与经股动脉途径对比

目的比较经桡动脉和经股动脉途径在冠状动脉造影和血管成形术中的优缺点,评价经桡动脉途径介入治疗老年冠心病的有效性与安全性。方法 60岁及以上冠心病或可疑冠心病患者1637例,按穿刺途径随机分为桡动脉组（n=909）和股动脉组（n=728）,比较两组间动脉穿刺成功时间、穿刺成功率、造影时间、X线曝光时间、经皮冠状动脉介入治疗（PCI）成功率、穿刺相关血管并发症、迷走反射发生率、平均住院时间及随访术后3个月主要心脏不良事件（MACE）发生情况。结果桡动脉组桡动脉穿刺成功897例（897/909,98.68%）,股动脉组股动脉穿刺成功722例（722/728,99.18%）。桡动脉组穿刺时间较股动脉组长（P〈0.05）。两组的穿刺成功率、PCI成功率,术后MACE等差异均无统计学意义（P〉0.05）。在造影时间、X线曝光时间、穿刺相关血管并发症、迷走反射发生率、平均住院时间等方面,桡动脉组明显低于股动脉组（P〈0.01）。结论经桡动脉途径行冠状动脉造影及PCI治疗老年冠心病安全可行,且易止血,术后无须卧床,并发症少,创伤小,可作为老年冠心病介入治疗的首选途径。     

两组压迫方法对经桡动脉途径行冠状动脉介入术患者桡动脉的影响

目的:探讨两组压迫方法对经桡动脉途径行冠状动脉介入术患者桡动脉的影响。方法:2010年3月～2011年6月于我院心内科病房经桡动脉行冠状动脉介入术的患者360例,随机分为实验组186例,对照组174例。两组患者于手术结束后均使用手腕式充气止血带压迫止血。实验组于术后1h第一次减压,单纯冠状动脉造影(CAG)患者于3h、冠状动脉造影加支架术(PCI)患者于4h后取止血带,改用无菌纱布条加绷带环绕包扎,24h后取下纱布。对照组于术后2h第一次减压,CAG者6h、PCI者8h后完全解除压力,无出血者取下止血带,用无菌敷贴覆盖穿刺点,有出血者再次充气加压直至不出血。观察两组患者的舒适度,桡动脉穿刺处出血并发症、假性动脉瘤、桡动脉闭塞的发生情况。结果:两组从桡动脉穿刺处出血并发症、假性动脉瘤、桡动脉闭塞等方面比较两组均有明显差异。术后1h开始减压没有发生出血。结论:3～4h取止血带后改用纱布条加绷带环绕止血在舒适度和术侧肢体并发症方面优于单纯用手腕式充气止血带加压6～8h后取止血带。术后1h后开始减压具有可行性。     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点，为针对性护理提供依据。方法 119例老年冠心病患者中57例经桡动脉途径置管（桡动脉组）、62例经股动脉途径置管（股动脉组），比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间。结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间，桡动脉组显著优于股动脉组（均P〈0．01）；两组一次置管成功率比较。差异无显著性意义（P〉0．05）。结论 经桡动脉与股动脉穿刺均安全、有效、可行；桡动脉组术后治疗性损害相对较轻，更适合老年患者。     

超声观察经皮冠状动脉介入术后桡动脉改变

目的探讨高频超声对介入术后1天、1个月桡动脉结构变化的诊断价值。方法对52例接受经桡动脉冠状动脉介入术患者,分别在术前、术后1天及1个月应用12MHz高频超声观察桡动脉。采用t检验比较术前、术后1天及1个月的内-中膜厚度（IMT）。结果术后1天桡动脉前后壁IMT较术前均增厚（P均〈0.001）,而术后1个月IMT值有所下降（P均〈0.001）,但仍大于术前。术后1天及术后1个月IMT增厚者分别为44例（86.62%）、30例（57.69%）;术后1天、1个月桡动脉局部管腔狭窄率〉15%者分别为8例（15.38%）、5例（9.62%）;术后1天、1个月出现管腔闭塞者分别为5例（9.62%）、3例（5.78%）;术后1例形成桡动脉假性动脉瘤,48h后闭合,形成前臂血肿。结论经桡动脉介入术对桡动脉有一定损伤,损伤反应及并发症于术后1天最为明显,于术后1个月有所恢复,此时桡动脉内-中膜仍较术前增厚。高频超声对显示桡动脉术后改变具有重要意义。     

