经桡动脉路径行经皮冠状动脉介入治疗过程中血管通路发生痉挛的危险因素分析及不同处置方法疗效探讨  

Analysis of Risk Factors of Vasoconstriction Caused by Percutaneous Coronary Intervention Through Transradial Artery Pathway and the Efficacy of Different Disposal Methods

作　　者：郭宏博[1] 李春梅[1] GUO Hongbo;LI Chunmei(Second People′s Hospital of Jiaozuo City,Jiaozuo 454001,Henan,China)

机构地区：[1]焦作市第二人民医院

出　　处：《中西医结合心脑血管病杂志》2019年第11期1714-1718,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：河南省医学科技攻关计划资金项目(No.201509047)

摘　　要：目的 探讨经桡动脉路径行经皮冠状动脉介入治疗术(PCI)血管通路痉挛的危险因素,探讨PCI导丝和球囊辅助跨越痉挛段血管的疗效。方法 回顾性分析2010年1月—2016年1月于我院心内科诊治并行PCI治疗的281例病人临床资料,根据是否发生桡动脉痉挛,将281例病人分为痉挛组(56例)和非痉挛组(225例)。根据处置方式,将56例桡动脉痉挛病人分为观察组(采用PCI导丝和球囊辅助术治疗,20例)和对照组(采用常规方式处理治疗,36例)。分析PCI手术发生动脉痉挛的危险因素及手术情况、痉挛发生部位、血肿、指引导管通过例数及时间、手术时间、住院总时间及住院总费用。结果 经Logistic多因素分析显示,性别、年龄、高脂血症、糖尿病、吸烟、前臂疼痛、桡动脉路径异常及术中导管交换次数均为PCI术病人发生桡动脉痉挛的危险因素。痉挛组,56例中53例仅运用1根导丝完成手术,3例应用2根导丝完成手术;观察组采用PCI导丝联合球囊辅助下20例病人的指引导管顺利跨越痉挛段。对照组12例顺利通过痉挛段血管,但操作时间较长,2例因拒绝穿刺股动脉而耗时约35min后顺利完成痉挛段的跨越,22例未成功通过痉挛段血管,并出现不同程度的对比剂外渗,说明存在血管夹层,改为对侧桡动脉或经股动脉路径PCI治疗。两组痉挛部位和前臂血肿情况比较差异无统计学意义(P>0.05)。观察组指引导管通过例数显著高于对照组(P<0.05),通过时间显著短于对照组(P<0.05),观察组手术时间及住院总时间均短于对照组(P<0.05)。但观察组住院费用与对照组比较差异无统计学意义(P>0.05)。结论 性别、年龄、高脂血症、糖尿病、吸烟、前臂疼痛、桡动脉路径异常及术中导管交换次数均为PCI术病人发生桡动脉痉挛的危险因素。应用PCI导丝联合球囊辅助下可有效提高指引导管跨越痉挛和(或)夹层段的成功率,疗效优�Objective To evaluate the risk factors of vasoconstriction in patients with percutaneous coronary intervention (PCI) through transradial artery pathway,and to explore the efficacy of PCI guide and balloon-assisted spanning blood vessels. Methods A retrospective study was conducted on the clinical data of281 patients who underwent PCI in our hospital from January2010 to January2016.According to the patients with radial artery spasm,281 patients were divided into spastic group (56 cases) and non - spasmodic group (225 cases).According to the different treatment,56 patients with radial artery spasm were divided into observation group (treated with PCI guide wire and balloon catheterization,20 cases) and control group (treated by conventional treatment,36 cases).The risk factors of arterial spasm in patients with PCI and the operation of the observation group and the control group,the location of spasticity,hematoma,the number of cases and time of catheter catheterization,the time of operation,the total time of hospitalization and the total cost of hospitalization were analyzed. Results Logistic multivariate analysis showed that gender,age,hyperlipidemia,diabetes mellitus,smoking,forearm pain,abnormal radial artery pathways and intraoperative catheterization were risk factors for radial spasm in patients who underwent PCI.The patients in the observation group were treated with PCI guide wire combined with balloon.All the patients underwent smooth catheterization.Fifty-three patients were treated with only one guidewire.3 patients were treated with two guide wires.Only12 cases of control group were successfully through the spasm of blood vessels,and the operation time was longer,2 patients refused to puncture the femoral artery and took about35 min after the successful completion of spasmodic crossing.In addition,21 patients failed to pass through the spasm of blood vessels,and the emergence of varying degrees of contrast agent extravasation,indicating the presence of vascular dissection,instead of contralateral radia

关 键 词：经桡动脉路径介入治疗 桡动脉痉挛 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病] R256.2[医药卫生—内科学]