经远端桡动脉入径行二次经皮冠状动脉介入治疗的可行性、安全性和手术时机研究  

Feasibility,Safety and Timing of Secondary Percutaneous Coronary Intervention via Distal Transradial Artery Approach

作　　者：刘明浩 王攀 高立建 徐淑清[3] 王欢欢 赵光贤 陈珏 乔树宾 徐波 袁晋青 LIU Minghao;WANG Pan;GAO Lijian;XU Shuqing;WANG Huanhuan;ZHAO Guangxian;CHEN Jue;QIAO Shubin;XU Bo;YUAN Jinqing(Coronary Artery Disease Center,Department of Cardiology,Fuwai Hospital,CAMS&PUMC,Beijing 100037,China;Department of Cardiology,Fifth Division Hospital of Xinjiang Production and Construction Corps,Bole 833400,China;Department of Cardiology,Changchun People's Hospital,Changchun 130051,China;Department of Cardiology,Yanbian University Hospital,Yanji 133099,China)

机构地区：[1]中国医学科学院阜外医院心内科冠心病中心,北京市100037 [2]新疆生产建设兵团第五师医院心内科,新疆维吾尔自治区博乐市833400 [3]吉林省长春市人民医院心内科,130051 [4]延边大学附属医院心内科,吉林省延吉市133099

出　　处：《中国全科医学》2023年第27期3366-3372,共7页Chinese General Practice

基　　金：国家科技支撑计划(2016YFC1301301)。

摘　　要：背景经远端桡动脉入径(dTRA)行经皮冠状动脉介入治疗(PCI)能有效降低桡动脉闭塞发生率,但目前国内尚无关于dTRA行二次PCI可行性、安全性及手术时机的研究报道。目的探讨d TRA行二次PCI的可行性、安全性及手术时机。方法连续纳入2021年7月—2022年7月中国医学科学院阜外医院收治的拟dTRA行二次PCI的患者70例,根据距上次dTRA行PCI时间间隔将其分为≤30 d组(n=33)与>30 d组(n=37)。比较两组患者一般临床资料、操作相关指标、冠状动脉病变情况及术前、术后24 h桡骨茎突近心端5、10、15 cm处桡动脉内径。结果70例患者中69例dTRA穿刺、置管均成功,成功率为98.6%(69/70);经评估需行二次PCI的67例患者中66例成功完成二次PCI,成功率为98.5%(66/67)。两组患者年龄、血小板计数、糖尿病发生率、病变血管支数、美国心脏病学会(ACC)/美国心脏协会(AHA)冠状动脉病变分型比较,差异有统计学意义(P<0.05)。两组患者均于术后3 h解除加压包扎,术后即刻、术后24 h均可触及穿刺侧桡动脉搏动,无一例出现桡动脉闭塞,桡动脉通畅率为100.0%(69/69)。≤30 d组患者术前、术后24 h桡骨茎突近心端5、10、15 cm处桡动脉内径均大于>30 d组(P<0.05);≤30 d组患者术后24 h桡骨茎突近心端15 cm处桡动脉内径小于术前,>30 d组患者术后24 h桡骨茎突近心端5 cm处桡动脉内径大于术前(P<0.05)。结论d TRA行二次PCI安全、可行,且无论距首次dTRA行PCI时间是≤30 d还是>30 d,均能满足dTRA行二次PCI的血管条件,临床可根据患者病情及穿刺部位等决定dTRA行二次PCI手术时机。Background Percutaneous coronary intervention(PCI)via distal transradial artery approach(dTRA)is effective in reducing the incidence of radial artery occlusion,however,there are no reports on the feasibility,safety and timing of secondary PCI via dTRA domestically.Objective To explore the feasibility,safety and timing of secondary PCI via dTRA.Methods A total of 70 patients who were to undergo secondary PCI via dTRA in Fuwai Hospital,CAMS&PUMC from July 2021 to July 2022 were consecutively included and divided into≤30 d group(n=33)and>30 d group(n=37)according to the time interval since the last PCI via dTRA.The general clinical data,operation-related indicators,coronary artery lesions and radial artery inner diameters at 5,10 and 15 cm proximal to the radial styloid process before and 24 h after PCI were compared between the two groups.Results The dTRA puncture and catheterization were successfully conducted in 69 of 70 patients,with a success rate of 98.6%(69/70).Second PCI via dTRA was successfully completed in 66 of 67 patients assessed for secondary PCI,with a success rate of 98.5%(66/67).There were significantly difference in age,platelet count,incidence of diabetes,number of lesioned vessels and ACC/AHA coronary artery lesions typing(P<0.05).The compression bandage was released 3 h after surgery,and the radial artery pulsation on the puncture side was palpable immediately and 24 h after surgery,and none of the patients occurred radial artery occlusion,with the radial artery patency rate of 100.0%(69/69).The radial artery inner diameters at 5,10 and 15 cm proximal to the radial styloid process in≤30 d group were significantly greater than that in>30 d group before and 24 h after PCI when comparing between the two groups,respectively(P<0.05).Radial artery inner diameter at 15 cm proximal to the radial styloid process 24 h after PCI was smaller than that before surgery in≤30 d group,radial artery inner diameter at 5 cm proximal to the radial styloid process 24 h after PCI was smaller than that before su

关 键 词：冠心病 冠状动脉疾病 经皮冠状动脉介入治疗 桡动脉 远端桡动脉 再手术 治疗结果 安全 

分 类 号：R541.4[医药卫生—心血管疾病] R543.3[医药卫生—内科学] R654.33[医药卫生—临床医学]