经桡动脉介入治疗在急性冠脉综合征患者中的临床应用

The application on transradial artery access for primary percutaneous coronary intervention in patients with acute coronary syndrome

目的观察急性冠脉综合征(ACS)患者经桡动脉入径行经皮冠状动脉介入治疗(PCI)的安全性及其疗效。方法选择2003年7有至2006年5月我院收治的157例临床诊断为急性冠脉综合征患者,分为经桡动脉穿刺冠状动脉成形术(TRCA)组71例和经股动脉穿刺冠状动脉成形术(TFCA)组76例。观察两组手术的成功率、介入治疗时间、并发症等。结果两组病例基本特征比较差异无统计学意义。TRCA组与TFCA组插管成功率比较差异无统计学意义(97.2%比98.6%,P>0.05)。从穿刺到指引导管撤出时间,TRCA组为(51.2±18.3)min,TFCA组为(46.7±16.9)min,两组比较差异无统计学意义(P>0.05)。术后与穿刺相关的并发症,TRCA组出现桡动脉痉挛2例,局部血肿1例。TFCA组出现局部血肿3例,迷走反射5例,假性动脉瘤1例,排尿困难6例,腰痛4例。结论对ACS患者,两种入径的PCI治疗时程和效果相似,但TRCA治疗血管、出血、血栓/栓塞并发症少,且有利于有效安全的抗凝治疗,可作为ACS可选择的血管途径之一。

Objective To observe the safety and effect of transradial coronary angioplasty （TRCA） in patients with acute coronary syndrome. Methods A total of 157 patients admitted from July 2003 to May 2006 with acute coronary syndrome undergoing angionlasty were randomized to have their procedure performed from either the radial or femoral access sites.Primary success rate and compucations were also examined. Results There was significant difference between the two groups in basic characteristics.The artery puncture and aculation success rates （97.2% vs 98.6%,P〉0.05 ）,and the angioplasty success rates （97% vs 96%,P〉0.05） were obtained. There was significant difference between the two groups in total procedural time[（51.2±18.3）min vs （46.7±16.9）min,P〉 0.05 ]. Post-operation complications in the TRCA group included radial spasm in 2 patients and local hematoma in 1 patient. In the TFCA group, local hematoma in 3 cases,vagus reflex in 5 patients, pseudo aneurysm in 1 patient, difficultly in micturating in 6 patients and lumbar pain in 4 patients were recorded after the operation. Conclusion Coronary intervention via the transradial approach is a safe and feasible alternative to the conventional transfemoral approach ,with relatively fewer vascular complications and more comfort for the patient with acute coronary syndrome.