RESUMO
Objective:To apply the best evidence for the prevention of radial artery occlusion after transradial coronary angiography or intervention to clinical practice and evaluate its effect.Methods:This was a quasi-experimental study. Based on the evidence continuous quality improvement model, evidence-based practice method was used to obtain the best evidence, formulated review indicators, analyzed the obstacles in the practice process and took action strategies. The 88 patients who underwent transradial coronary angiography or intervention in the Cardiology Department of Qilu Hospital of Shandong University (Qingdao) from June 1 to 30, 2020 were selected as the baseline review group by convenience sampling. The 94 patients who underwent this treatment from September 1 to 30, 2020 were selected as the evidence application group. The baseline review group used the original perioperative management plan, and the evidence application group used the perioperative management plan based on the best evidence. The implementation rate of each review indicator, the incidence of radial artery occlusion, the degree of compression pain, and the comfort level of patients were compared between the two groups.Results:The implementation rates of review indicators 1, 2, 3, 5, 6, 7, 8 in the evidence application group were 100.0% (94/94), 100.0% (94/94), 11.7(11/94), 88.3% (83/94), 100.0% (94/94), 100.0%(94/94), 85.1%(80/94), respectively, which were higher than those in the baseline review group(all 0), except for the review indicator 4, the differences were statistically significant ( χ2 values were 9.00-178.02, all P<0.05). The incidence of radial artery occlusion and the incidence of pain Numerical Rating Scale>3 points in the evidence application group were 2.1% (2/94) and 3.2% (3/94), respectively, which were lower than 14.8% (13/88) and 23.9% (21/88) in the baseline review group; the comfort level of patients in the evidence application group was 96.8% (91/94), which was higher than 63.6% (56/88) in the baseline review group. The differences were statistically significant ( χ2 = 8.01, 15.21, 30.10, all P<0.05). Conclusions:The best evidence for the prevention of radial artery occlusion after transradial coronary angiography or intervention can be applied to clinical practice, which can standardize the behavior of medical staff, reduce the incidence of postoperative radial artery occlusion, reduce the degree of compression pain, and improve the comfort of patients.
RESUMO
Objective To discuss the incidence and clinical predictor factors of anatomical variation of radial arteries among patients in the XingJing province of China. Methods A total of 1731 patients who underwent transradial coronary intervention for the first time during the period of Jan.2016-June.2016 in the People‵s Hospital of Xin jiang Uyghur Autonomous Region were enrolled in this study. All relevant basic information and related medical history were recorded in detail.Right radial artery angiography was performed in all patients, According to the definition of radial artery variation, the patients were decided into the radial artery variation group and the normal radial artery group. Single factor and multiple factors logistic regression analysis were performed to evaluate the predictive value of variables factors in radial artery variations. Results The incidence of radial artery variation was 4.97%(86/1731).The incidence of radial artery spasm in the radial artery variation group33.72%(29/86),and 2.74% (45/1645) in the normal radial artery group (P<0.001).The failure rate of coronary intervanton by right radial artery in the radial artery variation group was 26.74%(23/86)and 1.51%(25/1645)in the normal radial artery group(P<0.001).The overall success rate of coronary intervention through right radial artery approach was 97.23%(1683/1731).Female gender,short statue、low body weight,history hyperlipidemia,smoking,drinking rabbit,occupation as farmer were found to be associated with the existence of radial artery variation (all P < 0.05).Diabetes,body mass index,hyperlipidemia and ethnicity were not associated with the existence of radial artery variation (all P >0.05). Multivariate logistic regression analysis showed age, gender, farmer occupation, hyperlipidemia were associated with the occurrence of radial artery variation. Increased in age by every 10 years would bring a 0.264 fold increase in risk of radial artery variation(OR 1.264,95%CI 1.006-1.587, P=0.044)and the risk of radial artery variation in females was 3.999 times to males(OR 3.999, 95%CI 2.241-7.136,P<0.001).The risk of radial artery variation in patients with hyperlipidemia was 1.776 times to patients without hyperlipidemia(OR 1.776,95%CI 1.011-3.122,P=0.046)and the risk of radial artery variation in farmers was 2.188 times higher than others(OR 2.188,95%CI 1.238-3.867, P=0.007). Conclusions For people in Xinjiang in China,anatomical variation of radial artery was uncommon. Advanced age, female gender, short states, low body weight, hyperlipidemia, smoking, drinking and farmer occupation were associated with the occurrence of radial artery variation. Multivariates logistic regression analysis showed advanced age, female gender, hyperlipidemia, farmers were associated whit the presence of radial artery variation. These factors have predictive value for the existence of radial artery variation.
RESUMO
Objective To explore the causes of bone fascia compartment syndrome after radial artery coronary artery intervention and sum up the nursing experience. Method The clinical data of 8 patients with bone fascia compartment syndrome after radial artery coronary artery intervention from January 2009 to December 2014 were analyzed retrospectively to summarize the nursing countermeasures, including close observation of illness, swelling and pain nursing, medication and blood and monitoring of coagulation functions. Result The forearm of all patients were painful, swollen and enlarged, 6 of them with radial pulse abating,1 with finger pulling pain, 2 with muscle decreasing. Conclusions The early observation and treatment of bone fascia compartment syndrome are critical. Great importance to the complaints of patients should be attached in view of the causes of complications so that effective nursing strategy can be taken to save time of conservative treatment, alleviate the patients'pains and promote their early recovery.
RESUMO
BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.
Assuntos
Humanos , Artérias , Bradicardia , Catéteres , Vasos Coronários , Hipotensão , StentsRESUMO
BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.