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題 名 | Transradial Approach for Diagnosis of Cardiovascular Disease in Taiwanese Patients: Catheter Selection, Feasibility, Complications and Application=經橈動脈途徑診斷國人之心臟血管疾病:探討導管選擇,手術成功率與併發症及臨床應用 |
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作 者 | 黃建銘; 楊茂勳; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 15:1 1999.01[民88.01] |
頁 次 | 頁9-16 |
分類號 | 415.3026 |
關鍵詞 | 經頸靜脈途徑; 經橈動脈途徑; 非缺血性心臟病; 臺灣人; Transradial catheterization; Transjugualr approach; Non-ischemic heart disease; Taiwanese patients; |
語 文 | 英文(English) |
中文摘要 | 背景:國外文獻已證實經橈動脈途徑比徑比經股動脈或肱動脈徑引起的手術併發症較低。國內探討經橈動脈途徑診斷心臟血管疾病的研究報告,並不多見;且同時併用經橈動脈途徑及經頸靜脈途徑,以診斷非缺血性心臟病之方法,尚無文獻記載。本研究之主要目的在比較國人之診斷性心導管檢查,選用經橈動脈途徑時的手術成功率及併發症之機率;其次也要評估以併用經橈動脈途徑及經頸靜脈途徑之方法,替代傳統之經股動脈,股靜脈或頸靜脈途徑以進行非缺血性心臟病診斷之安全性。 方法:本研究對象總計320人,平均年齡為62歲,男性佔229例,女性佔91例。其中206人(63.6%)為缺血性心臟病,114人為非缺血性心臟病。在所有病患診斷性冠狀動脈攝影均經由右橈動脈施行。而在非缺血性心臟病患,除經由右橈動脈施行左心導管術外,並經由右頸靜脈施行右心導管或心內膜切片檢查。 結果:在所有病患,以經橈動脈方式進行診斷性冠狀動脈造影術其成功率可達97.8%(313/320 ),女性之失敗率為5.5%(5/91),是男性的6倍。主要的併發症為:一例發生無症狀之橈動脈閉塞,一例發生疼痛引發迷失走神經反應的短暫性休克,一例發生前臂血腫;橈動脈途逕冠狀動脈造影術失敗有7例,其分別是:橈動脈過度狹小者有2例,另外鎖骨下動脈阻塞,無名動脈(innominate artery)過度彎曲,橈動脈變異,迷走神經反應以及過往之肱動脈切割術(cut-down)各有一案例。以單一心導管進行左及右冠狀動脈造影術,Multipurpose之成功率可達59%(107/181),Kimny可達62%(8/13)。經頸靜脈及橈動脈途徑一個階段的方式可成功的完成包括瓣膜性心臟病,心肌病變,換心病患等114名非缺血性心臟病病患之診斷,且僅有二案例發生頸動脈穿刺之併發症。 結論:國人的體型雖比西方人矮小,但以經橈動脈途徑檢查心臟血管疾病,不但成功率高而且併發症也很低,因此經橈動脈途徑是一種安全且有效的方法。值得注意的是,女性的失敗率會比較高。 單導管進行冠狀動脈檢查時,用 Multipurpose 或 Kimny 都有不錯的成功率,不但可以降低醫療成本也可以減低在更換導管時引發血管痙攣現象的發生。本研究也成功的將經頸靜脈及橈動脈途徑的技術,應用在診斷非缺血性心臟病病患,且效果良好。因此,這種方法應該可考慮做為替代傳統方式診斷非缺血性心臟病。 |
英文摘要 | Background: Transradial approach using relatively small-sized catheters has been reported to have a significant lower risk of complication than other routes at vascular puncture site. Most authors focus through the transradial route primarily on diagnosing ischemic heart disease. The purpose of this paper was firstly to evaluate the feasibility of coronary angiography through the right radial approach in Taiwanese patients, and secondly to evaluate the efficacy and complications of a modified method with both transradial and transjugular approaches to diagnose non-ischemic heart disease. Methods: Radial artery puncture for diagnostic angiography was performed in a series of 320 patients. Among them, 206 patients (63.6%) were with ischemic heart disease and 114 with non-ischemic heart disease. Transradial approach was used for coronary angiogram in all patients. In patients with non-ischemic heart disease, right heart catheterization was performed via right internal jugular vein. Results: The total success rate of coronary angiography via radial artery was 97.8% with a six-fold higher failure rate among Taiwanese females than males. Major complications included one patient with reduced radial pulsation due to radial arterial thrombosis, one with transient vasovagal shock and one who had large hematoma at forearm. Of the seven failures, two resulted from inability to advance the guide wire to the brachial artery because of small arterial lumens. The other causes of failure were tortuosity of innominate artery, subclavian arterial stenosis, malformation of radial artery, previous surgery (brachial arterial cut-down), and transient vasovagal shock due to transradial puncture. In selection of a single catheter for diagnostic coronary angiography, multipurpose (MP) or Kimny catheters had success rates of 59% (107 in 181) and 62% (8 in 13), respectively. When a MP catheter was used, right coronary angiography was successfully engaged in 172 (95%) of 181 cases. The average success rate with a MP catheter for both right and left coronary angiography as initial attempt was 77%. On the other hand, the combined method of transradial and transjugular approaches was safely and successfully performed in 114 patients for one-stage diagnosis of patients with nonischemic heart disease. There were two minor complications related to carotid artery puncture. Conclusion: Transradial approach is a feasible and safe method for diagnostic cardiac catheterization of Taiwanese patients. The modified technique used in this study is different from the conventional method and might be considered as an alternative method for diagnosis in patients with non-ischemic heart disease. |
本系統中英文摘要資訊取自各篇刊載內容。