桡动脉途径失败后经肱动脉和股动脉途径行经皮冠状动脉介入治疗的比较研究

Comparison of Transbrachial Artery Approach with Transfemoral Artery Approach in Percutaneous Coronary Intervention after Transradial Failure

目的:探讨桡动脉穿刺失败后经肱动脉或股动脉途径行经皮冠状动脉介入诊疗的可行性及安全性。方法:将232例经桡动脉穿刺失败后行经皮冠状动脉介入治疗的患者随机分为肱动脉组(117例)及股动脉组(115例),比较不同穿刺途径的平均穿刺时间、穿刺成功率、X线曝光时间、术后穿刺点压迫时间以及穿刺部位出血、假性动脉瘤、迷走神经反射发生率等情况。结果:两组患者在穿刺时间、穿刺成功率、X线曝光时间方面比较,差异均无统计学意义(P> 0. 05)。肱动脉组术后穿刺点压迫时间短于股动脉组,差异有统计学意义(P <0. 05)。肱动脉组的假性动脉瘤发生率、拔除鞘管时迷走神经反射发生率均低于股动脉组,差异有统计学意义(P <0. 05)。结论:在经皮冠状动脉介入途径中,桡动脉途径穿刺失败后,肱动脉途径可优先于股动脉途径作为替代途径行冠状动脉介入诊疗。

Objective：To investigate the feasibility and safety of brachial arlery or femoral artery approach in percutaneous coronary intervention （PCI） after the transradial artery approach fails. Methods： After failure in transradial artery approach in PCI, the patients were randomly divided into two groups ： brachial artery approach （ n = 117） and femoral artery approach （ n = 115 ）. The average puncture time, puncture success rate, X-ray exposure time, postoperative compression time and the incidence of bleeding time in the puncture site, pseudoaneurysm, and vagal reflex were compared between the two groups. Results： There was no significant difference in puncture time, puncture success rate and X-ray exposure time between the two groups （ P 〉 0.05 ）. The postoperative compression time of the brachial artery group was significantly shorter than that of the femoral artery group （ P 〈 0.05 ）. In the brachial artery group, the incidence of pseudoaneurysm and vagai reflex after removal of the sheath were significantly lower than those in the femoral artery group（ P 〈 0.05 ）. Conclusion： In the PCI, the brachial artery approach can be prior to the femoral artery approach as a surrogate pathway after the transradial approach fails.