经桡动脉和股动脉途径对急性ST段抬高型心肌梗死患者行直接介入治疗的对比研究

Comparison of transradial and transfemoral primary percutaneous coronary intervention for patients with ST-segment elevation acute myocardial infarction

目的比较不同途径直接经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的安全性和有效性。方法回顾性分析120例STEMI患者的临床资料,比较经桡动脉PPCI治疗(TRI组,n=62)与经股动脉PPCI治疗(TFI组,n=58)的成功率、疗效和术后并发症的发生率。结果两组建立通路时间、手术操作时间、X-线暴露时间、穿刺成功率、血管开通率[心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流2级]比较有所差别,但差异无统计学意义(P>0.05)。TRI组手术并发症(如假性动脉瘤、拔管时迷走反射、尿潴留),卧床时间及住院时间低于TFI组,差异有统计学意义(P<0.01)。结论经桡动脉途径行PPCI治疗STEMI是安全、有效、可行的方法,与股动脉途径相比,经桡动脉途径术后并发症少,可作为急性心肌梗死PPCI治疗的首选途径,值得临床推广应用。

objectives To evaluate the effectiveness and safety of primary percutaneous coronary intervention（PPCI）via transradial and transfemoral approach in patients with ST-segment elevation myocardial infarction（STEMI）.Methods Clinical data of totally 120 patients with STEMI who received PPCI treatment were retrospectively analyed.Success rate,curative effect and postoperative complications′ rate were compared between transradial PPCI group（TRI group,n=62）,and transfemoral PPCI group（TFI group,n=58）.Results Vascular access construction time,operation time,X-ray exposure time,puncture success rate,reopen rate [thrombolysis in myocardial infarction（TIMI）grade 2 blood flow]were different between the two groups,but there were no statistical significances（P〈0.05）.Compared with TRI group,TFI group had less postoperative complications（pseudoaneurysms,vagal reflex during decannulation and uroschesis）,and reduced bedridden duration and hospital duration（P〈0.01）.Conclusions PPCI via radial artery is safe,effective and feasible.Compared with transfemoral PPCI,transradial PPCI has less postoperative complications.PCI treatment through radial artery can be used as the preferred way of PPCI in acute myocardial infarction,and it is worthy of clinical popularization and application.