Susanu Simona, Angelillis Marco, Giannini Cristina, Binella Rossella, Matteoni Anna, Bellucci Rita, Balestri Sandro, Ferrara Nicola, Falchi Federico, Micheletti Giuliano, Petronio Anna Sonia
Catheterization Laboratory, University of Pisa, Pisa, Italy.
Clin Exp Emerg Med. 2018 Jun;5(2):95-99. doi: 10.15441/ceem.17.210. Epub 2018 Jun 29.
The aim of this study was to investigate (1) whether the learning curve of new catheterization laboratory operators increases the incidence of complications of transradial access during percutaneous coronary interventions and (2) whether manual compression with a two-step approach is safe and efficient for radial access hemostasis.
We performed a prospective study with all consecutive patients who underwent a coronary diagnostic or intervention procedure with radial access. The primary end point was a composite of pulseless radial artery of the wrist and hematoma evaluated after 24 hours. The secondary end point of efficacy was defined as the presence of bleeding or hematoma after 30 seconds.
From March 2016 to June 2016, 150 consecutive patients, of whom 147 underwent coronary angiography and/or percutaneous coronary intervention through radial access, were included in the present study. The primary end point was present in 33%, but pulseless radial artery of the wrist was present only in 5.3%. We found that the incidence of primary end point was statistically different according to the number of puncture attempts, with a cutoff of two punctures with blood. The secondary end point of safety was present only in 4.7% of the cases.
Radial access is feasible and safe even if performed by training physicians. Manual compression with early evaluation after 30 seconds is a safe technique for managing the radial access after sheath removal.
本研究旨在调查（1）新的心导管插入实验室操作人员的学习曲线是否会增加经皮冠状动脉介入治疗期间经桡动脉穿刺并发症的发生率，以及（2）采用两步法手动压迫止血对于桡动脉穿刺止血是否安全有效。
我们对所有连续接受经桡动脉穿刺进行冠状动脉诊断或介入手术的患者进行了一项前瞻性研究。主要终点是24小时后评估的腕部无脉搏桡动脉和血肿的综合情况。疗效的次要终点定义为30秒后是否存在出血或血肿。
2016年3月至2016年6月，本研究纳入了150例连续患者，其中147例通过桡动脉穿刺进行了冠状动脉造影和/或经皮冠状动脉介入治疗。主要终点出现在33%的患者中，但腕部无脉搏桡动脉仅出现在5.3%的患者中。我们发现，根据穿刺尝试次数，主要终点的发生率在统计学上存在差异，以两次带血穿刺为临界值。安全性次要终点仅出现在4.7%的病例中。
即使由实习医生进行操作，桡动脉穿刺也是可行且安全的。在拔除鞘管后30秒进行早期评估并采用手动压迫是一种安全的桡动脉穿刺止血技术。
