门诊患者使用4F导管经桡动脉行冠状动脉造影的安全性与可行性

摘要

目的:评价门诊患者使用4F造影导管,经桡动脉途径行冠状动脉造影的安全性与可行性.方法:入选2008年5月至2009年10月,于北京安贞医院门诊就诊拟行冠状动脉造影的患者966例,使用随机数字表随机分为门诊组和住院组.所有患者均应用4F Judkins造影导管完成冠状动脉造影.比较两组间造影成功率、手术时间、单导管完成率、离院时间、医疗费用以及术中和术后桡动脉并发症和不良心血管事件.结果:门诊组与住院组相比,造影成功率、手术时间、单导管完成率等方面差异均无统计学意义(P＞0.05),离院时间门诊组明显短于住院组[(7.62±0.98)vs.(41.67 ±7.00)h,P＜0.001],医疗费用门诊组显著低于住院组[(4 183.11±189.44)vs.(5 492.12±294.12)元,P＜0.001],主要为检查费、药费、护理费、床位费及住院诊疗费.两组患者桡动脉痉挛、桡动脉闭塞、穿刺处血肿等,差异均无统计学意义,无其他心血管不良事件.结论:经选择的病情稳定的门诊患者使用4F导管经桡动脉行冠状动脉造影术安全、可行,同时避免繁琐的住院手续,缩短离院时间,加强病房周转,节约医疗成本.%Objective;This study tested the safety and feasibility of transradial coronary angiography on an outpatient basis via 4F catheter. Methods: From May 2008 to October 2009,966 patients who received transradial coronary angiography in Anzhen hospital were randomized to either outpatient or inpatient groups using 4F catheter. The procedure success rate,duration of operation,percentage of procedures completed with single catheter, discharged time,cost-effectiveness,complication of radial,and adverse cardiovascular events during and after procedures between the two groups were compared. Results; No significant difference was observed between the outpatient and inpatient groups in the procedure success rate(P > 0. 05) , duration of operation, percentage of procedures completed with single catheter, radial artery spasm,radial artery occlusion and access-site haematoma. Discharged time was shorter in outpatient group than inpatient group [(7. 62+0. 98) vs.(41.67±7.00)h,P< 0. 001 ]. The cost-effectiveness was lower in outpatient group than inpatient group [ (4 183.11 ± 189.44) vs. ( 5 492. 12 ± 294. 12 ) yuan, P < 0. 001 ]. Expenditure including chemical tests, medicine, nursing care, room and board all decreased significantly. No adverse cardiovascular events during and after procedures occurred in both groups. Conclusion; Transradil coronary angiography on an selected outpatient via 4F catheter was safe and feasible. This procedure could provide early discharge and cost reduction and could expedite room turnover.