主动脉弓严重成角畸形时J型导丝经股动脉入路输送JL导管改良应用.doc

主动脉弓严重成角畸形时J型导丝经股动脉入路输送JL导管改良应用摘 要 目的：探讨175cm0.035inch J型导引钢丝（J型导丝）在主动脉弓严重成角畸形时经股动脉入路输送6F左Judkins导管（JL导管）头端到达主动脉根部的改良方法及其疗效。方法：43例主动脉弓严重成角畸形患者分别运用常规方法（21例）与改良方法（22例）操作J型导丝与JL导管，记录导管头端从主动脉弓到抵达主动脉根部的X线透视时间，观察每例造影中左主干夹层及造影后栓塞性并发症的发生。结果：改良方法成功率（100%）远高于常规方法（42.86%），差异具有显著性（P＜0.05）。改良方法成功者X线透视时间明显短于常规方法成功者，而栓塞性并发症并未增加。结论：在主动脉弓严重成角畸形患者，J型导丝经股动脉入路输送JL导管的改良方法值得在选择性冠状动脉造影检查中常规方法不易成功时应用。 关键词 175cm0.035inch J型导丝 左Judkins导管 主动脉弓严重成角畸形 股动脉入路 Abstract Obsjective：To research effect of clinical application of the modified method of 175cm 0.035inch J shape guide wire guiding the tip of left Judkins catheter to aortic root in the cases of grave angulation of aortic arch in selective coronary angiography from femoral artery approach.Methods：43 cases of grave angulation of aortic arch were allocated into the routine method group(21 cases) and the modified method group(22 cases) at random,and applied with the two methods respectively in selective coronary angiography.The time exposed to X rays and other parameters relative to embolism were observed or measured.Results：The achievement ratio of the routine method group was 42.86%,and that of the modified method group 100% with much shorter time exposed to X rays and the same risk to embolism as that of the routine method group.Conclusions：The modified method is worth applying in the cases of grave angulation of aortic arch in selective coronary angiography from femoral artery approach. Key words 175cm 0.035inch J shape guide wire；left Judkins catheter；grave angulation of aortic arch；femoral artery approach 资料与方法 研究对象：在经股动脉途径行选择性冠状动脉造影检查时发现的主动脉弓严重成角畸形患者。入选标准：操作熟练的介入医生按常规方法用J型导丝经股动脉入路引导JL导管头端到达升主动脉远段撤出导丝后，操作JL导管X线透视时间达10秒而不能成功抵达主动脉根部者。入选病例43例，男19例，女24例，平均74.9岁；其中33例为主动脉结严重向左突出；10例主动脉弓向右侧严重突出，以上均经推送J型导丝探查及经导管用力推注造影剂粗略显影证实。所有病例被随机分配至常规方法组（21例）和改良方法组（22例）。成功标准：JL导管头端到达主动脉瓣影像学位置附近（由J型导丝探寻获得，见改良方法），或JL导管头端抵达左冠状动脉开口。失败标准：JL导管头端到达升主动脉远段后，操作JL导管的X线透视时间达15分钟仍未成功者。 改良方法：首先操作J型导丝J形头端到达主动脉根部来回轻柔推送导丝探寻主动脉瓣影像学位置；到达主动脉瓣后进一步推送J型导丝有阻力，影像学上