CAJ | 학술논문

目的对经桡动脉途径行冠状动脉介入诊疗中发生纵隔和颈部血肿并发症病例进行分析,提高临床医师对该并发症的认识.方法 2005年1月1日至2012年12月31日,在阜外心血管医院冠心病诊疗中心和介入中心经桡动脉途径冠状动脉造影和介入治疗中有病历记录的发生纵隔、颈部血肿的患者共8例,1例患者单纯行冠状动脉造影,另外7例患者行冠状动脉介入治疗,其中6例患者置入药物洗脱支架.对这些患者的临床资料进行回顾性分析.结果所有患者术中均使用有亲水涂层的泥鳅超滑导丝.术后临床表现包括胸痛、胸闷、颈部或咽部紧缩感.胸颈部CT证实,8例患者均有纵隔血肿,其中4例患者合并颈部血肿,2例患者发现可疑右锁骨下动脉或无名动脉分支血管破口.患者术后血红蛋白均明显下降.2例患者术后完全停用抗血小板药物至出院,4例患者双联抗血小板治疗药物减量或暂停,2例患者使用鱼精蛋白中和术中肝素,无患者进行输血.所有置入支架的患者均未发生急性或亚急性支架内血栓形成,无患者进行外科手术.8例患者住院期间以及远期随访预后均良好.结论经桡动脉途径行冠状动脉介入诊疗中并发纵隔和颈部血肿罕见,与操作过程中超滑导丝或导管误入分支小血管造成损伤有关;尽早进行胸颈部增强CT扫描有助于及早诊断和处理纵隔和颈部血肿.
목적 대경뇨동맥도경행관상동맥개입진료중발생종격화경부혈종병발증병례진행분석,제고림상의사대해병발증적인식.방법 2005년1월1일지2012년12월31일,재부외심혈관의원관심병진료중심화개입중심경뇨동맥도경관상동맥조영화개입치료중유병력기록적발생종격、경부혈종적환자공8례,1례환자단순행관상동맥조영,령외7례환자행관상동맥개입치료,기중6례환자치입약물세탈지가.대저사환자적림상자료진행회고성분석.결과 소유환자술중균사용유친수도층적니추초활도사.술후림상표현포괄흉통、흉민、경부혹인부긴축감.흉경부CT증실,8례환자균유종격혈종,기중4례환자합병경부혈종,2례환자발현가의우쇄골하동맥혹무명동맥분지혈관파구.환자술후혈홍단백균명현하강.2례환자술후완전정용항혈소판약물지출원,4례환자쌍련항혈소판치료약물감량혹잠정,2례환자사용어정단백중화술중간소,무환자진행수혈.소유치입지가적환자균미발생급성혹아급성지가내혈전형성,무환자진행외과수술.8례환자주원기간이급원기수방예후균량호.결론 경뇨동맥도경행관상동맥개입진료중병발종격화경부혈종한견,여조작과정중초활도사혹도관오입분지소혈관조성손상유관;진조진행흉경부증강CT소묘유조우급조진단화처리종격화경부혈종.
Objective The clinical features of patients with mediastinal and/or neck hematoma after transradial cardiac catheterization were reviewed and analyzed to help the clinicians to recognize this complication,and try their best to avoid the complication and treat the complication properly.Methods A total of 8 patients with mediastinal and/or neck hematoma after right transradial cardiac catheterization in Fuwai hospital from January 1,2005 to the end of 2012 were included in this study.Among these 8 patients,1 patient underwent coronary angiography,7 patients underwent percutaneous coronary intervention and drug eluting stents were successfully implanted in 6 patients.The clinical data of these patients were analyzed retrospectively.Results Super slide hydrophilic guild-wire was used in all patients.These patients felt chest pain,dyspnea and neck pain and neck or throat tightness after the procedure.CT scan was performed in all 8 patients and reviewed mediastinal hematoma,4 patients complicated with neck hematoma,and suspicious laceration on the right subclavian artery or branch of innominate artery were found in 2 patients.Post procedure hemoglobin decrease was evidenced in all 8 patients.Anti-platelet therapy was discontinued until discharge in 2 patients,dual anti-platelet drugs were transiently discontinued or underwent dosage reduction in 4 patients,protamine was administered in 2 patients to neutralize heparin.Blood transfusion was not required,there was no stent thrombosis,and surgery was not indicated for all 8 patients.No complication was reported during follow up.Conclusions Mediastinal and/or neck hematoma is a rare complication post transradial catheterization approach.This complication is caused by super slide guild-wire or catheter's injury of small vessels near the aortic arch or subclavian artery,especially with rough manipulation.Neck and mediastinal CT scan should be performed as early as possible for patients with suspect hematoma and prognosis is usually fine with suitable therapy.