Blankenship J C, Telesford L A, Modesto T A
Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania, USA.
J Invasive Cardiol. 1994 Jun;6(5):186-93.
The aim of this study was to compare the ease and safety of intravascular sheaths versus guidewires for maintaining arterial access during cardiac catheterization.
Two hundred patients with normal coagulation status undergoing routine diagnostic cardiac catheterization were randomized to intravascular sheath access versus guidewire access groups. Procedure times and difficulties were recorded during the procedure. Patients were asked to evaluate groin discomfort immediately after the procedure and two weeks later. Complications including groin hematoma, vascular damage, and stroke were assessed at the end of the procedure and the following morning.
There were no differences between the sheath and guidewire groups in patient discomfort, procedural time or difficulty, or total complications. Hematomas occurred in 18% of patients (sheath 16% vs. guidewire 20%, p = NS) and were more often large in the guidewire group (5% vs. 0%, p = .05). None required vascular repair. Oozing around the catheter was more frequent in the guidewire group (6% vs. 0%, p = .03) but did not lead to any significant complications.
We conclude that using guidewires for arterial access during cardiac catheterization leads to more large hematomas and more access site oozing during the procedure. However, there were no differences in patient comfort, overall procedural difficulty, or total complications between sheath and guidewire techniques.
本研究旨在比较血管鞘与导丝在心脏导管插入术期间维持动脉通路的便捷性和安全性。
200例凝血状态正常且接受常规诊断性心脏导管插入术的患者被随机分为血管鞘通路组和导丝通路组。记录手术过程中的操作时间和难度。要求患者在术后即刻和两周后评估腹股沟不适情况。在手术结束时及次日早晨评估包括腹股沟血肿、血管损伤和中风在内的并发症。
鞘组和导丝组在患者不适、手术时间或难度以及总并发症方面无差异。18%的患者出现血肿（鞘组16%，导丝组20%，p=无显著性差异），导丝组大血肿更常见（5%对0%，p=0.05）。均无需血管修复。导丝组导管周围渗血更频繁（6%对0%，p=0.03），但未导致任何严重并发症。
我们得出结论，在心脏导管插入术期间使用导丝进行动脉通路操作会导致术中出现更多大血肿和更多穿刺部位渗血。然而，鞘技术和导丝技术在患者舒适度、总体手术难度或总并发症方面无差异。
