透视引导左锁骨下动脉穿刺的方法学研究

目的　探讨在X线引导下行左锁骨下动脉 (LSCA)穿刺的方法 ,并评价其可行性和安全性。材料与方法　 5 0例患者经股动脉穿刺插管行LSCA造影。观察LSCA分支、走行情况及其与第 1肋外缘交点与毗邻骨性标志的关系。根据观察结果 ,临床上在透视引导下按骨性标志行LSCA穿刺 12 0例。以体表标志引导穿刺LSCA 68例为对照组 ,比较两组穿刺成功率、穿刺次数和并发症。结果　LSCA与第 1肋的交点至第 1肋外缘中点的距离为 0 .0 4± 1.5 6mm ,较恒定在第 1肋外缘的中点及附近。交点处LSCA内径为6.12± 0 .40mm。LSCA通过交点时与横断面的夹角为 3 1.0 2°± 5 .1°。在X线引导下按骨性标志行LSCA穿刺的技术成功率为97.5 % ,对照组为 91.0 %。穿刺次数为 4.7± 2 .3 ,最多达 10次 ,对照组为 8.0± 4.2 ,最多达 2 2次。发现并发症 4例 ,包括气胸 2例 ,局部血肿 2例 ;对照组为 10例 ,包括气胸 5例 ,血胸 1例 ,局部血肿 4例。经统计学检验 ,均有显著性差异 (P <0 .0 5 )。结论　透视下按骨性标志行LSCA穿刺是一安全可行的方法。

Fluoroscopically-Guided Left Subclavian Artery Puncture

Objective To investigate the methodology offluoroscopically-guided left subclavian artery (LSCA) puncture and to evaluate its safety and feasibility. Materials and Methods Fifty left subclavian arteriograms via femoral artery access were obtained from 50 consecutive adult patients. The position and width of LSCA at the site of its crossing over the first rib were recorded. Based on this X-ray anatomy, 120 LSCA punctures were performed with the first rib being served as a fluoroscopic marker (FM group). Based on applied anatomy, 68 LSCA punctures were done using body surface marker as guidance (BSM group). The technical success rate, number of needle passing and complications were recorded and compared between each other group. Results The distance was 0.04±1.56mm from the intersection point of LSCA and the first rib lateral ring (FRLR) to the median of FRLR. The angle of LSCA crossing over FRLR was 31°±5.1° with the inner diameter 6.12±0.40mm. The technical success rate of LSCA puncture in FM group and BSM group was 97.5% and 91%, respectively, with statistic significance (P＜0.05). The number of needle passing was 4.7±2.3 (maximum 10) in FM group and 8.0±4.2 (maximum 22) in BFM group (P＜0.01). Minor complications, including pneumothorax and hematoma, occurred in both FM group (n=4) and BSM group (n=10), and the difference between two groups was significant (P＜0.05). Conclusion Under fluoroscopic guidance, LSCA puncture by using bone marker is a safe and feasible technique.