经桡动脉入路行脑血管造影后发生早期桡动脉闭塞危险因素分析  

Incidence and predictors of early radial artery occlusion associated transradial approach

作　　者：吴剑 蔡然泽 齐飚 李秋平 WU Jian;CAI Ranze;QI Biao;LI Qiuping(Department of Neurosurgury,Xiamen Branch,ZhongShan Hospital,Fudan University,Xiamen 361000,China)

机构地区：[1]复旦大学附属中山医院厦门医院神经外科,厦门361000 [2]复旦大学附属中山医院神经外科

出　　处：《中国神经精神疾病杂志》2024年第6期332-336,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：福建省科技厅自然科学基金面上项目(编号:2022J011429);厦门市科技计划指导性项目(编号:3502Z20214ZD1083)。

摘　　要：目的探索经桡动脉入路(transradial approach,TRA)行全脑血管造影(digital subtraction angiography,DSA)后发生早期桡动脉闭塞(radial artery occlusion,RAO)的危险因素。方法纳入2021年7月至2024年1月在复旦大学附属中山医院厦门医院接受TRA行DSA的患者,分为RAO组和非RAO组,收集患者的基本信息、桡动脉穿刺次数、预防桡动脉痉挛药剂中是否加入肝素等,分析及探讨其发生早期RAO的相关因素。结果一共543例患者纳入研究,术后24 h行上肢血管多普勒超声评估,其中RAO组32例,非RAO组511例。穿刺成功后未即刻鞘注预防桡动脉痉挛的药剂中加入肝素,桡动脉穿刺次数大于3次,使用11cm短鞘,使用Cordis裸钢针的患者,其RAO发生比率明显高于非RAO组(P<0.05)。多因素logistic分析显示,穿刺成功后即刻鞘注预防桡动脉痉挛的药剂中加入肝素(OR=0.076,95%CI:0.018~0.321,P<0.001)、桡动脉穿刺次数小于3次(OR=0.245,95%CI:0.111~0.541,P<0.001)、使用16cm长鞘(OR=0.195,95%CI:0.067~0.564,P=0.003)、使用泰尔茂套筒针(OR=0.325,95%CI:0.148~0.717,P=0.005),可以减少术后早期RAO发生。结论鞘内注射肝素抗凝,用套管针提高穿刺成功率,使用16 cm长鞘,能显著降低DSA后早期RAO发生率。Objective This study was to explore factors related to early radial artery occlusion(RAO)associated transradial approach(TRA).Methods Patients who underwent the TRA from July 2021 to Jan 2024 were included in our study.Patients were divided into radial artery occlusion group and non-radial artery occlusion group.The data of general demography,the number of radial artery punctures attempts,and whether add heparin to the Antispasmodic Agents were recorded to assess the incidence and predictors of RAO.Results A total of 543 patients were included in the study.All patients underwent ultrasound evaluation 24h after DSA.Among them,32 cases experienced RAO,while 511 cases did not experienced RAO.The occurrence rate of RAO was significantly higher in patients without addition of heparin to the antispasmodic agents for the prevention of radial artery spasm,those with more than 3 radial artery puncture attempts and those using either an 11 cm short sheath,or Cordis puncture needles(all P<0.05).Multiple logistic analysis showed that addition of heparin to the Antispasmodic Agents(OR=0.076,95%CI:0.018~0.321,P<0.001),less than 3 radial artery puncture attempts(OR=0.245,95%CI:0.111~0.541,P<0.001),using an 16 cm longer sheath(OR=0.195,95%CI:0.067~0.564,P=0.003),using an Terumo puncture needles(OR=0.325,95%CI:0.148~0.717,P=0.005)could reduce the incidence of RAO.Conclusions Anticoagulation with intrathecal heparin,application of trocar to improve the success rate of puncture,and the use of a 16 cm long sheath can significantly reduce the incidence of early RAO after DSA.

关 键 词：脑血管造影 经桡动脉入路 桡动脉闭塞 股动脉入路 桡动脉痉挛 

分 类 号：R651[医药卫生—外科学]