经桡动脉介入时桡动脉痉挛的危险因素研究  

Clinical study of risk factors for radial artery spasm during transradial coronary catheterization

作　　者：陈艺[1] 周玉杰[2] 贾德安[2] 李月平[2] 成万钧[2] 聂斌[2] 

机构地区：[1]南京军区福州总医院心内科,福州350025 [2]首都医科大学附属北京安贞医院心内科

出　　处：《中华老年心脑血管病杂志》2010年第3期219-222,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察经桡动脉介入时,引起桡动脉痉挛的危险因素及临床预后,尤其是与桡动脉闭塞的关系。方法选择择期行经桡动脉冠状动脉造影或介入治疗的患者1427例。术前行双侧桡动脉超声检查。术后1个月随访患者预后情况。根据患者是否发生桡动脉痉挛分为桡动脉痉挛组(112例)和非桡动脉痉挛组(1315例),比较2组术前、术中和术后的差异。结果 112例(7.8%)患者发生桡动脉痉挛。logistic回归分析显示,桡动脉痉挛的独立预测因素为女性、桡动脉直径、糖尿病、反复穿刺和桡动脉变异。术后1个月有1361例患者完成了随访(失访率4.6%),较多桡动脉痉挛患者存在持续前臂中重度疼痛(16.1% vs 6.8%,P=0.001)。结论桡动脉痉挛主要是由桡动脉细小、变异和术中反复穿刺导致。桡动脉痉挛常合并持续前臂疼痛,但并不增加桡动脉闭塞发生率。Objectives To identify the risk factors for radial artery spasm and to analyze the clinical prognosis of spasm and its relation to radial artery patency during follow-up. Methods The study included 1427 patients who underwent transradial coronary angiography or intervention. All the variables associated with radial artery spasm,clinical characteristics of the patients and factors related to the procedure were analyzed. All the patients enrolled in the study were asked to return after 1 month of the procedure for assessment of the radial access,including the presence of pain, hematoma and patency. According to whether they had experienced radial artery spasm, the patients were divided into 2 groups. Radial artery spasm was assessed on the basis of radial artery angiography and a questionnaire that reflected the presence of pain and the technical difficulty of the procedure. Results Radial artery spasm was reported by 112 patients（7.8%）. Multivariate analysis showed that the independent predicting factors for radial artery spasm were radial artery anatomical anomalies, female, diabetes mellitus, radial artery diameter and repeated puncture. 1361 patients（95.4%） returned for a follow-up visit 30＋3 days after the performance of the procedure. Moderate to severe pain in the forearm was more frequent in patients who had radial artery spasm than in those without radial artery spasm（16.1% vs 6.8%, P = 0.001）. Conclusions Radia dia artery spasm during transradial coronary angiography and intervention mainly depends on raartery characteristics and procedural variables. At follow-up, radial artery spasm is associated moderate to severe pain in the forearm, but the radial artery occlusion rate does not increase.

关 键 词：桡动脉 动脉闭塞性疾病 放射摄影术 介入性 危险因素 冠状血管造影术 预后 

分 类 号：R543[医药卫生—心血管疾病]