保持穿刺点远端血流通畅对减少急性冠脉综合征患者桡动脉闭塞发生率的影响  

Effect of maintaining the distal blood flow unobstructed at the puncture point on reducing the incidence of radial artery occlusion in patients of acute coronary syndrome

作　　者：赵剑峰 朱红涛 芮立美[1] 刘学庆 李斌义[2] 丁晓军 欧阳巍立 龚军辉 ZHAO Jianfeng;ZHU Hongtao;RUI Limei;LIU Xueqing;LI Binyi;DING Xiaojun;OUYANG Weili;GONG Junhui(Department of Cardiology,the Affiliated Danyang Hospital of Nantong University,the People's Hospital of Danyang,Jiangsu Province,Danyang 212300;Department of Ultrasonography,the Affiliated Danyang Hospital of Nantong University,the People's Hospital of Danyang,Jiangsu Province,Danyang 212300)

机构地区：[1]南通大学附属丹阳医院,江苏省丹阳市人民医院心内科,丹阳212300 [2]南通大学附属丹阳医院,江苏省丹阳市人民医院超声科,丹阳212300

出　　处：《南通大学学报（医学版）》2021年第4期327-330,共4页Journal of Nantong University(Medical sciences)

基　　金：镇江市卫生科技重点项目(SHW2015020)。

摘　　要：目的:探讨急性冠脉综合征患者经皮冠状动脉介入术后,穿刺点局部压迫止血的同时保持远端血流通畅的可能性,以及是否能减少桡动脉闭塞(radial artery occlusion,RAO)的发生率。方法:选取南通大学附属丹阳医院住院的经桡动脉介入治疗的急性冠脉综合征患者100例,分为标准方法压迫组(标准组)及远端血流通畅压迫组(通畅组),各50例。记录手术结束时的活化凝血时间(activated clotting time,ACT),并在术后24 h及30 d通过多普勒超声评估桡动脉是否通畅。结果:术后24 h标准组RAO发生率为16.0%,通畅组RAO发生率为5.3%(P=0.003),两组穿刺点并发症差异无统计学意义;但30 d两组RAO的差异有缩小的趋势(10.5%vs 4.6%,P=0.026)。RAO的单变量预测因子是保持远端血流通畅的止血方式、高脂血症、当前吸烟史和更长的手术时间(P<0.05),手术结束时ACT与RAO之间没有关联(P>0.05)。调整协变量后与标准压迫相比,远端血流通畅的止血方式将RAO的风险降低70%。结论:保持远端血流通畅压迫止血方式是可行的,在预防急性冠脉综合征患者早期RAO方面非常有效。Objective:To investigate the possibility of local compression and hemostasis at the puncture point while maintaining the distal blood flow unobstructed after percutaneous coronary intervention in patients with acute coronary syndrome,and whether it can reduce the incidence of radial artery occlusion(RAO).Methods:Patients with acute coronary syndrome who underwent transradial intervention in the Affiliated Danyang Hospital of Nantong University were prospectively enrolled in the study(n=100).Radial haemostasis was obtained using standard radial compression(standard group,n=50)or patent haemostasis(patent group,n=50).An end-of-case activated clotting time(ACT)was recorded and radial artery patency assessed within 24 hours of sheath removal and 30 days after surgery by Doppler ultrasound.Results:The incidence of RAO in the standard group was 16.0%at 24 hours after operation,and the incidence of RAO in the patent group was 5.3%(P=0.003).There was no difference of complications in puncture sites between the two groups.However,the difference in RAO between the two groups was reduced in 30 days(10.5%vs 4.6%,P=0.026).Univariate predictors of RAO were patent haemostasis,hyperlipidaemia,history of current smoking and longer procedure times(P<0.05).There was no association between the end-of-case ACT and RAO(P>0.05).After adjusting the covariates,the hemostasis of the keeping distal blood flow reduced the risk of RAO by 70%compared to standard compression.Conclusion:It is feasible to maintain the distal blood flow and stop the hemostasis.It is very effective in preventing early RAO in patients with acute coronary syndrome.

关 键 词：急性冠状动脉综合征 远端血流通畅 桡动脉闭塞 

分 类 号：R541.4[医药卫生—心血管疾病]