超声二维应变评价冠状动脉介入治疗后左心室心肌收缩功能

目的应用超声二维应变（2DS）技术观察单支和多支冠状动脉病变心绞痛患者经皮冠状动脉介入治疗（PCI）后左心室局部心肌径向收缩功能改变有无差异。方法将63例心绞痛患者根据冠状动脉造影结果分为单支病变组（n=33）和多支病变组（n=30）,另选志愿者30名作为正常对照组,分别记录PCI术前、术后3个月及正常对照组左心室基底水平、乳头肌水平及心尖部水平18个室壁节段的二维灰阶图像。应用GE Echo PAC软件测量左心室短轴各室壁节段收缩期峰值径向应变。结果与正常对照组比较,单支病变组和多支病变组PCI术前大部分心肌节段和术后3个月部分心肌节段的左心室收缩期短轴峰值径向应变减低（P〈0.05）;单支病变组PCI术后3个月73.51%（136/185）心肌缺血节段恢复到正常水平,与多支病变组54.11%（158/292）差异有统计学意义（P〈0.01）。结论不同冠状动脉病变心绞痛患者PCI术后左心室径向收缩功能改善情况有所不同。     

延迟经皮冠状动脉介入治疗急性心肌梗死的近期并发症

目的探讨延迟经皮冠状动脉介入治疗对于急性心肌梗死(AMI)的安全性。方法对486例AMI患者(包括108例非ST段抬高型心肌梗死和378例ST段抬高型心肌梗死患者)行延迟经皮冠状动脉介入治疗,回顾分析术中和术后1周内的并发症。结果所有486例患者中,无复流4例(4/486,0.82%),慢血流6例(6/486,1.23%),冠状动脉破裂2例(2/486,0.41%),急性血栓形成3例(3/486,0.62%),冠状动脉内夹层1例(1/486,0.21%),支架脱落3例(3/486,0.62%),死亡6例(6/486,1.23%)。结论延迟经皮冠状动脉介入治疗AMI并发症发生率相对较低,适于基层医院开展。     

Safety and efficacy of radial access in trauma in 65 trauma endovascular cases

ObjectiveEndovascular techniques in trauma surgery are becoming increasingly important in patient management, with procedures such as pelvic and splenic angioembolization becoming the standard of care for certain injuries. Traditionally, such interventions are performed via femoral access, although the morbidity of this approach is not insignificant (3%-10%). Transradial access (TRA) is an attractive alternative, pioneered by cardiologists, with low rates of access site complications in patients undergoing coronary intervention. Recently, this technology has extended to other interventions. The aim of this study was to present the initial experience of a radial program in a busy trauma center, with specific regard to safety and complications.MethodsThe medical records of trauma patients undergoing endovascular procedures via TRA between March 2018 and December 2018 were queried for procedural and postoperative data. Demography and injury characteristics were presented for the overall cohort, followed by a comparison of procedural data and complications between laterality. Continuous variables were compared using a two-tailed t-test and categorical variables were compared using a χ² test.ResultsOver a 9-month period, 65 patients underwent 81 interventions via TRA, most commonly solid organ or pelvic angiography/embolization. Radial artery access was achieved in all patients, with procedural success achieved in all but two patients (n = 63 [96.9%]) who had hypoplastic radial artery anatomy, who underwent ulnar access. The overall technique-related complication rate was 1.5% with no difference observed between laterality (n = 1; P = .523). One patient with an admission Glasgow Coma Score of 3 and coagulopathy developed radial artery thrombosis after pelvic angiography via right TRA. Mortality was seen in seven patients (10.8%) owing to hemorrhagic shock (n = 3 [42.8%]) or multiorgan failure (n = 4 [57.1%]). There were no cases of postprocedural access site bleeding, hematoma, pseudoaneurysm, vascular injury, intraoperative arrhythmia or cerebrovascular accident, arteriovenous fistula formation, or infection.ConclusionsTRA is a feasible and low-risk alternative for endovascular intervention in the trauma patient. It yields good technical success with low morbidity. Although larger studies are needed to establish the full efficacy of TRA at the multi-institutional level, this single-institution study demonstrates the legitimacy of an alternative means for endovascular intervention in the trauma patient.     

Viabahn覆膜支架植入术急诊治疗医源性髂股动脉破裂出血

目的观察Viabahn覆膜支架急诊治疗医源性髂股动脉损伤的安全性和有效性。方法回顾性分析7例接受Viabahn覆膜支架急诊治疗的医源性髂股动脉损伤患者,统计技术成功率、手术时间、治疗效果及并发症。结果 7例各均成功植入1枚Viabahn支架,技术成功率100%(7/7)。手术时间30～55 min,平均(34.36±9.13)min。术后出血均停止。随访1个月,病情均稳定。术中及术后1个月内均未出现腔内治疗并发症(穿刺点血肿、动脉及支架内血栓形成、内瘘或支架移位等)。结论采用Viabahn覆膜支架腔内修复治疗医源性髂股动脉破裂出血安全有效。     

