经同侧肱-桡动脉路径开展CTO-PCI的可行性与安全性  

The feasibility and safety of trans ipsilateral brachial-radial artery intervention for the patients with chronic total coronary occlusion lesions

作　　者：游琼 钟一岳 莫海亮 林余标 陈陆军 袁朝汉 吴铿 YOU Qiong;ZHONG Yiyue;MO Hailiang;LIN Yubiao;CHEN Lujun;YUAN Chaohan;WU Keng(Department of Cardiology,The Affiliated Hospital,Guangdong Medical University,Zhanjiang,Guangdong,524001,China;Interventional Operation Room,The Affiliated Hospital,Guangdong Medical University,Zhanjiang,Guangdong,524001,China)

机构地区：[1]广东医科大学附属医院心血管内科,广东湛江524001 [2]广东医科大学附属医院介入手术室

出　　处：《临床心血管病杂志》2021年第8期753-757,共5页Journal of Clinical Cardiology

基　　金：广东医科大学附属医院复杂高危冠脉介入治疗团队建设项目(No:10201DF20190255)。

摘　　要：目的:分析经同侧肱-桡动脉介入(TB-RI)与经同侧股-桡动脉介入(TF-RI)治疗冠状动脉慢性闭塞性病变(CTO)的临床可行性、安全性并对比其疗效。方法:本研究为前瞻性队列设计。纳入2016年6月—2020年6月在广东医科大学附属医院行经皮冠状动脉介入治疗(PCI)的CTO患者287例,随机分为TB-RI组(138例)和TF-RI组(149例)。比较两组患者PCI情况和住院期间相关临床指标。结果:与TF-RI组相比,TB-RI组术后绝对卧床时间[(18.42±7.81)h∶(7.41±3.45)h,P<0.001]、术后住院时间[(6.09±2.22)d∶(4.45±1.15)d,P<0.001]均降低;TB-RI组患者迷走神经反射(10.7%∶2.9%,P<0.001)和动脉入路血肿发生率(8.1%∶2.2%,P<0.001)明显降低;TB-RI组动脉痉挛发生率高于TF-RI组(0.7%∶3.6%),但无明显统计学差异(P=0.109);两组动脉入路穿刺时间、指引导管置入时间、双侧造影操作完成时间、整个手术时程和PCI成功率无统计学差异。结论:TB-RI治疗CTO安全可行,可减轻患者血管路径并发症的发生,并缩短术后卧床时间及住院时间,有利于患者PCI术后的早日康复,是CTO-PCI动脉路径的选择之一。Objective:To compare the clinical feasibility and safety between trans ipsilateral brachial-radial artery intervention(TB-RI)and trans ipsilateral femoral-radial artery intervention(TF-RI)for the patients with chronic total coronary occlusion lesions(CTO).Methods:This was a prospective cohort study.Total of 287 cases admitted to the Affiliated Hospital of Guangdong Medical University from June 2016 to June 2020 were divided into the TB-RI group(n=138)and TF-RI group(n=149).The PCI procedure and clinical events during hospitalization between the two groups were compared.Results:Compared with the TF-RI group,the time of postoperative bed rest and postoperative hospitalization were decreased in the TB-RI group([7.41±3.45]h vs[18.42±7.81]h,[4.45±1.15]d vs[6.09±2.22]d,P<0.001),meanwhile the incidence of the vagusnerve reflex and arterial pathway hematoma were also decreased(2.9%vs 10.7%,2.2%vs 8.1%,P<0.001).The incidence of arterial spasm in TB-RI group was higher than that in TF-RI group,however,there were no significantly difference(P<0.109).There was no significantly difference in the time of arterial approach puncture,guiding catheter insertion,bilateral coronary angiography,PCI procedure,and the success rate between TB-RI group and TF-RI group.Conclusion:TB-RI,a safe and feasible procedure,can reduce the occurrence of artery access complications and shorten postoperative bedtime and hospital stay,which is beneficial to the early recovery of patients after PCI,and is one of the choices of CTO treatments.

关 键 词：慢性闭塞性病变 介入治疗 冠状动脉造影 

分 类 号：R543.3[医药卫生—心血管疾病]