两种不同手术路径行急诊PCI的对比研究

Two different surgical pathways for urgent percutaneous coronary intervention

目的对比经桡动脉和经股动脉两种不同途径在急诊经皮冠状动脉介入（PCI）治疗中的优劣势，探讨经桡动脉途径行急诊冠脉介入治疗在基层医院的可行性。方法将90例急性心肌梗死患者随机分为桡动脉组45例（经桡动脉介入治疗）和股动脉组45例（经股动脉介入治疗），均行急诊PCI，对比两组病人的门球时间（接诊到球囊开放的时间）、手术成功率、并发症发生率、X线曝光时间、住院天数。结果两组病人在门球时间[（92．0±6．1）minVS．（89．0±5．4）minl、手术成功率（93．3％vs．95．6％）方面无显著差异（P〉0．05），但桡动脉组并发症发生率更低（4．5％VS．13．0％，P〈0．05），住院天数也明显缩短[（6．3±1．5）d vs．（8．6±2．1）d，P〈0．01]，桡动脉组的X线曝光时间较股动脉组高但无显著差异（P〉0．05）。结论在急诊冠脉介入治疗中，经桡动脉途径行冠脉介入治疗手术成功率高，患者痛苦少、血管并发症少，适合在基层医院开展，但前提是必须先积累大量的经股动脉冠状动脉介入治疗术和经桡动脉冠脉造影术的实践经验。

Objective To compare the advantages and disadvantages in urgent percutaneous coronary inter- vention （ PCI ） with transradial or transfemoral approach, and to explore the feasibility of urgent PCI with transradial approach in primary hospitals. Methods 90 patients with acute myocardial infarction who needed interventional therapy were divided into transradial approach group （ n --- 45 ） and transfemoral approach group （ n = 45 ）. Time to balloon opening after medical visit, success rate of the procedures, incidence rate of complications, duration of X-ray exposure, and length of hospital day were compared between the two groups. Results The success rate of the procedures, time to balloon opening after medical visit, and duration of X-ray exposure did not differ significantly between the two group （ P 〉 0.05 for all comparisons ）. Length of hospital day were shortened and rate of c^mplications were lowered in the transradial procedure group （ P 〈 0.01 and P 〈 0.05 ）. Conclusions Urgent percutaneous coronary, intervention with transradial approach has a higher success rate and fewer complications, can relieve the pain level in patients, and is suitable to apply in primary hospital. But the prerequisite is accumulation of large amount of experience on transfemoral coronary intervention and transradial coronary angiography.