医源性肾动脉损伤性出血的介入诊疗

目的探讨超选择性动脉造影与栓塞治疗医源性肾动脉损伤性出血的临床价值。方法对11例肾穿刺活检或经皮肾镜取石术后大量肉眼血尿患者实施超选择性肾动脉造影与栓塞术,栓塞材料采用明胶海绵与弹簧圈。结果 11例中,假性动脉瘤2例,动-静脉瘘2例,假性动脉瘤合并动静脉瘘5例,动脉-肾盏瘘2例;损伤血管为肾脏后段、下段动脉及其叶间动脉分支,单支血管损伤10例,多支血管损伤1例。单纯采用明胶海绵栓塞4例,单纯采用弹簧圈栓塞4例,二者联合栓塞3例,其中1例为明胶海绵栓塞24h后复发尿血改用弹簧圈栓塞。栓塞后10min造影示出血征象消失,1~3天后患者血尿逐渐消失,未发生严重并发症。结论动静脉瘘为医源性肾动脉损伤的主要表现,以单发病变多见;超选择性动肾脉造影可迅速明确诊断,超选择性肾动脉栓塞微创、安全、有效,应作为治疗医源性肾动脉损伤性出血的首选方法。     

Histoacryl®组织胶超选择性栓塞肾动脉分支治疗医源性肾动脉出血

目的 观察以Histoacryl^®组织胶作为栓塞剂超选择性栓塞肾动脉分支治疗医源性肾动脉出血的效果。方法 回顾性分析52例医源性肾动脉出血患者,其中30例为经皮肾镜术后、15例为经皮肾穿刺活检术后、7例为部分肾切除术后;均接受数字减影血管造影（DSA）引导下超选择性栓塞患肾责任分支动脉,栓塞剂为Histoacryl^®组织胶。评价技术成功率、临床成功率、并发症及操作时间,比较栓塞前、后血红蛋白（Hb）、肌酐（Cr）和尿素氮（BUN）。结果 对52例均顺利完成治疗,平均操作时间（38.23±11.51） min,技术成功率、临床成功率均为100%。术前2 h与术后12 h内Hb、Cr及BUN差异均无统计学意义（P均>0.05）。术后4例（4/52,7.69%）出现轻微并发症（发热伴局部腰痛）,经对症及支持治疗后恢复;无肾脓肿、败血症、肾破裂等严重并发症发生。结论 以Histoacryl^®组织胶作为栓塞剂超选择性栓塞肾动脉分支治疗医源性肾动脉出血安全、有效。     

Cardiac Intervention Before Liver Transplantation

BackgroundCardiovascular complication is one of the leading causes of mortality after liver transplantation (LT). Thus, a thorough cardiac evaluation is a must before proceeding to a liver transplant surgery. Percutaneous coronary intervention (PCI) with stent and to a lesser extent coronary artery bypass grafting (CABG) are both valuable treatment options for patients with coronary artery disease.MethodsA retrospective, single-center study that included patients who underwent cardiac intervention and subsequent LT for end-stage liver disease. All patients who had PCI or CABG were included in the study.ResultsTwenty-nine adult patients out of 51 had a cardiac intervention before liver transplantation. Twenty-four patients had a diagnostic PCI, 3 patients had therapeutic PCI with stent, and 2 had failed PCI and proceeded to CABG before liver transplant. The mean age of the patients was 60.5 years. There were 24 men. All patients had cirrhosis. The 2 CABG cases were done during the same admission with a 13- and 18-day interval between the CABG and the transplantation. Both cases were live-related liver transplantation. No mortality was reported.ConclusionIn case of PCI failure, CABG may be a valuable and safe treatment option for cirrhotic patients as a preparation for liver transplantation. Live donor liver transplantation may be a good back-up for those patients in case they develop hepatic decompensation.     

Survival difference between coronary bypass surgery and percutaneous coronary intervention

Abstract

Objectives. To assess whether the previously observed lower death rate with coronary artery bypass surgery compared with percutaneous coronary intervention in subsets of patients with coronary artery disease persists in more recent years. Design. Retrospective study from Feiring Heart Clinic database of survival in 17739 patients followed for 5 years after coronary revascularization. The cohorts treated in 1999–2005 and 2006–2011 were compared using Cox regression and propensity score analyses. Results. Cox regression and propensity score analyses revealed no difference in survival in either time period in one- and two-vessel diseases. In three-vessel disease, the hazard ratios between bypass surgery and percutaneous intervention were 0.62 (95% confidence interval [CI]: 0.53–0.71, p <0.001) and 0.59 (95% CI: 0.47–0.73, p < 0.001), respectively, in the two time periods, indicating persistent higher survival with bypass surgery. Conclusions. The previously observed lower death rate of coronary artery bypass surgery compared with percutaneous intervention in patients with three-vessel disease is persistent in more recent years and indicates that bypass surgery still should be the standard treatment for these patients.