Tizón-Marcos Helena, Barbeau Gerald R
Department of Cardiology, Institut de Cardiologie de Québec, Hôpital Laval, Québec, Canada.
J Interv Cardiol. 2008 Oct;21(5):380-4. doi: 10.1111/j.1540-8183.2008.00361.x. Epub 2008 Jun 3.
Despite the fact that transradial approach is widely used, literature on this devastating complication after transradial approach is scarce. Pubmed review from 1992 to 2007 includes only 5 isolated reports. In one small series with 250 patients, an incidence of 0.4% is suggested.
We conducted a retrospective review of the transradial cases in Laval Hospital from 1994 to September 2007 (51,296 procedures) to know the incidence of compartment syndrome of the arm (CSA) and compare it with the literature.
In our institution CSA occurred in 2 of the 51,296 transradial procedures (0.004%). Both of them were in female patients with low BSA (1.7 and 1.5 m(2)) who received either an excess of unfractioned heparin during the procedure or uncorrected low-molecular-weight heparin after the procedure. Both of them underwent fasciotomy of the forearm. Recovery was complete in one patient. The other patient required skin graft and developed a partial Volkmann contracture at follow-up. This low incidence is due to a high index of suspicion when swelling or pain in the arm used for the procedure is noted and to the immediate application of a specific protocol. This protocol initiated by the nursing personnel consists of inflation of a tensiometer cuff at the point of pain or swelling. Cuff is inflated during at least 15 minutes up to 10-15 mmHg below the systolic pressure to allow distal pulsatile flow to the hand or forearm (monitored with oxymetry/plethismography) so the bleeding stops and diffuses to decrease the pressure within the forearm. Usually, two periods of 15 min of inflation are required to control bleeding.
Incidence of CSA is very low at our institution. A high suspicion with any complaint of pain and swelling in the arm and a proper management of anticoagulation especially in the postprocedure period with great emphasis in patients with low BSA or low creatinine clearance are the key points. Implantation of an immediate specific nursing protocol is required.
尽管经桡动脉途径已被广泛应用，但关于经桡动脉途径后出现这种严重并发症的文献却很稀少。1992年至2007年的PubMed综述仅包含5篇独立报道。在一个250例患者的小样本系列中，提示发生率为0.4%。
我们对1994年至2007年9月拉瓦尔医院的经桡动脉病例（51296例手术）进行了回顾性研究，以了解手臂骨筋膜室综合征（CSA）的发生率，并与文献进行比较。
在我们机构，51296例经桡动脉手术中有2例发生CSA（0.004%）。这两例均为体表面积较低（分别为1.7和1.5 m²）的女性患者，她们在手术过程中接受了过量的普通肝素，或在术后未纠正低分子量肝素。两人均接受了前臂筋膜切开术。其中一名患者完全康复。另一名患者需要植皮，随访时出现了部分Volkmann挛缩。这种低发生率归因于当注意到手术侧手臂肿胀或疼痛时高度的怀疑指数，以及立即应用特定方案。该方案由护理人员启动，包括在疼痛或肿胀部位使用张力计袖带充气。袖带充气至少15分钟，压力比收缩压低10 - 15 mmHg，以允许手部或前臂有远端搏动性血流（通过血氧饱和度测定/体积描记法监测），从而使出血停止并扩散以降低前臂内压力。通常需要两个15分钟的充气期来控制出血。
在我们机构，CSA的发生率非常低。对任何手臂疼痛和肿胀的主诉保持高度怀疑，以及正确管理抗凝，尤其是在术后阶段，对于低体表面积或低肌酐清除率的患者尤为重要，这是关键要点。需要实施即时特定护理方案。
