经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死的对比研究  

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

作　　者：傅向华[1] 马宁[1] 刘君[1] 吴伟力[1] 谷新顺[1] 李世强[1] 姜云发[1] 屈长强[1] 李亮[1] 郝国桢[1] 刘晓堃[1] 王占启[1] 田英平[1] 

机构地区：[1]河北医科大学第二医院河北医科大学心脏介入中心,石家庄050000

出　　处：《中华心血管病杂志》2003年第8期573-577,共5页Chinese Journal of Cardiology

摘　　要：目的　对经桡动脉与股动脉入径直接经皮冠状动脉介入 (TRA pPCI与TFA pPCI)治疗急性心肌梗死 (AMI)的临床可行性、安全性及其疗效进行对比研究。方法　 2 0 0 0年 9月至 2 0 0 2年 8月期间 ,2 0 8例 [男性 159例 ,女性 49例 ,平均年龄 (58 9± 11 9)岁 ]发病在 12h内的AMI患者 ,随机分为TRA pPCI组 10 6例 ,TFA pPCI组 10 2例。比较两种入径 pPCI各操作时程和疗效及术后出血、血栓 /栓塞和血管并发症 ;观察桡动脉痉挛发生率并评价药物预防和解痉效果。并随访比较TRA pPCI组术后 1个月双侧桡动脉内径和血流速度及桡动脉血管并发症。结果　TRA pPCI组和TFA pPCI组各 2例患者因入径血管困难而交叉调组。TRA pPCI组PCI处理病变血管 10 6支 ,其中完全闭塞病变 2 8支。TFA pPCI组PCI处理病变血管 10 2支 ,完全闭塞 3 4支。两组患者在桡 /股动脉穿刺时间、指引导管置入时间、病人到达医院至球囊开始扩张时间、总pPCI时程无明显差异 [(18 3± 3 3 )s比 (16 9± 4 2 )s ;(6 0± 1 6)min比 (5 8± 0 9)min ;(45 3± 19 6)min比 (42 8± 2 2 7)min ;(49 2± 2 4 1)min比 (46 5± 2 6 4)min ,P均 >0 0 5]。两组一次入径血管穿刺成功率、梗死相关动脉 (IRA)开通率和PCI成功率亦相似 (93 4%比 96 1% ;10 0 %比Objective To compare the feasibility,safety with outcome of transradial artery with transfemoral artery access for primary percutaneous c oronary intervention (PCI) in patients with acute myocardial infarction(AMI) Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49,age 58 9±11 9 (34-88) years, were randomly divided into transradial artery access for primary PCI (TRA-pPCI) group of 106 cases and transfemoral artery access for primary PCI (TFA-pPCI) group of 102 cases during Sept, 2000 to Aug, 2002 The protocols of the manipulation duration and the effect as well the incidence of complications such as bleeding, vessel injury,thrombi and embolism of TRA-pPCI and TFA-pPCI procedures were compared respectively The incidence of vessel spasm was observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated The inner diameter and blood velocity of the right and left radial artery as well the complications of radial artery were compared following up 1 month after TRA-pPCI procedure, respectively Results Two cases in each of TRA-pPCI and TFA-pPCI group were crossed over each other because of the failed procedure of the transradial or transfemoral access One handred and six vessels associated with 28 vessels of total occlusion in TRA-pPCI group and 102 vessels with 34 vessels in total occlusion in TFA-pPCI group were angioplasticized There were no significant difference in the averagetime of puncture in access artery,of engaging in target vessels of guiding catheters,door to balloon and of the total procedure of PCI between the two groups (18 3±3 3s vs 16 9±4 2s;6 0±1 6min vs 5 8±0 9min;45 3±19 6min vs 42 8±22 7min; 49 2±24 1min vs 46 5±26 4min,P>0 05) The successful rates of the first time puncture in access artery, the re-patence IRA and pPCI were similar in TRA-pPCI and TFA-pPCI groups (93 4% vs 96 1%;100% vs 100%;96 2% vs 97 1%,P>0 05) The access artery complications such a

关 键 词：桡动脉 股动脉 经皮冠状动脉介入治疗 急性心肌梗死 心肌梗塞 血管成形术 

分 类 号：R542.22[医药卫生—心血管疾病]