老年冠心病经桡动脉穿刺介入治疗的可行性研究

Transradial approach matched transfemoral approach for coronary intervention in the aged

目的 对比评价老年冠心病经桡动脉穿刺介入治疗的安全性及疗效。方法 沈阳军区总医院心内科于 2 0 0 2 -0 1～ 2 0 0 4 - 0 8对 774例 6 0岁以上的老年冠心病行介入治疗 ,患者按动脉穿刺途径随机分成桡动脉组 (n =382 )和股动脉组 (n =382 ) ,观察两组间动脉穿刺成功率、动脉穿刺时间、手术操作时间、X线曝光时间、造影剂用量、外周血管并发症和术后肺栓塞发生情况。结果 经桡动脉穿刺途径成功共 36 8例 ,经股动脉穿刺途径成功共 372例。两组间动脉穿刺成功率、X线曝光时间、造影剂用量差异无显著性 (P >0 0 5 )。动脉穿刺时间桡动脉组明显多于股动脉组 (P <0 0 5 ) ,外周血管并发症桡动脉组明显少于股动脉组 (P <0 0 5 ) ,在股动脉组术后肺栓塞发生2例 ,而桡动脉组 0例。桡动脉组和股动脉组行血管内超声 (32例∶34例 )和球囊切割术 (38例∶37例 )差异无显著性(P >0 0 5 )。总介入治疗手术成功率为 98 2 % (76 0 /774 )。结论 只要规范化操作 ,老年冠心病的经桡动脉穿刺介入治疗方法安全、可行和有效 ,术后外周血管并发症发生少。

Objective To evaluate the safety and effect of transradial approach for coronary intervention in the aged.Methods There were 774 cases >60 years old with coronary artery disease in hospital from Jan.2002 to Aug 2004 who accepted coronary intervention.They were divided into Tansradial group(TRA,n=382) and Transfemoral group(TRF,n=382).The success rate and time of puncture,x-ray exposure time,procedure duration,dose of dye,complication in puncture site and pulmonary embolism were observed in the two groups.Results 368 out of 382 cases success in TRA group and 372 cases in TRF group.The success rate was not different.The success rate of puncture,x-ray exposure time,procedure duration and dose of dye had no difference between the two groups.But the complication in puncture site and pulmonary embolism were more in TRF group than in TRA group.The coronary intravascular ultrasound and cutting balloon technique were successfully done in two groups.The mean in-hospital time was less in TRA group (2.1±0.6 days) than in TRF group (4.2±1.6days,P<0.05).Conclusion Transradial approach for coronary intervention the in aged is safe and effective so long as standardized manipulation is practised.