经远端桡动脉行急诊冠状动脉介入治疗预防桡动脉急性闭塞  

Distal radial access for primary percutaneous coronary intervention to prevent acute radial artery occlusion

作　　者：齐淑媛 王雨杰 郝明辉[1] 陈文明[1] 杨婧[1] 杨璐 刘冉[1] 柳子静[1] 徐荣[1] 郭金成[1] QI Shu-yuan;WANG Yu-jie;HAO Ming-hui;CHEN Wen-ming;YANG Jing;YANG Lu;LIU Ran;LIU Zi-jing;XU Rong;GUO Jin-cheng(Department of Cardiology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京市101149

出　　处：《中国心血管病研究》2023年第8期684-689,共6页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项(首发2022-2-7086);潞河医院青年孵育科研专项(LHYY2021-LC02)。

摘　　要：目的探讨经远端桡动脉(dRA)路径是否能降低急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后24 h桡动脉闭塞(RAO)发生率。方法连续入选2021年9月至2022年5月于首都医科大学附属北京潞河医院心脏重症监护中心(CCU)住院且行急诊PCI治疗的STEMI患者共308例。按介入路径分为dRA组(n=147例)和近端桡动脉(pRA)组(n=161例),比较两组患者急诊PCI术后24 h超声明确的RAO和直径≥5 cm的血肿发生率。结果dRA与pRA两组患者的穿刺置管成功率相似(94.6%比92.5%,P>0.05)。穿刺至导丝通过病变中位数时间(9 min比8 min,P>0.05)无差异。与pRA组相比,dRA组患者术后24小时的RAO(2.0%比7.5%,P=0.028)及直径≥5 cm的血肿发生率(1.3%比9.9%,P=0.001)均显著降低,穿刺置管中位时间延长[2.4(1.7,4.6)min比1.8(1.5,2.7)min,P<0.001]。结论经dRA路径在不延长血运重建时间前提下,显著降低STEMI患者急诊PCI术后24小时RAO发生率,直径≥5 cm的血肿发生率更低。Objective To investigate whether primary percutaneous coronary intervention(PCI)via distal radial artery(dRA)access reduces the incidence of radial artery occlusion(RAO)at 24 h after the procedure in patients with ST segment elevation myocardial infarction(STEMI).Methods From September,2021 to May,2022,a total of 308 STEMI patients undergoing primary PCI in Beijing Luhe hospital,Capital Medical University,were consistently observed and were divided intu two groups:the dRA group(n=147)and proximal radial artery(pRA)group(n=161).The incidence of RAO and hematoma(≥5 cm)assessed by vascular ultrasound at 24 h after the procedure were compared between the two groups.Results The puncture success rate was 94.6%and 92.5%in dRA group and pRA group,respectively.Puncture to guidewire crossing time was similar between the two groups(9 min vs.8 min,P>0.05).Comparing with pRA group,dRA group had significantly lower incidences of RAO(2.0%vs.7.5%,P=0.028)and hematoma≥5 cm in diameter(1.3%vs.9.9%,P=0.001)at 24 h after the procedure.Longer puncture time was observed in dRA group[2.4(1.7,4.6)min vs.1.8(1.5,2.7)min,P<0.001].Conclusion The dRA access can significantly reduce the incidences of RAO and hematoma(≥5 cm)at 24 h after the primary PCI without prolonging the puncture to guide wire crossing time.

关 键 词：远端桡动脉 ST段抬高型心肌梗死 急诊介入治疗 桡动脉闭塞 

分 类 号：R541.4[医药卫生—心血管疾病]