经皮桡动脉入路在急性心肌梗死直接冠状动脉介入治疗中的疗效观察及对炎性因子的影响  

Efficacy of transradial approach in the treatment of acute myocardial infarction with direct coronary intervention and its influence on inflammatory factors

作　　者：秦毅 李原 孙运强 Qin Yi, Li Yuan, Sun Yunqiang(Department of Vasculocardiology, Rizhao Central Hospital of Shandong Province, Shandong Rizhao 276800, Chin)

机构地区：[1]山东省日照市中心医院心血管内科,276800

出　　处：《中国医师进修杂志》2017年第10期869-872,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨桡动脉入路在急性心肌梗死经皮冠状动脉介入治疗（PCI）中的安全性及对炎性因子的影响.方法 146例急性ST段抬高型心肌梗死患者按随机数字表法分为桡动脉组和股动脉组,各73例,桡动脉组给予经桡动脉途径行PCI治疗,股动脉组给予经股动脉途径行PCI治疗.观察两组手术时间、穿刺至球囊打开时间、X线曝光时间、造影剂用量、PCI成功率、再灌注心律失常发生率、围手术期并发症发生率、住院时间、3个月内心脏主要不良事件发生率及术前、术后12 h、术后3 d、术后7 d血清肿瘤坏死因子（TNF）-α、超敏C反应蛋白（hs-CRP）水平.结果 两组手术时间、穿刺至球囊打开时间、X线曝光时间、PCI成功率、再灌注心律失常发生率比较差异均无统计学意义（P〉0.05）.桡动脉组围手术期并发症发生率及住院时间与股动脉组比较均显著降低[5.48%（4/73）比28.77%（21/73）,（7.83±1.13）d比（9.74±1.57）d],差异有统计学意义（P〈0.05）.两组术前TNF-α和hs-CRP水平比较差异均无统计学意义（P〉0.05）;两组术后12 h TNF-α和hs-CRP水平均显著升高,与本组术前比较差异均有统计学意义（P〈0.05）;术后3、7 d两组TNF-α、hs-CRP水平逐渐回落.两组术后各时间点TNF-α、hs-CRP水平比较差异均无统计学意义（P〉0.05）.术后3个月,两组主要心血管事件发生率比较差异无统计学意义（P〉0.05）.结论由操作熟练医师通过经桡动脉途径PCI治疗急性ST段抬高型心肌梗死具有与股动脉途径同样的可行性和安全性,且可降低围手术期并发症发生率和住院时间.Objective To investigate the efficacy of transradial approach in the treatment of acute myocardial infarction （AMI） with direct coronary intervention and its influence on inflammatory factors. Methods One hundred and forty-six patients with acute ST elevation myocardial infarction were randomly divided into radial artery group and femoral artery group with 73 cases in each group. The patients in radial artery group received transradial percutaneous coronary intervention （PCI） by transradial approach, and those in the femoral artery group were treated with PCI by transfemoral approach. The operation time, puncture to balloon opening time, X-ray exposure time, contrast agent dosage, the success rate of PCI, reperfusion arrhythmia, perioperative complication rate, hospitalization time, the incidence of major adverse cardiac events in 3 months and the levels of necrosis factor alpha （TNF-alpha）, high sensitive C reactive protein （hs-CRP） at preoperative and postoperative 12 h, postoperative 3 d and 7d were observed and compared between two groups. Results The operation time,puncture to balloon opening time, X-ray exposure time, PCI rate, the incidence of reperfusion arrhythmias in two groups had no significant differences （P 〉 0.05）. The incidences of perioperative complications and hospitalization time in radial artery group were significantly shorter than those in femoral artery group： 5.48%（4/73） vs. 28.77%（21/73）, （7.83 ± 1.13） d vs.（9.74 ± 1.57） d, P〈0.05. The levels of TNF-αand hs-CRP in two groups before operation had no significant difference （P〉0.05）. The levels of TNF-αand hs-CRP in two groups 12 h after operation were significant increased （P〈0.05）, and gradually decreased 3 d and 7 d after operation. The levels of TNF-αand hs-CRP in two groups had no significant differences （P〉0.05）. The incidence of major adverse cardiac events in 3 months in two groups had no significant difference （P〉0.05）. Conclusions Transradial approach by skille

关 键 词：冠状动脉疾病 经皮冠状动脉介入治疗 桡动脉穿刺 股动脉穿刺 炎性因子 

分 类 号：R542.22[医药卫生—心血管疾病]