高龄患者经桡动脉与经股动脉途径冠状动脉介入诊疗的临床对比研究  

Clinical comparative study of transradial versus transfemoral approach for coronary angiography and percutaneous coronary intervention in senile patients

作　　者：刘立新 毕磊 崔振双 施冰 武云涛 冬兰 

机构地区：[1]陆军总医院干部病房一科,北京100700

出　　处：《中国循证心血管医学杂志》2016年第7期836-839,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨高龄患者经桡动脉途径与经股动脉途径冠状动脉介入诊疗的有效性和安全性。方法 选取2008年1月~2014年5月陆军总医院干部病房一科收治的住院患者246例，男性194例，女性52例；年龄80~93岁，平均（83.5±2.7）岁。患者根据介入途径分为桡动脉组（130例）和股动脉组（116例），比较两组手术一般情况、围手术期并发症和不良情况、1年时主要不良心血管事件。结果 两组造影剂用量无统计学差异（P＞0.05）；桡动脉组的穿刺时间明显长于股动脉组，而术后卧床时间则明显更短，差异有统计学意义（P均＜0.05）。两组行PCI患者在病变特征、支架数量及PCI成功率方面比较，差异无统计学意义（P均＞0.05）。术后1年期主要不良心血管事件比较，差异无统计学意义（P＞0.05）。股动脉组的血管并发症明显多于桡动脉组（18.1% vs. 6.2%，P＜0.01），其中血管迷走性反射、局部皮肤张力性水泡、穿刺区域及血管走行区出血/血肿比例也明显高于桡动脉组，差异均具有统计学意义（P均＜0.05）。两组均未发现急性脑卒中、远端肢体缺血。此外，股动脉组术后不良情况发生率明显多于桡动脉组，差异具有统计学意义（P＜0.05）。结论 高龄患者经桡动脉途径冠状动脉介入的临床疗效与经股动脉相似，但血管并发症和术后不良情况更少。Objective To explore the effectivity and safety of coronary angiography and percutaneous coronaryintervention (PCI) through radial artery and femoral artery in senile patients. Methods 246 cases over 80 years oldwere divided into a radial artery group (n=130) and a femoral artery group (n=116) according to the interventionalapproach. The success rate of the PCI, general conditions of the intervention, perioperative vascular complicationsand adverse situation, major adverse cardiovascular event (MACE) at 1 year in both groups were evaluated.Results The success rate of PCI between two groups had no significant difference (88.5% vs. 92.7%, P>0.05), so aswith the incidence of MACE at 1 year (2.7% vs. 3.6%, P>0.05). The transradial approach had a higher conversionrate compared with the transfemoral approach (6.2% vs. 0%, P<0.01). Time of arterial puncture was longer with theradial versus femoral approach, while in-bed time was shorter with the radial approach (P<0.01). The incidenceof vascular complications in the femoral artery group was significantly higher than that in the radial artery group(18.1% vs. 6.2%, P<0.01), such as vasovagal reaction, vesicular skin injuries, bleeding/haematomas from thepuncture site had significant difference (P<0.05). The incidence of postoperatve adverse situation in the femoralartery group was significantly higher than that in the radial artery group, including abdominal distension, dysuresia,indwelling urethral catheter, lumbago and back pain, insomnia, post-operative limb pain and constipation (P<0.05).Conclusion The transradial approach for coronary angiography and percutaneous coronary intervention in senilepatients has a similar clinical effect compared with the transfemoral approach, but with less vascular complicationsand postoperatve adverse situation.

关 键 词：冠状动脉造影 经皮冠状动脉介入治疗 桡动脉 股动脉 老年人 

分 类 号：R816.2[医药卫生—放射医学]