急性心肌梗死患者经桡动脉与经股动脉途径急诊PCI治疗的对比研究

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

目的观察经桡动脉途径行急性心肌梗死经皮冠脉介入(PCI)的临床疗效及可行性和安全性。方法2006年2月至2008年2月确诊急性ST段抬高心肌梗死有急诊PCI指征共60例患者入选,随机分为经桡动脉组32例(TRA组)、经股动脉组(TFA组)28例,观察两组的成功率、操作时间和并发症发生率。出院后随访3月,评估术侧桡动脉、股动脉搏动情况及心脏事件发生情况。结果两在处理病变血管支数、病变程度,以及在PCI术操作时间、疗效和成功率等方面均无显著差异。术后TFA组出血等血管并发症发生率明显高于TRA组(P<0.05)。术后三个月随访TRA组仅1例患者出现桡动脉搏动减弱,两组心脏事件发生率及心功能无明显差异。结论经桡动脉途径行急诊PCI是安全和可行的,且有显著优点,可在临床大力推广应用。

Objective To study the feasibility, safety and outcome of percutaneous coronary intervention （PCI） by transradial artery approach in patients with acute myocardial infarction （AMI）. Methods Sixty patients with AMI within 12 hours were randomly divided into transradial artery access for primary PCI （ TRA - pPCI） group and transfemoral artery access for PCI （ TFA - pPCI） group. There were 32 cases in TRA - pPCI group and 28 cases in TFA - pPCI group. The protocols of the manipulation duration, effect, and incidence of complications before and after operation were compared respectively. Results There were no significant differences in the average time of puncture, the number of treated vessels, the degree of pathological change, the total procedure of PCI, effect and successful rates between TRA - pPCI and TFA - pPCI groups. The access artery complications such as bleeding, thrombosis/embolism after operation in TFA - pPCI group were much more than those in TRA - pPCI group （ P 〈 0.05 ）. Conclusion The duration and effect of TRA - pPCI in AMI patients with stable hemodynamics are similar to those of TFA - pPCI. TRA - pPCI may be selected as an access vessel for pPCI in AMI patients with stable hemodynamics.