Naslov
Radijalni pristup u kateterizaciji srca – ispitivanje vazoreaktivnosti radijalne arterije
(Radial approach in cardiac catheterization - radial artery reactivity)

Autori
Lukenda, Josip

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, doktorska disertacija

Fakultet
Medicinski fakultet

Mjesto
Zagreb

Datum
16.07

Godina
2009

Stranica
181

Mentor
Prof. dr. sc. Boris Brkljačić

Ključne riječi
koronarografija; PCI; radijalni pristup; spazam radijalne arterije; vazodilatatori; verapamil; urapidil; alfentanil
(coronary angiography; PCI; transradial approach; radial artery spasm; vasodilators; verapamil; urapidil; alphentanyl)

Sažetak
Spazam radijalne arterije je najučestalija komplikacija transradijalne kateterizacije srca. Svrha rada bila je ispitati prevenciju spazma s α-blokatorom urapidilom i sedaciju alfentanilom u usporedbi s tradicionalno korištenim verapamilom, proučiti tlakove u arteriji i stupanj boli i neugode kod bolesnika. Kod 126 bolesnika učinjena je angiografija radijalne arterije prije i nakon zahvata, praćena krivulja tlaka te ispitan intenzitet boli i nelagode kratkim oblikom McGillovog upitnika.Urapidil i verapamil imali su sličan vazodilatatorni učinak, ali verapamil je značajno bolje preveniro spazam. Sedacija alfentanilom dodatno je smanjila spazam ali učinak nije bio statistički značajan. Uveden je novi kriterij spazma, umjereno teški (20-40%) i teški spazam (>40%), a češće su ga imali muškarci, pušači, bivši pušači i oni sa početno širom arterijom, moguće zbog većeg broja dodirnih točaka katetera sa širokom arterijom.Unatoč izraženijem snižavanju sistemne vaskularne rezistencije, koja je proporcionalnu srednjem arterijskom tlaku, urapidil je slabije prevenirao spazam, i nije se pokazala kao znak spazma. Alfentanil i urapidil značajno su povećali popustljivost arterijskog sustava, koja je proporcionalna sniženju tlaka pulsa, što također nije bilo povezano sa spazmom. Sniženje sistoličkog tlaka pokazalo se kao jedini znak spazma.Bol i nelagoda tijekom pretrage bili su slični u radijalnoj i femoralnoj skupini ali nakon pretrage tegobe su bile značajno manje u radijalnoj skupini. Ukupna bolnost i nelagoda bili su veći u femoralnoj skupini. SUMMARY: Radial artery spasm during transradial approach is frequent complication. The objective of this study was to examine the spasm prevention of α-blocker urapidil and sedation with alfentanil in comparison with the traditionally used verapamil, and to study the radial pressure waveforms as well as the degree of pain.A total of 126 patients were included and radial artery angiography was performed before and after the procedure. Pressure waveforms were monitored and the intensity of pain and discomfort were tested by the short-form McGill Pain Questionnaire. Despite a similar basal effect of both drugs, verapamil had a significantly better effect than urapidil in the prevention of spasm. Sedation with alfentanil further prevented spasm, but the effect was not statistically significant. New spasm criteria have been introduced, moderately severe spasm (20-40%), and severe spasm (> 40%), and they were more frequent in men, smokers and previous smokers and those with a higher initial artery width. This could be explained by a larger number of contact points of a catheter within a wider artery.Despite somewhat higher lowering of the systemic vascular resistance, which is proportional to mean arterial pressure, urapidil had the poorer effect on spasm prevention, and this was not a marker of spasm. Alfentanil and urapidil significantly increased arterial compliance, which is proportional to lowering of pulse pressure ; however, it also had no influence on final radial artery spasm. A decrease in systolic pressure was only one significant marker of severe artery spasm.Pain and discomfort during the procedure were similar in the radial and femoral approach, but after procedure suffering was significantly less in the radial group. In addition, total soreness and discomfort related to the procedure were significantly higher in the femoral approach.

Izvorni jezik
Hrvatski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA