应用5F引导导管经桡动脉行冠状动脉介入治疗

目的 评价应用5F引导导管经桡动脉行冠状动脉(冠脉)介入治疗(PCI)的可行性、安全性及优越性，探讨其应用策略。方法 应用5F引导导管经桡动脉对120例患者的166处病变进行PCI，桡动脉穿刺成功后动脉鞘内注入维拉帕米5mg，根据造影显示冠脉起始段和病变近端的情况选择合适引导导管，按常规进行PCI操作；术后立刻拔出鞘管，加压包扎穿刺处，4h后解除加压包扎；术后仅限制患者穿刺侧上肢活动。结果 右冠脉(RC)病变43例中有67．4％应用Judkins RC导管(JR)，32．6％应用Amplatz导管。92例患者的121处左冠脉(LC)病变，66．3％应用Judkins LC导管，18．5％应用EBU导管，15．2％应用Amplatz LC导管。2例静脉旁路病变均应用JR。PCI成功率97％；5处(3％)仅行经皮冠脉成形术未成功；并发症仅有1例(0．8％)桡动脉闭塞，但不影响手部供血。结论 应用5F引导导管经桡动脉行PCI具有可行性，由于导管细软，大大降低冠脉和穿刺部位的并发症，具有很高的安全性和优越性；但操作难度较大，需掌握导管的选用策略，以增加导管的支持力和同轴性，提高成功率。

Using 5 French guiding catheters trans radial in percutaneous coronary intervention

Objective To evaluate the feasibility ,safety and advantage of using 5 French guiding catheters trans radial in percutaneous coronary intervention(PCI), to explore the strategy for choice of guiding catheter curves Methods One hundred and sixty-six lesions of 120 patients were treated with PCI using 5 French guiding catheters trans radial After radial artery cannulation an intraarterial injection of Verapamil 5 mg was given to reduce spasm Select suitable guiding catheters for PCI The arterial sheath was removed immediatly after PCI , followed by application of a pressure bandage for 4 hours when the patient was demanded immobilizing the upper limb Results Only Medtronic 5F guiding catheters were used in this study Right Judkins catheter (JR) was used in 67 4%,left Amplatz catheter (AL) in 23 3% and right Amplatz catheter in 9 3% for 43 right coronary lesions Left Judkins catheter (JL) was used in 66 3%, EBU catheter in 18 5% and AL in 15 2% for 121 left coronary lesions in 92 patients; JR in 2 cases of saphenous vein grafts was used Among 166 lesions, 119 lesions were directly stented, and 42 lesions were dilated with balloon and then stented The successful rate of PCI was 97% Five lesions (3%) were only dilated with balloon and ended in failure The complication of vascular access site occurred only in one patient, which was occlusion of arterial radial but without ischemia of hand Conclusions The use of 5 French guiding catheters in PCI was both feasible and safe with a very low risk of coronary and access site complications However it is necessary to know well the strategy for choice of guiding catheter curves in order to obtain an easier and safer operation