あかね会土谷総合病院小児科Department of Pediatrics, Tsuchiya General Hospital ◇ Hiroshima, Japan
背景：肉厚の薄いGlidesheath Slender®（GS）の使用により，小児のカテーテル治療でも低侵襲化が期待される．小児におけるGS使用による大腿静脈（FV）アプローチの安全性を検討した．
方法：1）2015～2016年に当院でカテーテル検査を行った1歳以上の小児32例を対象に，それぞれ16例ずつ従来のシースを使用したC群とGSを使用したS群に分け，有害事象について比較検討した．2）ex vivoで2種類の治療用バルーン（Tyshak II 12 mm, MUSTANG 6×20 mm）が5Fr GSへ挿入可能か検討した．
結果：1）シースのkinkはS群で1例認めた．止血時間は平均4.6分（C群），5.6分（S群）だった．抜去後の皮下血腫は1例（C群），1例（S群），再出血は1例（C群），2例（S群），FV閉塞は0/15例（C群），0/13例（S群）だった．いずれも有意差はなかった．2）2種類のバルーンはいずれも安全に挿入可能だった．
結論：GSは小児の大腿静脈アプローチにおいても安全に使用できた．新生児や乳児のカテーテル治療への使用は検討課題である．
Background: The Glidesheath slender (GS) has a thinner wall structure compared to the conventional sheath introducer (CS). Femoral venous (FV) access with the GS in children undergoing catheter intervention is less invasive. The aim of this study was to evaluate the safety of the GS for FV access in children.
Methods: 1) This prospective study included 32 children who underwent cardiac catheterization at our institute between 2015 and 2016. Patients were divided into two groups of sixteen each using the CS (Group C) and GS (Group S), respectively. Group C and S were compared for adverse events, including kinking of the sheath during the procedure, and access site complications. 2) We also investigated the insertability of two balloons (Tyshak II 12 mm, MUSTANG 6×20 mm) into the 5Fr GS ex vivo.
Results: 1) Adverse events did not differ significantly between the groups (kinking of the sheath occurred in one patient in Group S; hematoma after procedure, 1[6.2％] vs. 1[6.2％], respectively; rebleeding, 1[6.2％] vs. 2[12.5％], respectively; FV occlusion, 0/15[0.0％] vs. 0/13[0.0％], respectively). The mean time to hemostasis was 4.6 and 5.6 minutes, respectively; 2) Both balloons could be safely inserted into the 5Fr GS ex vivo.
Conclusions: The GS is safe for FV access in children. Further investigations are required to confirm the feasibility of use of the GS for catheter interventions in neonates and young infants.
Key words: Glidesheath slender; femoral venous access; less invasive; Balloon atrial septostomy; infant
© 2017 日本Pediatric Interventional Cardiology学会© 2017 Japanese Society of Pediatric Interventional Cardiology
This page was created on 2017-05-11T14:24:07.383+09:00
This page was last modified on 2017-08-30T11:00:08.12+09:00
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