合并慢性左心衰竭的老年冠心病患者经桡动脉介入治疗的临床评估

Clinical evaluation of transradial approach PCI for elderly CHD patients with chronic heart failure

目的探讨经桡动脉途径介入治疗合并慢性左心衰竭的老年冠心病患者的优势及安全性。方法选择91例合并慢性左心衰竭的老年(>65岁)冠心病患者,其中男69例,女22例,平均年龄(76±6.7)岁。分为经股动脉介入治疗组(对照组41例)和经桡动脉介入治疗组(桡动脉组50例)。观察并对比如下指标:X线曝光时间,术后卧床时间,与穿刺相关的并发症(出血、血肿、无脉征、动-静脉瘘等)发生率,下肢深静脉血栓形成,术后卧床期间急性左心衰竭的发生率,体循环及肺循环栓塞的发生率。结果桡动脉组X线曝光时间平均(46.8±21.3)min,对照组平均(40.2±24.8)min,两组比较差异无统计学意义(P>0.05);桡动脉组术后卧床时间平均(3.4±1.9)h,对照组平均(22.5±8.1)h,两组比较差异有统计学意义(P<0.01);桡动脉组穿刺相关的并发症发生率为4.0%,对照组为9.8%,两组比较差异有统计学意义(P<0.05);桡动脉组术后下肢深静脉血栓形成发生率为0,对照组4.9%,两组比较差异有统计学意义(P<0.05);卧床期间急性左心衰竭的发生率桡动脉组为2.0%,对照组为9.8%,两组比较差异有统计学意义(P<0.01);桡动脉组体循环栓塞发生率为0,对照组为2.4%,两组比较差异有统计学意义(P<0.05);桡动脉组肺栓塞的发生率为0,对照组为2.4%,两组比较差异有统计学意义(P<0.05)。住院期间两组无1例发生死亡。结论对于合并慢性左心衰竭的老年冠心病患者的冠状动脉介入治疗,经桡动脉和股动脉两种径路均是安全可行的,且经桡动脉途径具有更多的优势。

Objective To investigate the advantage and safety of transradial approaeh（TRA）PCl for elderly （＇HI） patients with chronic heart failure. Methods Ninety-one elderly（age 〉 65 years）CHD patients with chronic heart failure[69 males and 22 fe males, mean age （76±6.7）years], who were admilted to this department for PCI, were enrolled in this study. The patients were randomized to TRA group and transfemoral approach group（control）. The indicators for inrestigation and comparsion were as follows：△X-ray exposure time,post-PCI bed staying time,complication rates related to the puncture such as puncture site bleeding, hematoma,radial pulselessness,puncture site artery-venous fistula, leg deep venous thrombosis and acute left heart failure（LHF） rates related to post-PCl bed-staying. Results The X-ray exposure time was （46.8±21.3）min in TRA group and （40.2±24.8） min in the control group（P〉0.05） ;post-PCl bed-staying time was （3.4±1.9）h in TRA group and （22.5±8. 1）h in the control group（P〈0. 01）;the complication rate was 4. 0% in TRA group and 9. 8% in the control group（P〈0. 05）; leg deep venous thrombosis rates were 0 vs 4.9%（P〈0.05）;the acute LHF rates were 2.0% vs 9.8% （P〈0.01）. The rates of systemic emboli and pulmonary embolism were 0 % and 2.4 % in TRA group and control group respectively,with statistical difference between the two groups（P〈0.05）. There was no hospital death in the two groups. Conelusion Both TRA-PCl and transfemoral PCI for elderly CHD patients with chronic heart failure are feasible and safe.