经桡动脉急诊冠状动脉介入治疗的安全性与可行性

A study on the feasibility and safety of emergent percutaneous coronary intervention with transradial access in acute myocardial infarction patients

目的观察给急性心肌梗死(acute myocardial infarction,AMI)患者经桡动脉行急诊冠状动脉介入治疗(percutaneous coronary intervention,PCI)的安全性与可行性。方法选择2004年6月至2005年12月我院收治的289例临床诊断为AMI患者,发病均在12 h内。其中男性患者201例,女性患者88例,平均年龄(55.8±10.9)岁,分为经桡动脉介入(transradial coronary intervention,TRI)组142例与经股动脉介入(transfemoral coronary intervention,TFI)组147例。观察两组穿刺成功率、手术成功率、介入治疗时间、术后与穿刺相关并发症情况。结果TRI组142例患者,包括单支病变的患者82例,多支病变的患者60例,其中完全闭塞病变患者47例。TFI组147例患者,包括单支病变的患者85例,多支病变的患者62例,其中完全闭塞病变患者50例。两组病例基本特征比较差异无统计学意义。TRI组与TFI组手术穿刺成功率比较差异无统计学意义(98.6%比99.3%,P>0.05)。罪犯血管TIMI3级开通率,TRI组与TFI组比较差异无统计学意义(95.1%比93.9%,P>0.05)。从麻醉到第一次球囊扩张时间,TRI组为(29.1±6.2)min,TFI组为(27.5±7.0)min,P>0.05,从麻醉到指引导管撤出时间,TRI组为(47.3±16.0)min,TFI组为(43.0±17.1)min,P>0.05,两组比较差异无统计学意义。术后与穿刺相关的并发症,TRI组出现严重桡动脉痉挛3例,局部血肿2例。TFI组出现局部血肿7例,迷走反射12例,假性动脉瘤2例,排尿困难10例,腰痛5例。结论经桡动脉与经股动脉PCI治疗AMI同样具有较高的成功率,而术后与穿刺血管及其他因素相关的并发症的发生率,经桡动脉组却明显少于经股动脉组。因此桡动脉可作为给AMI患者行急诊PCI的常规途径之一。

Objective To observe the feasibility and safety of emergent percutaneous coronary intervention （PCI） with transradial access in patients with acute myocardial infarction （AMI）. Methods A total of 289 patients （162 males and 127 females, mean age 55.8 ± 10.9 years） admitted from June 2004 to December 2005 with AMI within 12 hours were randomly divided into transradial coronary intervention （TRI） group （ n = 142） and transfemeral coronary intervention （TFI） group （n = 147）. The success rates of puncture and PCI, the anethesia- to-balloon time and the incidence of complications associated with puncture and operation. Results There were 142 target vessels including 47 total occlusion leisons in the TRI group, whereas in the TFI group, three were 147 target vessels and 50 total occlusion leisons. There was no significant difference between the two groups in basic characteristics. The success rates of puncture were similar between the TRI group and the TFI group （98.6% vs. 99.3 %, P 〉 0.05）. There was no statistical difference between the two groups in recanalization with TIMI m flow of culprit vessels （95.1% vs. 93.9%, P〉 0.05）. The anesthesia-to-balloon time was 29.1 ±6.2 min in the TRI group and 27.5 ± 7.0 min in the TFI group （ P 〉 0.05）. There was no significant difference between the two groups in total procedural time （47.3 ± 16.0） min vs. （43.0 ± 17.1） min, P 〉 0.05. Post-operation complications in the TRI group included severe radial spasm in 3 patients and local hematoma in 3 patients. In the TFI group, local hematoma in 7 cases, vagus reflex in 12 patients, pseudo aneurysm in 2 patients, difficultly in micturating in 10 patients and lumbar pain in 5 patients were recorded after the operation. Conclusion Transradial and transfemeral PCI show similar high success rate. The incidence of complications associated with puncture was less in the TRI group than that in the TFI group. Transradial access can be applied as a routine access for emergent PCI with AMI.