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目的探讨经肘正中静脉行分侧肾上腺静脉取血(AVS)的安全性和可行性。方法 2013年2月至12月对原发性醛固酮增多症患者连续50例经肘正中静脉行AVS,记录选用的导管,并统计两侧取血成功率、手术时间、X线曝光时间、造影剂用量和并发症发生率。AVS成功定义为肾上腺血样皮质醇与外周血样皮质醇比值≥3。结果 50例患者均先使用5F MPA1导管寻找右侧肾上腺静脉,其中47例插入,其余3例改用5FTIG导管插入,而左侧肾上腺静脉均使用5FTIG导管插入。90.0%(45/50)患者右侧取血成功,94.0%(47/50)患者左侧取血成功,88.0%(44/50)患者双侧取血成功。术中平均导管操作时间(16.5±4.3)min,X线曝光时间(5.2±1.5)min,造影剂用量(14.9±4.5)mL。1例(2.0%)患者发生右侧肾上腺血肿。结论经肘正中静脉行AVS安全可行,双侧取血成功率较高,但因样本量小,仍需进一步研究验证。
Objective To investigate the safety and feasibility of subarachnoid vein blood collection (AVS) through the median elbow vein. Methods From February to December 2013, 50 consecutive patients with primary aldosteronism underwent AVS through the median elbow vein and the catheter selection was recorded. The successful rate of blood collection, operation time, X-ray exposure time, contrast medium Dosage and incidence of complications. AVS was successfully defined as adrenal blood samples of cortisol and peripheral blood cortisol ratio ≥ 3. Results All the 50 patients first used the 5F MPA1 catheter to find the right adrenal vein, of which 47 were inserted and the other 3 were inserted into the 5FTIG catheter while the left adrenal vein was inserted with 5FTIG catheter. Right side of 90.0% (45/50) patients had successful blood sampling, 94.0% (47/50) patients succeeded in obtaining blood on the left side, and 88.0% (44/50) patients succeeded in bilateral blood taking. Intraoperative mean catheterization time was (16.5 ± 4.3) min, X-ray exposure time was (5.2 ± 1.5) min and contrast agent dosage was (14.9 ± 4.5) mL. One patient (2.0%) developed a right adrenal hematoma. Conclusions AVS is safe and feasible in the middle of the elbow. The success rate of bilateral blood taking is high. However, due to the small sample size, further study and verification are needed.