经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和介入治疗研究

Coronary angiography and percutaneous coronary intervention through single transradial guiding MAC

目的评价经桡动脉路径应用单根MAC指引导管在急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者中行急诊冠状动脉造影和介入治疗(percutaneous coronary intervention,PCI)的安全性和有效性。方法入选2013年8月至2013年12月北京通州区潞河医院心内科经急诊室-CCU-导管室途径连续收治的STEMI患者72例,其中男性53例,女性19例,平均年龄(59.1±12.2)岁。随机将患者分为2组,对照组(36例)和MAC组(36例)。对照组常规冠状动脉造影后再用MAC3.5指引导管介入治疗,MAC组直接应用MAC3.5指引导管行冠状动脉造影和介入治疗。记录导管室门-囊(cathlab door to balloon,C2B)时间、门-囊(door to balloon,D2B)时间、造影剂用量、总的操作时间、透视时间、放射剂量面积乘积和穿刺部位并发症等。结果两组患者在PCI术前/后TIMI血流分级、药物使用、介入操作等方面差异无统计学意义(P均>0.05)。与对照组比较,MAC组C2B时间[(22.58±9.94)min vs.(18.38±5.43)min],总的操作时间[(37.65±12.51)min vs.(29.64±11.26)min],透视时间[(10.68±4.42)min vs.(7.80±4.24)min]均减少,差异具有统计学意义(P均<0.05)。MAC组较对照组放射剂量面积乘积降低,差异具有统计学意义(P<0.05)。两组穿刺部位局部血肿比例差异无统计学意义(2.78%vs.2.78%,P>0.05)。结论经桡动脉应用单根MAC3.5指引导管同时行STEMI患者急诊冠状动脉造影和PCI能够缩短C2B时间、透视时间,介入治疗安全有效。

Objective To review the safety and efficacy of single transradial guiding MAC applied in coronary angiography （CAG） and percutaneous coronary intervention （PCI） in patients with ST-segment elevation myocardial infarction （STEMI）.Methods The patients （n=72, male 53, female 19 and average age： 59.1±12.2） were chosen from Aug. 2013 to Dec. 2013, and then divided into control group and MAC group （eachn=36）. The control group was treated with routine CAG and then with MAC3.5 for PCI, and MAC group was treated directly with MAC3.5 for CAG and PCI. The time of C2B, time of D2B, contrast doseage, the total operation time, radiological time, product of radiological dose area and complications at puncture site were recorded.Resutls The difference in TIMI flow grading, drug administration and intervention operation had no statistical significance between 2 groups before/after PCI （allP〉0.05）. Compared with control group, in MAC group time of C2B, [（22.58±9.94） minvs. （18.38±5.43） min], the total operation time, [（37.65±12.51） minvs. （29.64±11.26） min] and radiological time [（10.68±4.42） minvs. （7.80 ±4.24） min] decreased （allP〈0.05）. The product of radiological dose area decreased in MAC group compared with control group （P〈0.05）. The difference in percentage of patients with hematoma at puncture site had no statistical significance between 2 groups （2.78%vs. 2.78%,P〈0.05）.Conclusion The application of single transradial guiding MAC can shorten time of C2B and radiological time, and is safe and effective in patients with STEMI undergone CAG and PCI.