经桡动脉冠状动脉介入术后桡动脉狭窄及闭塞的危险因素分析  

Risk factors of radial artery stenosis and occlusion after transradial coronary procedures

作　　者：赵亚男[1] 李志樑[1] 刘芳[2] 

机构地区：[1]南方医科大学珠江医院心内科,广东广州510282 [2]南方医科大学珠江医院门诊部,广东广州510282

出　　处：《热带医学杂志》2013年第4期415-418,共4页Journal of Tropical Medicine

基　　金：广东省科技计划项目(2010B031500030)

摘　　要：目的探讨经桡动脉途径冠状动脉介入术后桡动脉狭窄及闭塞的危险因素。方法观察323例经桡动脉入路成功行冠状动脉介入术的患者,应用彩色多普勒超声评价患者是否发生桡动脉狭窄及闭塞,据此将观察病例分为正常组(n=256)和桡动脉狭窄及闭塞组(n=67)。比较两组患者的临床特征,通过多因素Logistic回归分析探索引起术后桡动脉狭窄及闭塞的危险因素。结果67例(20.74%)患者术后发生桡动脉狭窄甚至闭塞。单因素分析显示,桡动脉狭窄及闭塞组女性、糖尿病、既往TRI或TRA史、反复穿刺、留置鞘管患者的比例高于正常组,鞘管留置时间、压迫止血时间大于正常组;而桡动脉内径与鞘管外径的比值(RAID/SOD)及术中肝素用量小于正常组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示糖尿病、RAID/SOD、术中肝素用量、鞘管留置时间及压迫止血时间是桡动脉狭窄及闭塞的独立危险因素。结论选择与桡动脉内径匹配的动脉鞘管、足够强度的抗凝治疗、减少鞘管留置的时间及压迫止血的时间,有利于减少术后桡动脉狭窄及闭塞的发生,对糖尿病患者及桡动脉内径较小的患者更应注意采取预防措施。Objective To analyze the risk factors of radial artery stenosis and occlusion after transradial coronary procedures. Methods 323 patients who underwent transradial coronary angiography or intervention were observed. According to the conditions of radial artery after transradial coronary procedures, the patients were divided into normal group（n--256） and radial artery stenosis and occlusion group （n=67）. Radial artery stenosis and occlusion were evaluated with vascular ultrasound. The clinical characteristics of the patients in two groups were compared and the risk factors of radial artery stenosis and occlusion were identified by logistic regression model. Results Stenosis even occlusion of radial artery occurred in 67 patients （20.74%）. Compared with the patients in normal group, there were more female, diabetes mellitus, TRI or TRA history, repeated puncture and sheath reservation patients in radial artery stenosis and occlusion group. The duration of post-procedure compression hemostasis and the duration of sheath reservation were longer than that of normal group （P〈0.05）, while the dosage of heparine used in the operational procedure and RAID/SOD is significantly less than normal group（P〈0.05）. Logistic regression analysis presented that diabetes mellitus, RAID/SOD, dosage of heparine used in the operation, duration of sheath reservation and duration of post-procedure compression hemostais were independent risk factors for stenosis and occlusion of radial artery. Conclusion Select proper sheath, offer appropriate anticoagulation, shorten the sheath reservation time and avoid prolonged duration of post-procedure compression hemostasis should be done to reduce the incidence of radial artery stenosis and occlusion, especially in patients with diabetes mellitus and smaller radial artery diameter.

关 键 词：桡动脉 狭窄及闭塞 冠状动脉介入术 危险因素 

分 类 号：R543.3[医药卫生—心血管疾病]