冠状动脉导丝辅助房间隔穿刺与常规穿刺技术的随机对照研究  

Use of a coronary guidewire to facilitate transseptal puncture:a randomized comparison with a conventional technique

作　　者：梁卓[1] 刘丽凤 刘铮 王云龙[1] 刘小青 LIANG Zhuo;LIU Lifeng;LIU Zheng;WANG Yunlon;LIU Xiaoqing(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Anzhen Road,Chaoyang District,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029 [2]首都医科大学附属北京朝阳医院心脏中心

出　　处：《心肺血管病杂志》2023年第7期666-671,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然基金(82100335);中国博士后科学基金(2020M680610)。

摘　　要：目的:冠状动脉导丝辅助房间隔穿刺(transseptal puncture,TSP)与常规穿刺技术的安全有效的研究。方法:共入选TSP患者240例(其中228例心房颤动,12例左侧旁道),进行描述分析。将患者分为导丝组(Wire-TSP,n=120),TSP使用SWARZ鞘和Brockenbrough房间隔穿刺针,并且穿刺针内芯插入0.36mm冠状动脉导丝,穿刺针一旦穿过房间隔后可将冠状动脉导丝软端推入左心房(left atrium,LA),并送入左上肺静脉(left superior pulmonary vein,LSPV),证实针尖已进入LA。然后将扩张鞘和外鞘淹没针尖进入LA,将穿刺针和冠状动脉导丝交换为0.81mm的导丝,导丝送入LSPV。扩张鞘和外鞘通过0.81mm的导丝进入左心房。常规方法组(Con-TSP,n=120),使用标准TSP方法通过TSP在左心房注射造影剂确认针尖位置。结果:两组患者LAD无明显差异,均能够成功进行TSP建立了LA通道,且没有出现严重并发症。导丝组房间隔一次性穿刺成功率显著高于造影剂组(82.1%vs.75%,P<0.001),Wire-TSP组平均尝试1.2次(范围1~3),而Con-TSP组平均尝试1.9次(范围1~4)(P<0.05)。两组在房间隔膨出瘤比较,Wire-TSP组TSP操作时间明显缩短(30 vs.230s)结论:导丝组TSP方法安全且有较高的一次通过成功率,因此是常规TSP方法的一种备选方法。该方法尤其适用于房间隔膨出瘤及造影剂过敏的患者。Objective:Transseptal puncture(TSP)is routinely performed for left heart intervention,but it can sometimes be complex and life-threatening.This study introduced a safe and effective method to facilitate TSP for left atrial access.Methods:A total of 240 patients(228 with atrial fibrillation,12 with a left accessory pathway)were prospectively analyzed.In the guidewire group,TSP was performed using a SWARTZ sheath and a Brockenbrough needle with a 0.36mm coronary guidewire instead of an inner stylet.The needle tip position was confirmed by pushing the guidewire into the left superior pulmonary vein after initial puncture in 120 patients.In the contrast group,TSP was performed in 120 patients using standard devices by injecting contrast to confirm needle-tip position.Results:There was no significant difference in left atrial diameter(LA)between the two groups.Left atrial access was achieved successfully in all patients in the two groups without serious complications.The guidewire group showed a higher first-pass rate for left atrial access compared with the contrast group(82.1%vs.75%P<0.001,respectively).Wire-TSP group averaged 1.2 attempts(range 1-3)and Con-TSP group averaged 1.9 attempts(range 1-4)(P<0.05).In TSP subgroup,compared with Con-TSP group,the TSP operation time in wire-TSP group was significantly shortened(30 vs.230s).Conclusions:Coronary guidewire TSP is safe and is associated with a high success rate,and it is thus a useful alternative to conventional TSP.This method is useful for patients with septal aneurysms and contrast allergies.

关 键 词：房间隔穿刺 冠状动脉导丝 造影剂 心房颤动 消融 

分 类 号：R54[医药卫生—心血管疾病]