Cordis和Terumo穿刺套在桡动脉穿刺中的对比研究

摘要

目的 比较Cordis和Terumo穿刺套在桡动脉穿刺中的优劣性.方法 选取2012年6月至2014年12月于北京市第六医院心内科拟行冠状动脉介入诊治患者214例,完全随机分为Terumo组(107例)和Cordis组(107例),Cordis组在钢针穿透前壁见血回喷后,送入导丝;Terumo组在钢针穿透前壁回血后,带鞘及针继续向前推进,然后开始回撤,当涌出动脉血时停止后撤,送入导丝.比较2组患者平均穿刺时间、一次成功率、穿刺失败率、误入夹层发生率、血肿发生率和术中桡动脉痉挛发生率.结果 Terumo组平均穿刺时间短于Cordis组[(281 ±115)s比(318±152)s],一次成功率高于Cordis组[76.6％ (82/107)比63.6％(68/107)],差异均有统计学意义(均P＜0.05).Terumo组穿刺成功101例,有6例穿刺失败,其中5例出现误入夹层,而Cordis组穿刺成功99例,有8例穿刺失败,其中1例出现误入夹层,2组总体穿刺失败率和误入夹层发生率比较,差异无统计学意义(P＞0.05);Terumo组术中桡动脉痉挛发生率低于Cordis组[1.0％(1/101)比7.1％ (7/99)],差异有统计学意义(P=0.038).2组患者住院期间均无血肿及桡动脉闭塞发生.结论 Terumo穿刺方法可以缩短穿刺时间,提高一次成功率,减少桡动脉痉挛发生率,但可能会增加导丝误入夹层风险.%Objective To compare the efficacy of Cordis and Terumo transradial sheath in radial artery puncture.Methods Two hundred and fourteen eligible patients undergoing coronary angiography examination from June 2012 to December 2014 were randomized into Terumo group (107 cases) and Cordis group (107 cases) group.In Cordis group,the guidewire was inserted after steel needle penetrated the front wall of radial artery and blood returned; in Terumo group,after steel needle penetrated the front wall of radial artery and blood returned,the sheath and the needle were pushed onward,then pulled out until the blood flew out,afterward the guidewire was inserted.The puncture duration,one-time success rate of puncture,failure rate of puncture,incidence of dissection,hematoma and radial artery spasm were compared between the two groups.Results The puncture duration in Terumo group was significantly shorter than that in Cordis group [(281 ± 115) s vs (318 ± 152) s] (P ＜ 0.05),the one-time success rate of puncture in Terumo group was significantly higher than that in Cordis group [76.6％ (82/107) vs 63.6％ (68/107)] (P ＜ 0.05).Totally 101 operations in Terumo group and 99 operations in Cordis group were successful; correspondingly,there were 6 failed cases in Terumo group and 8 failed cases in Cordis group,among them,5 in Terumo group and 1 in Cordis group experienced dissection,without significant difference regarding puncture failure rate between the two groups (P ＞ 0.05).lntraoperative spasm occurred in 1 patient in Terumo group and in 7 patients in Cordis group,with significant difference [1.0％ (1/101) vs 7.1％ (7/99)] (P =0.038).No hematoma and radial artery occlusion were observed in both groups.Conclusion Terumo technique shortens the puncture duration,improves the one-time success rate,and reduces the incidence of radial artery spasm,but increases the risk of dissection compared with Cordis technique.