经桡动脉入路急诊冠状动脉介入治疗的临床研究

Clinical Study on Percutaneous Coronary Intervention with Transtradial Access in Acute Myocardial Infarction Patients

目的:通过对比桡动脉与股动脉入径行急诊冠脉介入治疗的对比研究,来观察急性心梗患者经桡动脉行急诊冠脉介入治疗的安全性和可行性。方法:选择2005年12月至2006年11月我院诊断明确急性心肌梗死(AMI)的患者83例(男性64例),均为血液动力学稳定、桡动脉波动良好、Allen’s试验阳性患者,随机分组。经桡动脉介入组为38例,经股动脉介入组为49例。结果:PCI总成功率为100%,桡动脉组插管成功率为94.7%(36/38),股动脉组插管成功率为100%(49/49),p>0.05,无统计学意义。罪犯血管最终开通率(TIMI3级)桡动脉组为86.8%(33/36)其中2例因导管不能到位改为股动脉入径。股动脉组为91.8%(45/49),p>0.05,无统计学意义。建立动脉通路时间和整个手术时间两组间无明显统计学差异,桡动脉组为45.7±20.3min,股动脉组为48.5±16.3min。p>0.05,无统计学意义。术后出血并发症桡动脉组为0,股动脉组为11%(5/45)。两组间有统计学差异p<0.05。结论:对血流稳定的AMI患者,两种介入途径的PCI治疗时程和效果相似,但桡动脉组并发症明显减少,更有利于治疗安全,可作为AMI患者行急诊PCI的常规途径之一。

Objective： To observe the safety and availability of emergent PCI with transradial access in patients with A-MI. Methods：patients（64male） admitted from Dec 2005to Nov 2006 with AMI within 12 hours were randomly divided into transradial coronalr interventiony （ TPd ） group （ n = 38 ） and transfemoral coronary intervention （TFI） group （ n = 49）. All patients have stable hemodyamically,strong palpable radial pulse and positive allen test. Results：Overall success rate of PCI was 100%. The success rate was 94.7% （36/38）in TRI group and 100% （49/49）in TFI group There was no statistical differernce between the two group in recanalization with TIMI Ⅲ flow of culprit vessel（ 86.9% vs 9.8%, p 〉 0.05 ）. There was no statistical differemce beteen the two group in the carrnulation time（45.7 ±20.3rain vs 48.5±16.3min p 〉 0.05 ） ,There were no Post - operation complications included local hematoma in TFI group. Conclusion： Transrdial and tranfemoral PCI show similar high success rate. The incidence of complications associated with puncture was less in the TRI group than in the TFI group. It is the first alternative for the patients who have hemodynamically,posltive Allen test and strong palpable radial pulse.