基于倾向性匹配评分的老年患者X线对比超声引导股动脉穿刺的安全性分析  

Safety of X-ray-versus ultrasound-guided femoral artery puncture in elderly patients:an analysis based on propensity score matching

作　　者：闫鹤 张冬燕 郭旭 郭玉清[1] 马宁 张建军 关晓楠 Yan He;Zhang Dongyan;Guo Xu;Guo Yuqing;Ma Ning;Zhang Jianjun;Guan Xiaonan(Department of Interventional Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院介入科,100043 [2]首都医科大学附属北京朝阳医院心脏中心,100043

出　　处：《中华老年心脑血管病杂志》2024年第7期774-778,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 分析老年患者应用X线对比超声引导经股动脉穿刺的安全性。方法 选取2016年1月至2022年12月于北京朝阳医院行经股动脉心脑血管介入治疗的患者480例,采用X线透视引导股动脉穿刺患者326例作为X线组,采用血管多普勒超声引导股动脉穿刺患者154例作为超声组。采用倾向性评分匹配(PSM)以1?1比例进行分组,最终纳入患者270例,分为X线组135例,超声组135例。比较2组一般临床资料、穿刺成功率、穿刺位置及血管并发症。多因素logistics回归分析血管并发症的危险因素。结果 PSM前,2组皮肤皱褶到股总动脉分叉距离、褶皱到腹股沟韧带距离比较无显著差异[(2.5±1.0)cm vs(2.4±0.8)cm,P>0.05;(6.4±1.4)cm vs(6.3±1.7)cm,P>0.05]。PSM后,X线组穿刺位置位于股总动脉分叉以下发生率高于超声组(14.8%vs 6.7%,P<0.05),2组穿刺一次成功率、血管并发症发生率比较无显著差异(P>0.05)。多因素logistics回归分析显示,穿刺位置非股总动脉和股动脉钙化是血管并发症的独立危险因素(OR=8.379,95%CI:3.561~19.717;OR=3.922,95%CI:1.664~9.242)。结论 X线与超声引导股动脉穿刺安全性无显著差异。在临床工作中根据不同患者选择合适的穿刺技术或者结合使用。Objective To assess the safety of femoral artery puncture procedures guided by X-ray and ultrasound among elderly patients.Methods A total of 480patients undergoing transcatheter interventional treatment for cardiovascular and cerebrovascular diseases through the femoral artery in our hospital between January 2016and December 2022were enrolled in the study.Of them,326patients receiving femoral artery puncture guided by X-ray fluoroscopy were assigned into X-ray group,while the other 154patients guided by vascular Doppler ultrasound were into ultrasound group.With propensity score matching(PSM)in a ratio of 1:1,finally 270patients were included.Their general clinical data,success rate of puncture,puncture site,and incidence of vascular complications were compared between the two groups.Multivariate logistic regression analysis was used to identify the risk factors for vascular complications.Results Before PSM,there were no statistical differences in the mean distance from the skin fold to the bifurcation of the common femoral artery(2.5±1.0cmvs 2.4±0.8cm)or the distance from the fold to the inguinal ligament(6.4±1.4cmvs 6.3±1.7cm)between the X-ray group and the ultrasound group(P>0.05).After PSM,the X-ray group exhibited an obviously higher incidence of puncture points below the common femoral artery than the ultrasound group(14.8%vs 6.7%,P<0.05),but no significant differences were observed in the one-time success rate of puncture or the occurrence of vascular complications between the two groups(P>0.05).Multivariate logistic regres-sion analysis indicated that the presences of non-common femoral artery and femoral artery calcification at the puncture site was independent risk factors for vascular complications(OR=8.379,95%CI:3.561-19.717;OR=3.922,95%CI:1.664-9.242).Conclusion There is no statistical disparity in safety between X-ray-versus ultrasound-guided femoral artery puncture procedures.Clinicians should choose appropriate puncture procedure or combine them together based on individual condition of patie

关 键 词：X线 内镜超声引导细针穿刺 超声检查 多普勒 危险因素 LOGISTIC模型 血管并发症 经股动脉穿刺 

分 类 号：R543[医药卫生—心血管疾病]