不同途径行PCI治疗高龄冠心病患者的临床疗效和安全性比较

Comparison of the Therapeutic Effect and Safety of Percutaneous Coronary Intervention via Different Arteries on the Elderly Patients with Coronary Artery Disease

目的:比较不同动脉途径行经皮冠状动脉介入(PCI)治疗高龄冠心病患者的临床疗效和安全性。方法:选取214例高龄冠心病患者,按动脉途径不同分为对照组(107例)与研究组(107例),对照组行经股动脉PCI(TFI),研究组行经桡动脉PCI(TRI),比较两组的手术情况、手术前后心功能相关指标的变化及不良反应的发生情况。结果:两组手术成功率、支架置入数量、造影剂用量比较无显著差异(P>0.05);研究组动脉穿刺时间、导管插入时间、X线曝光时间均显著长于对照组(P<0.05),术后卧床时间、住院时间均显著少于对照组(P<0.05)。手术后1 d,两组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左心射血分数(LVEF)较手术前均明显改善,但两组比较无显著性差异(P>0.05)。研究组治疗期间外周血管并发症的发生率显著低于对照组(P<0.05),但治疗期间及术后6个月心血管不良事件的发生率与对照组间无显著差异(P>0.05)。结论:经桡动脉途径与股动脉PCI用于治疗高龄冠心病患者对患者心功能的改善作用相当,但经桡动脉行PCI术后卧床时间及住院时间较短,外周血管并发症的发生率较低,安全性更高。

Objective：To compare the clinical efficacy and safety of different arterial approaches for percutaneous coronary intervention（PCI） in elderly patients with coronary heart disease.Methods：214 elderly patients with coronary artery disease were selected and divided into the control group and the study group according to different arterial pathways with 107 cases in each group.The control group underwent transfemoral PCI（TFI） and the study group underwent transradial PCI（TRI）.The operation conditions,changes of cardiac function related indicators before and after surgery and the incidence of adverse reactions were compared between the two groups.Results：There was no significant difference between the two groups in the success rate,the number of stents,and the amount of contrast agent（P〉0.05）.The arterial puncture time,catheter insertion time,and X-ray exposure time were significantly longer in the study group than those in the control group（P〈0.05）,and the bed rest time and length of stay were significantly shorter in the study group than those in the control group（P〈0.05）.The left ventricular end-systolic diameter（LVESD）,left ventricular end-diastolic dimension（LVEDD） and left ventricular ejection fraction（LVEF） were significantly improved on the 1 st day after surgery,but there was no significant difference between the two groups（P〉0.05）.The incidence of peripheral vascular complications during treatment was significantly lower in the study group than that in the control group（P〈0.05）,but there was no significant difference in the incidence of adverse cardiovascular events during the treatment period and at 6 months after surgery（P〉0.05）.Conclusions：Radial artery approach and femoral PCI could improve the heart function in the treatment of elderly patients with coronary heart diseas,the time to stay in bed and the length of stay in the transradial artery after PCI were shorter,the incidence of peripheral vascular complications was lower and the safety was higher.