老年患者经皮左、右桡动脉入路冠状动脉造影的比较

Comparison of percutaneous left and right radial approach for coronary angiography in Elderlyaged patients

目的：探讨在老年患者中经左、右桡动脉入路行择期冠状动脉造影（CAG）的安全性和有效性。方法将502例择期行经桡动脉CAG检查的65岁及以上患者，按随机数字表法分为经左桡动脉入路组（240例）及经右桡动脉入路组（262例）。比较两组患者操作成功率、手术时间、透视时间、放射剂量、术后并发症等方面的差异。结果经左桡动脉入路组成功率96.2%（231/240），经右桡动脉入路组成功率96.2%（252/262），两组成功率比较差异无统计学意义（P＞0.05）。两组桡动脉穿刺时间、造影时间、透视时间、对比剂用量、累积皮肤表面入射剂量及剂量面积值比较差异无统计学意义（P＞0.05）。经左桡动脉入路组导管到位时间比经右桡动脉入路组明显缩短，差异有统计学意义[（2.7±2.5）min比（3.3±3.3）min，P＝0.036]。虽然经左桡动脉入路组手术时间有缩短趋势，但与经右桡动脉入路组比较差异无统计学意义[（13.3±6.1）min 比（14.3±6.2）min，P＝0.075]。结论在老年患者中经左桡动脉入路行CAG对比经右桡动脉入路成功率和安全性相似，而且还能有效缩短导管到位时间，有可能减少手术时间，可以作为经桡动脉入路行择期CAG的首选入路或备用入路。

Objective To explore the safety and feasibility of coronary angiography （CAG） via percutaneous left radial artery approach （LRA） compared with right radial artery approach （RRA） in aged patients, and determine whether LRA is a valid alternative for CAG. Methods A total of 502 consecutive patients who were aged 65 or older underwent diagnostic CAG were recruited and randomized to the LRA group （240 patients） or RRA group （262 patients）. The study end points included total procedural duration, coronary time, fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications. Results Coronary procedural success rate was 96.2%（231/240） in LRA group and 96.2%（252/262） in RRA group. There was no significant difference （P〉0.05）. The radial cannulation time, fluoroscopy time, look through time, dose of radiation, contrast volume and the percentage of hydrophilic wire used in two group had no significant difference （P 〉 0.05）. The catheter in place time in LRA was significantly shorter than that in RRA group：（2.7 ± 2.5） min vs. （3.3 ± 3.3） min, P=0.036）. There was a trend toward shorter procedural duration in LRA group than that in RRA group, but there was no significant difference： （13.3 ± 6.1） min vs. （14.3 ± 6.2） min, P=0.075. Conclusions LRA approach has similar safety and feasibility in terms of performing coronary angiography compared with RRA.It seems to be a feasible alternative for CAG in aged patients.