国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
4期
289-292
,共4页
脑血管造影术%血管造影术,数字减影%桡动脉%痉挛%卒中%脑缺血
腦血管造影術%血管造影術,數字減影%橈動脈%痙攣%卒中%腦缺血
뇌혈관조영술%혈관조영술,수자감영%뇨동맥%경련%졸중%뇌결혈
Cerebral Angiography%Angiography,Digital Subtraction%Radial Artery%Spasm%Stroke%Brain Ischemia
目的 探讨缺血性脑血管病患者经桡动脉导管插入全脑数字减影血管造影术(digital subtraction angiography,DSA)时发生桡动脉痉挛(radial artery spasm,RAS)的危险因素及其预防处理办法.方法 纳入因缺血性脑血管病经桡动脉途径而行DSA的患者,收集临床资料、手术并发症和桡动脉痉挛,比较经桡动脉DSA时发生RAS与未发生RAS患者的资料,并采用多因素logistic回归分析经桡动脉DSA时发生RAS的危险因素.结果 共纳入100例经桡动脉DSA的缺血性脑血管病患者(缺血性卒中74例,短暂性脑缺血发作26例),其中21例(21％)出现RAS.在21例出现RAS的患者中,4例暂停操作并在痉挛缓解后完成DSA,另外17例鞘内给予鸡尾酒(肝素2500 U、硝酸甘油0.5 mg、维拉帕米1.25 mg)解痉后完成DSA.RAS组桡动脉直径[(1.89±0.28 mm对(2.12±0.17)mm;t=1.582,P=0.041]、操作持续时间[(12.3±3.1)min对(9.8±2.7)mm;t1.264,P=0.038]以及桡动脉直径＞2mm(9.52％对65.82％;x2=9.624,P=0.002)、桡动脉解剖学变异(23.81％对0.27％;x2=14.185,P＜ 0.001)、首次穿刺成功(42.86％对78.48％;x2=5.335,P=0.021)的患者比例与无RAS组存在显著性差异.多变量logistic回归分析显示,桡动脉解剖学变异[优势比(odds raio,OR)1.940,95％可信区间(confidence interval,CI)1.372～2.241;P=0.023]是发生RAS的独立危险因素,桡动脉直径＞2 mm(OR 0.752,95％ CI0.352 ～0.847;P=0.043)、首次穿刺成功(OR 0.843,95％ CI0.367～0.941;P=0.045)是RAS的独立保护因素.结论 RAS是经桡动脉DSA的常见并发症,反复穿刺、桡动脉直径以及桡动脉解剖学变异是其最主要的影响因素.
目的 探討缺血性腦血管病患者經橈動脈導管插入全腦數字減影血管造影術(digital subtraction angiography,DSA)時髮生橈動脈痙攣(radial artery spasm,RAS)的危險因素及其預防處理辦法.方法 納入因缺血性腦血管病經橈動脈途徑而行DSA的患者,收集臨床資料、手術併髮癥和橈動脈痙攣,比較經橈動脈DSA時髮生RAS與未髮生RAS患者的資料,併採用多因素logistic迴歸分析經橈動脈DSA時髮生RAS的危險因素.結果 共納入100例經橈動脈DSA的缺血性腦血管病患者(缺血性卒中74例,短暫性腦缺血髮作26例),其中21例(21％)齣現RAS.在21例齣現RAS的患者中,4例暫停操作併在痙攣緩解後完成DSA,另外17例鞘內給予鷄尾酒(肝素2500 U、硝痠甘油0.5 mg、維拉帕米1.25 mg)解痙後完成DSA.RAS組橈動脈直徑[(1.89±0.28 mm對(2.12±0.17)mm;t=1.582,P=0.041]、操作持續時間[(12.3±3.1)min對(9.8±2.7)mm;t1.264,P=0.038]以及橈動脈直徑＞2mm(9.52％對65.82％;x2=9.624,P=0.002)、橈動脈解剖學變異(23.81％對0.27％;x2=14.185,P＜ 0.001)、首次穿刺成功(42.86％對78.48％;x2=5.335,P=0.021)的患者比例與無RAS組存在顯著性差異.多變量logistic迴歸分析顯示,橈動脈解剖學變異[優勢比(odds raio,OR)1.940,95％可信區間(confidence interval,CI)1.372～2.241;P=0.023]是髮生RAS的獨立危險因素,橈動脈直徑＞2 mm(OR 0.752,95％ CI0.352 ～0.847;P=0.043)、首次穿刺成功(OR 0.843,95％ CI0.367～0.941;P=0.045)是RAS的獨立保護因素.結論 RAS是經橈動脈DSA的常見併髮癥,反複穿刺、橈動脈直徑以及橈動脈解剖學變異是其最主要的影響因素.
