急性心肌梗死经桡动脉直接经皮冠状动脉介入治疗临床观察

Clinical study of PCI by radial artery approaching in patients with acute myocardial infarction

目的探讨经桡动脉途径对急性心肌梗死患者行直接经皮冠状动脉介入（PCI）治疗的可行性及安全性。方法选取于我院确诊急性心肌梗死患者90例，分为两组：A组（桡动脉径路组）35例，B组（股动脉径路组）55例，比较两组临床基础资料、穿刺成功率、病变特征、PCI术成功率、术后及术后1年内并发症及事件主要心血管（MACE）。结果两组基础资料相似，A、B两组穿刺置管成功率为97．1％vs 100％，穿刺时间为（3．0±1．5）min vs（2．5±1．1）min，手术成功率为94．2％VS98．2％，两组比较差异均无统计学意义（P〉0．05），两组病变特征比较差异无统计学意义，术后平均卧床时间A组（4．5±1．1）h明显短于B组（13．5±3．4）h，术后与穿刺相关的并发症A组明显低于B组（P〈0．05），术后1年内主要心血管事件两组比较差异无统计学意义（P〉0．05）。结论经桡动脉（TRA）对急性心肌梗死患者行直接PCI治疗成功率与经股动脉（TFA）途径相似，并发症少，有良好的安全性及可行性。

Objective To investigate the safety and feasibility of direct percutanous coronary intervention （PCI） by radial artery approaching in patients with acute myocardial infarction. Methods Ninety patients with acute myocardial infarction were divided into two groups： group A（ trans -radial ap- proach group）with 35 cases and group B（trans -femoral approach group）with 55 cases. Clinical datas, puncture results, characteristics of target lesion, status of PCI, successful rate of operation, complication after operation and during one year follow - up were observed. Results The clinical datas were similar, the successful rates of puncture were 97.1% （group A） vs 100% （group B）, the puncture times was （3.0＋l.5）min （group A） vs （2.5_＋1.1） rain （group B）, the successful rates of PCI were 94.2% （group A ） vs 98.2% （group B ）, there was no significant difference between the two groups （P 〉 0. 05）. There were no significant differences of relative infarction and characteristic of target lesion, while the average bed - time after procedure in group A was shorter than that in group B [ （4.5 ± 1.1 ） h vs（13.5±3.4）h]. The ratio of relative complication on pucture and procedure in group A was lower than group B （P 〈 0.05）. The major cardiovascular events （MACE） had no significant difference between the two groups during 1 year following - up. Conclusions The successful rate of trans - radial PCI in patients with acute myocardial infarction is the same as trans - femoral PCI. Trans - radial PCI has less puncture relative complication and is safe and feasible for patients with acute myocardial infarction.