远端桡动脉入径在老年STEMI患者急诊PCI中的可行性及安全性研究  

Feasibility and safety study of distal radial artery approach in emergency PCI of elderly STEMI patients

作　　者：王辉[1,2] 杨宁[3] 刘迎午 李玉明[3] Wang Hui;Yang Ning;Liu Yingwu;Li Yuming(Clinical School of Cardiovascular Disease,Tianjin Medical University,Tianjin 300457,China;Heart Center,the Third Central Hospital of Tianjin,Tianjin 300170,China;TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,天津300457 [2]天津市第三中心医院心脏中心,天津300170 [3]泰达国际心血管病医院心内科,天津300457

出　　处：《中华心血管病杂志》2024年第3期276-280,共5页Chinese Journal of Cardiology

基　　金：中华心血管病学发展专项基金(Z-2019-42-1908-1)。

摘　　要：目的探讨老年ST段抬高型心肌梗死(STEMI)患者经远端桡动脉行急诊经皮冠状动脉介入治疗(PCI)的疗效及安全性。方法该研究为横断面研究。选取2020年1月—2022年12月就诊于天津市第三中心医院并行急诊PCI的STEMI老年患者,根据穿刺位置不同分为远端桡动脉组和经典桡动脉组。记录2组穿刺成功率、穿刺时间、手术成功率及手术时间;记录患者并发症发生情况,包括桡动脉闭塞率、桡动脉痉挛率、局部血肿率、动脉瘤发生率等。结果远端桡动脉组70例,其中男性33例(47.1%),年龄(65.6±6.7)岁;经典桡动脉组70例,男性35例(50.0%),年龄(66.4±6.9)岁。远端桡动脉组与经典桡动脉组穿刺成功率、穿刺时间、手术成功率及手术时间比较,差异无统计学意义(P>0.05)。远端桡动脉组桡动脉闭塞发生率低于经典桡动脉组,差异有统计学意义(1.4%比8.6%,P=0.024),远端桡动脉组术后压迫时间小于经典桡动脉组,差异有统计学意义[(291.6±10.5)min比(343.5±9.8)min,P=0.047]。2组桡动脉痉挛发生率、局部血肿发生率、动脉瘤发生率比较,差异无统计学意义(P>0.05)。结论经远端桡动脉行急诊PCI的桡动脉闭塞率低,压迫时间短,安全性好,可以作为老年STEMI患者急诊PCI入径应用于临床。Objective To investigate the feasibility and safety of distal radial artery approach in emergency percutaneous coronary intervention(PCI)of elderly ST-segment elevation myocardial infarction(STEMI)patients.Methods This study is a cross-sectional study.Elderly patients with acute myocardial infarction who received emergency PCI at the Third Central Hospital of Tianjin from January 2020 to December 2022 were selected.They were divided into the distal radial artery group and the classic radial artery group based on the puncture location.The success rate,puncture time,surgical success rate,and surgical time of the two groups were observed;The incidence of complications in patients,including radial artery occlusion rate,radial artery spasm rate,local hematoma rate,aneurysm incidence rate were recorded.Results There were 70 cases in the distal radial artery group,including 33 males(47.1%),aged(65.6±6.7)years old;There were 70 cases in the classic radial artery group,including 35 males(50.0%),aged(66.4±6.9)years old.There was no statistically significant difference in puncture success rate,puncture time,surgical success rate,and surgical time between the distal radial artery group and the classical radial artery group(P>0.05).The incidence of radial artery occlusion in the distal radial artery group was significantly lower than that in the classical radial artery group(1.4%vs.8.6%,P=0.024).The postoperative compression time in the distal radial artery group was significantly shorter than that in the classical radial artery group((291.6±10.5)min vs.(343.5±9.8)min,P=0.047).There was no statistically significant difference in the incidence of radial artery spasm,local hematoma,and aneurysm between the two groups(P>0.05).Conclusions The distal radial artery approach has a lower radial artery occlusion rate,shorter compression time,and better safety.It can be used as a new approach for emergency PCI in elderly patients with STEMI for clinical application.

关 键 词：心肌梗死 远端桡动脉 经皮冠状动脉介入治疗 桡动脉闭塞 

分 类 号：R542.22[医药卫生—心血管疾病]