목적 탐토결혈성뇌혈관병환자경뇨동맥도관삽입전뇌수자감영혈관조영술(digital subtraction angiography,DSA)시발생뇨동맥경련(radial artery spasm,RAS)적위험인소급기예방처리판법.방법 납입인결혈성뇌혈관병경뇨동맥도경이행DSA적환자,수집림상자료、수술병발증화뇨동맥경련,비교경뇨동맥DSA시발생RAS여미발생RAS환자적자료,병채용다인소logistic회귀분석경뇨동맥DSA시발생RAS적위험인소.결과 공납입100례경뇨동맥DSA적결혈성뇌혈관병환자(결혈성졸중74례,단잠성뇌결혈발작26례),기중21례(21％)출현RAS.재21례출현RAS적환자중,4례잠정조작병재경련완해후완성DSA,령외17례초내급여계미주(간소2500 U、초산감유0.5 mg、유랍파미1.25 mg)해경후완성DSA.RAS조뇨동맥직경[(1.89±0.28 mm대(2.12±0.17)mm;t=1.582,P=0.041]、조작지속시간[(12.3±3.1)min대(9.8±2.7)mm;t1.264,P=0.038]이급뇨동맥직경＞2mm(9.52％대65.82％;x2=9.624,P=0.002)、뇨동맥해부학변이(23.81％대0.27％;x2=14.185,P＜ 0.001)、수차천자성공(42.86％대78.48％;x2=5.335,P=0.021)적환자비례여무RAS조존재현저성차이.다변량logistic회귀분석현시,뇨동맥해부학변이[우세비(odds raio,OR)1.940,95％가신구간(confidence interval,CI)1.372～2.241;P=0.023]시발생RAS적독립위험인소,뇨동맥직경＞2 mm(OR 0.752,95％ CI0.352 ～0.847;P=0.043)、수차천자성공(OR 0.843,95％ CI0.367～0.941;P=0.045)시RAS적독립보호인소.결론 RAS시경뇨동맥DSA적상견병발증,반복천자、뇨동맥직경이급뇨동맥해부학변이시기최주요적영향인소.
Objective To investigate the risk factors and their prevention and treatment approaches for occurring radial artery spasm (RAS) during the brain digital subtraction angiography (DSA) with transradial catheterization in patients with ischemic cerebrovascular disease.Methods The patients who underwent DSA of transradial approach because of ischemic cerebrovascular disease were enrolled.Their clinical data,surgical complications,and radial artery spasm were collected.The data of occurring RAS or not during DSA of transradial approach in patients were compared.Multivariate logistic regression analysis was used to analyze the risk factors for occurring RAS during DSA of transradial approach.Results A total of 100 patients with ischemic cerebrovascular disease who underwent DSA of transradial approach (74 ischemic stroke,26 transient ischemic attack) were enrolled,of which 21 (21％) had RAS.Of the 21 patients with RAS,4 suspended their operations and completed their DSA after spasm relief; another 17 were treated with intrathecal cocktail (heparin 2500 U,nitroglycerin 0.5 mg,verapamil 1.25 mg) and completed their DSA after spasm relief.There were significant differences in the proportions of radial artery diameter (1.89 ±0.28 mm vs.2.12 ± 0.17 mm; t =1.582,P =0.041),duration of operation (12.3 ± 3.1 min vs.9.8 ±2.7 min; t =1.264,P =0.038),and radial artery diameter ＞2 mm (9.52％ vs.65.82％ ;x2 =9.624,P =0.002),radial artery anatomy variation (23.81％ vs.0.27％; x2 =14.185,P＜ 0.001),and the first successful puncture (42.86％ vs.78.48 ％ ;x2 =5.335,P =0.021) in patients between RAS group and the non-RAS group.Multivariate logistic regression analysis showed that the radial artery anatomy variation (odds ratio [OR] 1.940,95 ％ confidence interval [CI] 1.372-2.241; P=0.023) was an independent risk factor for the occurrence of RAS.Radial artery diameter ＞2 mm (OR 0.752,95％ CI 0.352-0.847;P=0.043) and the first successful puncture (OR 0.843,95％ CI 0.367-0.941; P=0.045) were the independent protective factors for RAS.Conclusions RAS is a common complication of DSA of transradial approach.Repeated puncture,radial artery diameter,and radial artery anatomy variation are its most important influencing factors.
