急性心肌梗死经桡及股动脉直接经皮冠状动脉介入治疗比较  

Comparison between transradial and transfemoral approaches for primary percutaneous coronary intervention in patients with acute myocardial infarction

作　　者：叶慧明[1,2] 卢明瑜[1] 王伟民[1] 刘健[1] 赵红[1] 马玉良[1] 李琪[1] 刘传芬[1] 

机构地区：[1]北京大学附属人民医院心脏中心,100038 [2]北京世纪坛医院心内科

出　　处：《上海医学》2012年第5期430-433,共4页Shanghai Medical Journal

摘　　要：目的对比经桡、股动脉路径行直接经皮冠状动脉介入治疗(pPCI)的临床应用价值。方法选择2009年1月—2010年12月在北京大学附属人民医院连续行pPCI的191例急性心肌梗死(AMI)患者,依据手术穿刺路径分为桡动脉组62例和股动脉组129例,观察疗效、并发症及住院期间主要心血管不良事件(MACE)。结果两组间临床基线资料的差异均无统计学意义(P值均>0.05),两组间梗死相关动脉分布、围术期糖蛋白Ⅱb/Ⅲa受体拮抗剂使用率、主动脉内球囊反搏泵(IABP)使用率的差异均无统计学意义(P值均>0.05),两组间手术操作成功率、手术操作时间和Needle-to-Balloon时间的差异均无统计学意义(P值均>0.05),而桡动脉组的出血并发症发生率及住院期间病死率有降低的趋势,但差异均无统计学意义(P值均>0.05)。桡动脉组的造影剂使用量较股动脉组显著减少(P=0.043)。结论与经股动脉路径相比,经桡动脉路径行pPCI后MACE无明显改变,出血并发症发生率及住院期间病死率有降低趋势,造影剂使用量更少,故在经验丰富的临床中心可将其作为pPCI血管路径的选择。Objective To compare transradial access with transfemoral access for primary percutaneous coronary intervention （pPCI）. Methods From January 2009 to December 2010, 191 consecutive acute myocardial infarction （AMI） patients received pPCI and were divided into radial group （n=62） and femoral group （n=129） according to different operative approaches. The therapeutic effect, complications and major adverse cardiac events （MACE） of both groups were evaluated. Results There was no statistical difference in baseline clinical data between both groups （P0.05）, and neither were differences in infarction-related artery distribution, use of glucoprotein Ⅱb/Ⅲa receptor antagonist, intraaortic balloon counterpulsation （IABP）, operative achievement ratio, operating time and needle-to-balloon time in both groups. There was a reduced tendency of blood loss and in-hospital death in the radial group, but there was no statistical difference between the two groups （P0.05）. The dose of contrast medium in the radial group was significantly less than that in the femoral group （P=0.043）. Conclusion Compared with transfemoral approach, there is a reduced tendency of blood loss and in-hospital death and remarkably decreased consumption of contrast medium in transradial approach for pPCI. But there is no obvious difference of MACE between the two methods. Transradial approach can be a feasible choice for pPCI in clinical center with rich experience.

关 键 词：桡动脉 股动脉 直接经皮冠状动脉腔内成形术 

分 类 号：R542.22[医药卫生—心血管疾病]