经桡动脉和经股动脉途径PCI治疗冠状动脉慢性闭塞性病变的可行性和安全性比较  

Comparison of the Feasibility and Safety of Transadial Versus Transfemoral Approach for Percutaneous Coronary Intervention of Chronic Total Occlusion Lesions

作　　者：张俊霞[1,2] 王志梅[1,2] 许田[1,2] 叶飞[1,2] 田乃亮[1,2] 张俊杰[1,2] 陈绍良[1,2] 葛震[1,2] 

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 [2]南京市心血管病医院,江苏南京210006

出　　处：《现代生物医学进展》2014年第36期7060-7063,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81270191);江苏省临床医学科技专项(BL2013001)

摘　　要：目的:比较经股动脉和经桡动脉途径介入治疗冠状动脉慢性闭塞性病变的可行性和安全性。方法:选择2011年1月至2012年8月南京市第一医院收治的325例因为冠状动脉慢性闭塞性病变行经皮冠状动脉介入治疗的患者为研究对象,根据手术途径分为经桡动脉治疗(n=211)和经股动脉(n=114)组,回顾性分析和比较患者的基线特征、病变特征、手术经过和手术相关并发症。结果:经桡动脉和经股动脉组手术成功率分别为79.62%和80.70%(P>0.05)。两组患者的性别、年龄、危险因素(高血压、糖尿病及高脂血症)以往PCI及CABG手术史及冠心病临床表现比较均无统计学差别(均P>0.05);两组患者的慢性闭塞性病变病变数量、术中主动脉内球囊反搏(intra-aortic balloon pump,IABP)使用率、术后TIMI血流、手术时间、冠状动脉穿孔并发症的发生率比较无统计学差别(均P>0.05),但经股动脉手术组较经桡动脉组术中血管内超声(intravascular ultrasound,IVUS)的使用率更高(57.01%vs45.02%,P=0.039)。结论:经桡动脉PCI治疗冠状动脉慢性闭塞性病变更安全、有效,其IVUS的使用率低于经股动脉PCI治疗,但对于复杂慢性闭塞性病变病变术者可能更倾向于采用经股动脉途径。Objective： The aim of the study was to compare the feasibility and safety of the transradial versus the transfemoral approaches during the percutaneous coronary intervention（PCI） of chronic total occlusion lesion（CTO）. Methods： From January 2011 to August 2012, 325 patients required PCI because of CTO in Nanjing First Hospital were enrolled in this study and were divided into transradial（n=211） and transfemoral groups（n=114） respectively according to the access site. The baseline characteristics, angiographic results, interventional procedures as well as procedural complications were retrospectively analyzed and compared between the two groups. Results： Successful catheterization was achieved in 79.62% of patients in the transradial and 80.70% patients of in the transfemoral group. There was no significant difference in the gender, age, risk factors（hypertension, diabetes, and hyperlipidemia）,previous PCI or CABG between the two groups. Also, no significant difference was found in the CTO number, the usage rate of IABP（intra-aortic balloon pump）, postprocedural TIMI flow, procedural duration and the complication of coronary perforation. IVUS（intravascular ultrasound） was used more in the transfemoral than in the transradial group（57.01% v.s. 45.02%, P=0.039）. Conclusion：Transradial PCI of CTO was safe and feasible with similar results to those of the transfemoral approach, but the usage rate of IVUS was lower than that of the transfemoral access. It was preferred to select transfemoral approach for complicated CTO.

关 键 词：经皮冠状动脉介入治疗 慢性闭塞性病变 经桡动脉途径 经股动脉途径 

分 类 号：R541.4[医药卫生—心血管疾病]