经桡动脉入径与腕背支动脉入径穿刺行经皮冠脉介入治疗的疗效比较  

Efficacy comparison of percutaneous coronary interventional therapy by puncture of the transradial artery access and dorsal carpal artery access of the wrist

作　　者：梁燕敏 段舒晨 李刚 王旭 刘伟 王艳琳 石凤霞 Liang Yanmin;Duan Shuchen;Li Gang;Wang Xu;Liu Wei;Wang Yanlin;Shi Fengxia(Cangzhou People's Hospital,Cangzhou 061000,Hebei,China)

机构地区：[1]沧州市人民医院,河北沧州061000

出　　处：《中国中西医结合急救杂志》2023年第3期329-332,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省沧州市科技计划项目(204106020)。

摘　　要：目的比较经桡动脉入径(TRA)穿刺与腕背支动脉入径(DCAA)穿刺行经皮冠脉介入治疗(PCI)的优缺点,观察PCI术后应用硫酸氢氯吡格雷和替格瑞洛对并发症发生率的影响。方法选择沧州市人民医院2020年11月至2021年4月确诊为冠心病需行PCI的128例患者作为研究对象。根据桡动脉穿刺入路不同将患者分为TRA组(65例)和DCAA组(63例),TRA组穿刺成功64例(穿刺成功率98.46%);DCAA组穿刺成功56例(穿刺成功率88.89%),最终TRA组纳入64例,DCAA组纳入56例。比较两组穿刺时间、术后出血时间的差异;再将PCI术后患者按服用血小板抑制药物不同分为硫酸氢氯吡格雷组和替格瑞洛组,观察术后使用硫酸氢氯吡格雷和替格瑞洛对穿刺部位并发症(如出血、血肿、动脉闭塞、血栓)发生率的影响。结果TRA组穿刺时间较DCAA组明显缩短(s:154.95±3.93比168.16±5.24,P<0.05),术后出血时间较DCAA组明显延长(s:278.78±4.53比142.25±1.54,P<0.05)。DCAA组术后应用硫酸氢氯吡格雷治疗后血肿发生率较应用替格瑞洛明显升高〔10.71%(3/28)比0%(0/28),P<0.05〕;TRA组应用硫酸氢氯吡格雷治疗后血肿、动脉闭塞、血栓发生率均较应用替格瑞洛明显升高〔18.75%(6/32)比3.13%(1/32)、9.38%(3/32)比0%(0/32)、12.50%(4/32)比0%(0/32),均P<0.05〕,应用硫酸氢氯吡格雷和替格瑞洛后两组均无出血事件发生。结论DCAA是一种安全可行的新型PCI入路方式,为患者和PCI医生提供了其他选择,在患者舒适度方面更有优势。替格瑞洛和硫酸氢氯吡格雷均有血小板抑制作用,且替格瑞洛的血小板抑制作用优于硫酸氢氯吡格雷,应用替格瑞洛在血肿、桡动脉闭塞及血栓等并发症发生率方面相对较低,而在出血事件方面,替格瑞洛和硫酸氢氯吡格雷无差异。Objective To compare the advantages and disadvantages of percutaneous coronary intervention(PCI)with transradial artery access(TRA)and dorsal carpal artery access(DCAA),and investigate the incidence of postoperative complications between Clopidogrel bisulfate sulfate and Ticagrelor after PCI.Methods A total of 128 patients diagnosed with coronary heart disease and did PCI in Cangzhou People's Hospital from November 2020 to April 2021 were selected as the study objects,and the patients were divided into TRA group(65 cases)and DCAA group(63 cases)according to different radial artery approach.There were 64 successful cases in TRA group(puncture success rate 98.46%)and 56 successful puncture cases in the DCAA group(puncture success rate 88.89%).Finally,64 cases were included in the TRA group and 56 cases in the DCAA group.The time of puncture,the time of postoperative bleeding were compared between the two groups.After PCI,the patients were divided into Clopidogrel bisulfate sulfate group and Ticagrelor group according to different platelet inhibition drugs,to observe the effects of Clopidogrel bisulfate sulfate and Ticagrelor on the incidence of complications(such as bleeding,hematoma,aneurysm,artery occlusion,and thrombosis)at the puncture site.Results The time of puncture in TRA group was significantly shorter than that in DCAA group(seconds:154.95±3.93 vs.168.16±5.24,P<0.05),and the time of postoperative bleeding in TRA group was significantly longer than that in DCAA group(seconds:278.78±4.53 vs.142.25±1.54,P<0.05).The incidence of hematoma in DCAA group after treatment with Clopidogrel bisulfate sulfate was significantly higher than that with Ticagrelor[10.71%(3/28)vs.0%(0/28),P<0.05],hematoma,arterial occlusion and thrombus in TRA group after Clopidogrel bisulfate treatment were significantly higher than Ticagrelor treatment[18.75%(6/32)vs.3.13%(1/32),9.38%(3/32)vs.0%(0/32),12.50%(4/32)vs.0%(0/32),all P<0.05].There is no bleeding events in both groups after the application of Clopidogrel bisulfate sulfate

关 键 词：经皮冠脉介入治疗 桡动脉通路穿刺 腕背支动脉通路穿刺 硫酸氢氯吡格雷 替格瑞洛 

分 类 号：R259[医药卫生—中西医结合]