经桡动脉冠状动脉介入术前多普勒超声评价前臂动脉的临床价值研究

目的 探讨术前多普勒超声检查在经桡动脉冠状动脉介入治疗(TRI)准确选择前臂动脉中的价值.方法 连续入选择期行TRI患者1863例,随机分入术前前臂动脉多普勒超声检查组(超声组931例)和非多普勒超声检查组(对照组932例).研究主要终点包括手术操作成功率和血管并发症;次要终点包括前臂动脉内径、超声下入路解剖变异发生率及分型.结果 超声组术前超声检查发现右桡动脉入路解剖变异181例,术前13例更换入路,余168例患者造影证实解剖变异与超声结果吻合率达到92.9%(156/168).超声组介人手术成功率98.0%,对照组97.2%(P≥0.05),且两组在手术时间和对比剂用量方面上相似.超声组血管并发症发生率(8.7%)显著低于对照组(11.6%),P<0.05.单项事件分析显示超声组在动脉穿孔和桡动脉闭塞方面发生率较低(P=0.025和0.028).结论 经桡动脉冠状动脉介入诊疗前对前臂动脉行多普勒超声检查可以减少血管并发症的发生,有助于合理选择动脉入路和器械.

Value of Doppler ultrasound in examining forearm artery before transradial coronary intervention

Objective To explore the value of Doppler ultrasound in examining forearm artery before transradial coronary intervention（TRI）. Methods One thousand eight hundred and sixty-three consecutive patients undergoing elective TRI were screened, they were randomly divided into ultrasound group （931 cases） and convention group without ultrasound examination （932 cases ）. The primary endpoints included the procedural success rate and incidence of vascular related complications, the secondary endpoints were the average diameter of forearm artery and anatomic variations of approach. Results There were 181 cases of right forearm artery abnormility. The procedural success rate in ultrasound group and convention group was similar （98. 0% vs 97.2%, P〉0.05 ）. The incidence of vascular complications in ultrasound group was significantly lower than convention group （8.7% vs 11.6%, P〈0.05 ）. Regarding artery perforation and radial artery occlusion, the incidences of those in ultrasound group occurred less frequently （P = 0. 025 and 0. 028, respectively）. Conclusion Examination of forearm artery by Doppler ultrasound could not only detect anatomic variations and reduce vascular complication effectively, but it also be helpful to select suitable approach and instruments.