经桡动脉途径开展门诊冠状动脉造影的可行性与安全性

目的 评价门诊经桡动脉途径开展冠状动脉造影的可行性与安全性.方法 选择2007年2月至6月在首都医科大学附属北京安贞医院门诊就诊的患者100例作为试验组,另选取同期住院接受冠状动脉造影检查的患者100例作为对照组.主要观察指标包括:造影成功率、不同直径造影导管使用率、术中不良事件(包括死亡,恶性心律失常,急性心肌梗死,冠状动脉痉挛、夹层、穿孔和闭塞)及术后不良事件(包括死亡,急性心肌梗死,患侧上肢血肿、假性动脉瘤、骨筋膜室综合征和桡动脉闭塞)等.结果 门诊经桡动脉冠状动脉造影的成功率为100%.与对照组比较,试验组造影时间[(12.5±3.4)min比(10.8±3.6)min,P=0.517]及X线透视时间[(4.3±1.0)min比(4.1±1.0)min,P=0.629]差异无统计学意义.两组术中均观察到桡动脉痉挛和冠状动脉痉挛,术后均观察到血肿,两组的差异均无统计学意义,无其他不良事件.试验组总医疗费用较对照组显著降低[(4m2±238)元比(5329±371)元,P<0.001],节省的费用主要包括造影前后的检查费用、药物治疗费、床位费、护理费及其他费用.结论 在病情相对平稳的患者中开展门诊经桡动脉冠状动脉造影检查安全、可行,同时能够大幅节省医疗费用,缩短住院时间.

Safety and feasibility of transradial coronary angiography at the outpatient clinic

Objective To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic. Methods From February 2007 to June 2007, 100 outpatients who received transradial coronary angiography in Anzhen hospital were included in this analysis, 100 inpatients underwent coronary angiography were selected as control group. Primary endpoints included success rate, percent of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.). Results The success rate (100% vs. 100%), procedure duration time [(12.5±3.4) min vs. (10.8±3.6) min, P=0.517] and exposition time [(4.3±1.0) min vs. (4.1±1.0) min, P=0.629] were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. The total cost of the outpatient group was significantly lower than the inpatient control group [(4012±238) yuan vs. (5329±371) yuan, P<0.001]. Expenditure including chemical tests, medicine, nursing care, room and board all decreased significantly. Conclusion Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.