经肘静脉与股静脉路径行肾上腺静脉取血的比较研究.docVIP

2017年第4期专刊 “心血管新技术”约稿 经肘静脉与股静脉路径行肾上腺静脉取血的比较研究 刘洁1,2，曲曼古丽.阿布力孜1,3，许建忠1，唐晓峰1，朱理敏1，张瑾1，钟久昌1，高平进1，王继光1 1上海市高血压研究所，上海交通大学医学院附属瑞金医院高血压科 2 中国人民解放军第101医院 3 新疆医科大学附属中医医院 摘要 目的 比较初学者经肘静脉与经股静脉路径行分侧肾上腺静脉取血（AVS）的成功率及安全性。方法 2014年8月-2015年11月由一个初学者对连续65例原发性醛固酮增多症患者行AVS以明确分型，其中15例经传统经典的股静脉路径，50例经肘静脉路径。比较两者的取血成功率、X线曝光时间、造影剂用量等。结果 右肾上腺静脉：经肘静脉路径50例，使用5F MPA1导管插管，成功率为94.0%；经股静脉路径15例患者，使用SIM1导管插管，成功率仅为66.7%，两者有统计学差异（p=0.013）；左侧肾上腺静脉：经肘静脉使用5F TIG导管插入，经股静脉路径使用SIM2导管，均有1例失败 (98.0% vs 93.3%, p=0.411)，无统计学差异。术中平均导管操作时间、X线曝光时间、造影剂用量，两者之间无统计学差异。1例经肘静脉AVS患者发生右侧肾上腺血肿，经股静脉无手术并发症。结论 本研究表明经肘静脉路径行AVS安全，可行；与经股静脉路径相比，其右侧取血成功率较高，更适合在初学者中开展，可作为经股静脉路径的替代。 关键词: 肾上腺静脉取血；肘静脉路径；股静脉路径，原发性醛固酮增多症 Comparison of via forearm and femoral vein access for adrenal venous samplings LIU Jie，ABLIZ Qimangul, XU Jian-zhong, TANG Xiao-fen, ZHU Li-min，ZHANG Jin, ZHONG Jiu-chang, GAO Ping-jin, WANG Ji-guang *Shanghai Institute of Hypertension, Shanghai Jiaotong University school of medicine, Ruijin hospital, Shanghai 200025 Abstract: Objective The purpose of this study was to compare the forearm access with femoral access for adrenal vein sampling (AVS). Methods From August 2014 to December 2015, 65 consecutive patients diagnosed with primary aldosteronism (PA) underwent AVS by one beginner. Fifteen patients underwent AVS via forearm and 50 patients via femoral access. The catheters of bilateral adrenal vein cannulations were recorded, the success rate of bilateral adrenal sampling, operation time, fluoroscopy time, dosage of contrast and incidence of complications were calculated. Results Adrenal venous sampling was technically successful in 47 (94%) patients on the right side via forearm access and 49 (98%) patients on the left side. The rate of successful adrenal sampling via femoral vein access on right and left was 66.7% (10/15), and 93.3%(14/15) respectively. The mean time of operation, mean fluoroscopy time and the mean use of contrast had no significant between two groups. The incidence of adrenal hematoma was 2.0% (1/