经桡动脉和股动脉途径PCI治疗高龄冠心病患者的临床效果分析

Analysis on the Clinical Effects of Transradial and Femoral Approaches for Percutaneous Coronary Interventions Treatment on Elderly Patients with Coronary Heart Disease

目的:评价经桡动脉和股动脉途径PCI治疗高龄冠心病患者近期和远期临床效果。方法:选取2007年1月至2012年2月在我院行PCI治疗且年龄≥80岁的冠心病患者237例,按照患者入院PCI治疗途径分为经桡动脉途径组(Ⅰ组,n=114)和经股动脉途径组(Ⅱ组,n=123)。记录和比较两组患者的手术效果、术后卧床时间和住院时间、术后并发症和主要不良心血管事件的发生情况。结果:两组患者置入支架数、支架直径、支架长度、手术时间、对比剂用量、对比剂肾病和手术成功率比较差异均无统计学意义(P>0.05)。Ⅰ组11.4%患者PCI过程中需更改介入路径,发生率显著高于Ⅱ组(P<0.05);Ⅰ组患者术后卧床时间和住院时间分别为(4.8±1.4)h和(1.7±1.1)d,均显著短于Ⅱ组患者(P<0.05);Ⅰ组患者血管并发症、围术期TIMI小出血和围术期TIMI大出血的发生率均明显低于Ⅱ组患者(P<0.05);随访12个月和24个月时,两组患者主要不良心血管事件的发生率比较差异均无统计学意义(P>0.05)。结论:经桡动脉途径行PCI治疗高龄(≥80岁)冠心病患者具有时间短、出血等并发症少的优势,近期效果优于股动脉径路,但远期临床效果与股动脉径路相当。

Objective： To investigate the short-term and long-term clinical effect of transradial and femoral approaches for percutaneous coronary interventions treatment on elderly patients with coronary heart disease. Methods： 237 cases of patients with coronary heart disease who were aged≥80 years for PCI treatment were selected from January 2007 to February 2012. All the cases were divided into transradial group（group Ⅰ, n=114） and femoral group（Ⅱ group, n=123）. The surgical results, postoperative bedridden time and hospital stay, incidence of postoperative complications and major adverse cardiovascular events were recorded and compared between the two groups. Results： No significant difference was observed in the numbers of stent placement, stent diameters, stent lengths,operation times, the amount of contrast agents, contrast-induced nephropathies and surgical success rate between the two groups（P0.05）.11.4% of patients in group Ⅰ needed to change the involved path in the PCI process, the rate was much higher than that of groupⅡ（P0.05）. The bedridden time and hospital stay of group Ⅰ were respectively（4.8±1.4） h and（1.7±1.1） d, which were obviously shorter than those of group Ⅱ（P0.05）. The incidence rates of vascular complications, perioperative TIMI minor bleeding and perioperative TIMI major bleeding of group Ⅰ were all significantly lower than those of groupⅡ（P0.05）. Followed up for 12 months and 24 months, no significant difference was found in the incidence rates of major adverse cardiovascular events between the two groups（P0.05）.Conclusion： Transradial PCI had the advantages of shorter hospital stay and lower incidence of bleeding and other complications in the treatment of elderly（≥80 years） patients with coronary heart disease. Its short-term efficacy was better than that of femoral PCI, but the long-term efficacy was equal to that of femoral PCI.