经肱动脉入路对冠状动脉复杂病变介入治疗的回顾性研究

A retrospective study of interventional therapy for complex coronary lesions via brachial artery approach

目的探究桡动脉穿刺失败后经同侧肱动脉途径介入治疗冠状动脉复杂病变的安全性及可行性。方法回顾我院2014年12月至2017年12月16153例介入手术中桡动脉穿刺失败后改用经股动脉、肱动脉入路行冠状动脉复杂病变介入治疗患者141例,其中股动脉组83例,肱动脉组58例,比较2组患者介入治疗成功率、并发症发生率、以及患者术后的生活质量、住院时间。采用SPSS20.0软件进行数据处理。依据数据类型分别采用t检验,Wilcoxon秩和检验和χ^2检验对2组间数据进行比较。结果肱动脉组与股动脉组手术时长与手术成功率差异无统计学意义[(108.35±40.55)vs(104.33±43.57)min,95.2%(79/83)vs91.3%(53/58);P>0.05]。但肱动脉组术后并发症发生率更低[(5.17%(3/58)vs10.84%(9/83),P<0.05]、生活质量改善[(46.15±15.34)vs(33.00±18.01)分,P<0.05]、焦虑程度更低[(51.22±30.11)vs(35.00±27.18)分,P<0.05]、平均住院时间明显缩短[(4.74±1.25)vs(2.52±1.09)d,P<0.05]。结论桡动脉穿刺失败后,改经肱动脉较股动脉入路更有利于患者术后的生活质量和心理状态的改善,不影响复杂介入手术的成功率。

Objective To investigate safety and feasibility of percutaneous coronary intervention(PCI)via ipsilateral brachial artery approach for complex coronary artery lesions after unsuccessful radial artery puncture.Methods A retrospective study was conducted of 141 patients with complex coronary artery lesions,who were treated by PCI via femoral artery approach and brachial artery approach after unsuccessful radial artery puncture in Chinese PLA General Hospital from December 2014 to December 2017.They were divided into femoral group(n=83)and brachial group(n=58).The two groups were compared in success rate,incidence of com-plications,postoperative quality of life,and length of hospitalization.SPSS statistics 22.0 was used for statistical analysis.Student′s t test,Wilcoxon rank test,or Chi-square test was employed for comparison between groups.Results There was no significant difference in the operation time[(108.35±40.55)vs(104.33±43.57)min,P>0.05]and success rate[(95.2%(79/83)vs 91.3%(53/58),P>0.05]between two groups.The brachial group,however,showed a lower incidence of complications(5.17%(3/58)vs 10.84%(9/83)],higher quality of life[(46.15±15.34)vs(33.00±18.01)score],milder anxiety[(51.22±30.11)vs(35.00±27.18)score],and shorter average hospitalization[(4.74±1.25)vs(2.52±1.09)d],the difference being statistically significant(P<0.05 for all).Conclusion PCI via brachial artery approach after unsuccessful radial artery puncture improves post-operative quality of life and psychological state of patients without compromising success rate.