经肘正中静脉分侧肾上腺静脉采血术操作流程改良的效果  

The effect of improved operation procedure of sequential adrenal venous sampling via median cubital vein

作　　者：何德化[1] 林开敏[1] 张紫冠[1] 邓琴升 陈紫凡 谢强[1] 李卫华[1] 黄峥嵘[1] HE De-hua;LIN Kai-min;ZHANG Zi-guan;DENG Qin-sheng;CHEN Zi-fan;XIE Qiang;LI Wei-hua;HUANG Zheng-rong(Cardiovascular Department,The First Affiliated Hospital of Xiamen University,Xiamen Institute ofCardiovascular Diseases,Xiamen Prevention and Control Center of Hypertension,Xiamen Quality Control Center of Hypertension,Xiamen Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院心内科,厦门市心血管病研究所,厦门市高血压防治中心,厦门市高血压质控中心,福建厦门361003

出　　处：《中华高血压杂志》2020年第6期539-543,共5页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81870183,81670224);福建省医学创新课题(2017-CXB-14)。

摘　　要：目的探索经肘正中静脉分侧肾上腺静脉采血术(AVS)操作流程改良方案的效果。方法选择2019年2-7月的54例AVS作为对照组,2019年8-12月的66例AVS作为改良组。对照组采用传统的AVS操作流程(双导管策略):先用MPA1导管采集右肾上腺静脉血(如失败,换用Tig导管),再换用Tig导管采集左肾上腺静脉血,最后用Tig导管采集下腔静脉血。改良组采用改良的AVS操作流程(优先单导管策略):先用Tig导管采集下腔静脉血,再直接后撤Tig导管至左肾上腺静脉采血,最后反转Tig导管至右肾上腺静脉采血(如失败,换用MPA1导管)。比较两组患者的导管到位率情况、手术操作时间、放射量、造影剂用量以及导管费用。结果与对照组比较,改良组的左右侧导管到位率[98.5%(65/66)比100%(54/54)、86.4%(57/66)比87.0%(47/54)]的差异无统计学意义(均P>0.05)。与对照组比较,改良组的手术操作时间[(11.4±3.5)比(17.8±4.6)min]明显缩短,放射量[(10.3±3.2)比(15.4±4.9)mGy]明显降低,造影剂用量[(10.9±3.7)比(17.6±4.8)mL]更少,且导管费用[(260.6±84.6)比(331.0±0)元]更节省(均P<0.05)。结论改良后的AVS操作流程操作时间更短,放射量更低,造影剂用量更少,费用也更节省,值得推广。Objective To investigate the effect of improved operation procedure of sequential adrenal venous sampling(AVS).Methods A total of 54 cases of AVS from February 2019 to July 2019 were selected as the control group,and 66 cases of AVS from August 2019 to December 2019 were used as the improved group.The control group used the traditional AVS procedure(dual-catheter strategy):MPA1 catheter was first used to collect right adrenal venous blood(if failed,replaced with Tig catheter),and then Tig catheter was used to collect left adrenal venous and inferior vena cava blood in order.The improved group adopted an improved AVS procedure(priority single catheter strategy):Tig catheter was first used to collect inferior vena cava blood,then it continued to be used directly to collect left adrenal venous blood,and finally it was inverted to collect right adrenal venous blood(if failed,replaced with MPA1 catheter).The catheter placement rate,operation time,radiation dose,contrast agent consumption and catheter cost were compared between the two groups.Results Compared with the control group,the placement rates of left and right side catheter in the improved group[98.5%(65/66)vs 100%(54/54)and 86.4%(57/66)vs 87.0%(47/54)]were not significantly different(P>0.05).However,compared with the control group,the operation time[(11.4±3.5)vs(17.8±4.6)min]was significantly shortened,the radiation dose[(10.3±3.2)vs(15.4±4.9)mGy]was significantly reduced,the amount of contrast agent[(10.9±3.7)vs(17.6±4.8)mL]was less,and the catheter cost[(260.6±84.6)vs(331.0±0)yuan]was more saved(all P<0.05)in the improved group.Conclusion The improved AVS operation process has shorter operation time,lower radiation dose,less contrast agent consumption and more cost savings,which is worth promoting.

关 键 词：肾上腺静脉采血术 高血压 继发性高血压 操作流程改良 

分 类 号：R586.24[医药卫生—内分泌]