经不同途径介入治疗高龄冠心病患者的短期和长期效果  

Comparison of short- and long-term outcome after percutaneous transluminal interventional therapy in octogenarians with coronary artery disease from radial or femoral approach

作　　者：尤威[1] 叶飞[1] 陈绍良[1] 张俊杰[1] 田乃亮[1] 林松[1] 刘志忠[1] 王蓉[1] 阚静[1] 许田[1] 刘玲玲[1] 林玲[1] 徐海梅[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院心内科,210006

出　　处：《中华心血管病杂志》2013年第9期736-739,共4页Chinese Journal of Cardiology

摘　　要：目的 探讨高龄冠心病患者经桡动脉和股动脉途径行经皮冠状动脉介入治疗（PCI）后的短期和长期效果。 方法 回顾性研究2005年1月至2010年12月行PCI的≥80岁冠心病患者共488例。根据介入途径的不同，将患者分为TRI组（经桡动脉途径，共235例）和TFI组（经股动脉途径，共253例）。比较两组患者PCI的有效性和安全性。 结果 TFI组与TRI组的手术成功率、手术时间、对比剂用量、对比剂肾病发生率、住院期间主要不良心血管事件发生率、术后1年主要不良心血管事件发生率、术后2年主要不良心血管事件发生率差异均无统计学意义（P均＞0.05）；TRI组血管并发症［17.9%（42/235）比26.9%（68/253），P〈0.05］、围手术期TIMI大出血［1.3%（3/235）比4.7%（12/253），P〈0.05］、围手术期TIMI小出血［5.1%（12/235）比15.8%（40/253），P〈0.01］的发生率均低于TFI组，PCI术后卧床时间［3.6（2.8～4.2）h比24.4（24.0～25.1）h，P〈0.01］和住院时间［3.0（3.0～4.0）d比5.0（5.0～6.0）d，P〈0.01］短于TFI组，需要更改介入治疗途径的比例TRI组高于TFI组［11.5%（27/235）比2.0%（5/253），P〈0.01］。 结论 高龄冠心病患者经桡动脉途径PCI的短期及长期效果与经股动脉途径相似，但需要更改介入途径的比例较高。Objective To compare the short-term and long-term outcome after pereutaneous coronary intervention （PCI） between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients. Methods From January 2005 to December 2010, 488 consecutive elderly patients（ ≥80 years old）were enrolled in this retrospective study. Patients were divided into TRI group （n = 235, PCIs were performed trans-radial approach ） and TFI group （ n = 253, PCIs were performed trans-femoral approach）. Efficacy and safety data were compared between the two groups. Results There were no rlifferences in success rate of stenting, procedure time, contrast amount, rates of contrast-induced nephropathy, major adverse cardiovascular events during hospitalization, at one year follow up and at two years follow up. Lower vascular complications were associated with TRI approach[ 17.9% （42/253）vs. 26.9% （68/253）, P 〈0.05], especially in TIMI major bleeding ratio [1.3% （3/235） vs. 4.7% （12/253）, P〈0.05],TIMI minor bleeding [5.1% （12/235） vs. 15.8% （40/253）, P〈0.01], and time lying in bed [3.6 （2.8-4.2）h vs. 24.4 （24.0-25.1）h, P〈0.01] and hospitalization [3.0 （3.0 -4. 0）d vs. 5.0 （5.0 -6.0）d, P 〈0. 01 ], and higher rates of crossover approach were associated with TRI [ 11.5% （27/235） vs. 2.0 （5/253）, P 〈 0. 01 ]. Conclusion TRI is as feasible, safe and effective as TFI in elderly patients during short-term and long-term follow up, and TRI is associated with higher rates of crossover approach.

关 键 词：血管成形术 经腔 经皮冠状动脉 桡动脉 股动脉 

分 类 号：R541.4[医药卫生—心血管疾病]