经桡动脉介入治疗术后桡动脉闭塞的危险因素及防止闭塞的方法

The Risk Factor Analysis for Radial Artery Occlusion After Transradial Coronary Intervention With its Prevention Method

目的:观察分析经桡动脉介入治疗(TRI)术后桡动脉闭塞的危险因素,探索防止桡动脉闭塞的有效方法。方法:2008-06至2010-04期间来我院就诊的TRI的患者2 658例,根据术后有无桡动脉搏动减弱的情况分为搏动减弱组187例和正常组2 471例。通过多因素Logistic回归分析桡动脉搏动减弱的危险因素。观察阻断同侧尺动脉血流恢复桡动脉搏动并探索防止桡动脉闭塞的有效性。结果:搏动减弱组患者女性比例、既往TRI比例、鞘管留置时间、术后压迫时间均高于正常组,差异均有统计学意义(P均<0.001);而有创收缩压水平搏动减弱组低于正常组,差异有统计学意义(P<0.05)。多元逐步Logistic回归分析发现桡动脉搏动减弱的发生与鞘管留置时间、术后压迫时间和有创收缩压呈明显相关性。血管超声多普勒观察187例搏动减弱组穿刺侧的桡动脉比对侧的桡动脉舒张期、收缩期血流速度降低,差异均有统计学意义(P<0.001)。通过压迫同侧尺动脉后,使得187例搏动减弱组患者中185例(98.93%)患者桡动脉搏动恢复。结论:鞘管留置时间长、术后压迫时间长、有创收缩压低是桡动脉搏动减弱的危险因素。桡动脉舒张期血流速度显著降低可以认为是桡动脉闭塞的预测指标。持续阻断同侧尺动脉血流可以恢复桡动脉搏动,有效防止术后桡动脉闭塞。

Objective： To analyze the risk factors of radial artery occlusion（RAO） after transradial coronary intervention（TRI） and to find the effective method for its prevention. Methods： A total of 2658 patients who underwent TRI in our hospital from June 2008 to April 2010 were retrospectively stu-died.The patients were divided into Pulse weakness group,n=187 and Normal group,n=2471 by palpation near the original entry site.The speed of bloodstream at systolic and diastolic period were examined by ultrasound and the related risk factors for radial artery pulse weakness were analyzed by logistic regression model.The RAO prevention was performed by blocking the bloodstream of parallel ulnar artery（UA）. Result： In Pulse weakness group,the female patients＇ ratio and TRI history were higher than that in Normal group,the duration of post-procedure compression and the sheath reservation were longer than that in Normal group（P0.05 respectively）.Multiplicity logistic regression analysis presented that the radial artery pulse weakness was obviously related with the duration of post-procedure compression,sheath reservation and the invasive systolic blood pressure.Ultrasound examination indicated the decreased speed of bloodstream at systolic and diastolic period in pulse weakness patients.By blocking the parallel UA,185 patients（98.93%） had the recovered radial artery pulse. Conclusion： Prolonged duration of post-procedure compression,sheath reservation and decreased invasive systolic blood pressure were the risk factors for radial artery pulse weakness after TRI.The reduced diastolic speed of bloodstream of radial artery should be considered as the RAO predictor.Blocking of parallel UA bloodstream can effectively prevent RAO after TRI.