改良止血法降低急性冠状动脉综合征患者经皮冠状动脉介入治疗后桡动脉闭塞的效果

Effect of improved hemostasis on reducing radial artery occlusion after percutaneous coronary intervention in patients with acute coronary syndrome

目的比较改良止血法与标准桡动脉压迫法减少急性冠状动脉综合征(acute coronary syndrome,ACS)患者经桡动脉行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后桡动脉闭塞(radial artery occlusion,RAO)发生的效果。方法纳入2016年5月至2018年11月佛山市中医院经桡动脉PCI治疗的ACS患者300例:术后通过标准桡动脉压迫(n=150)或改良止血法(n=150)进行桡动脉止血。记录了介入结束时激活凝血时间(activated clotting time,ACT)并通过反向Barbeau测验评估24 h内的鞘管去除情况。结果标准桡动脉压迫组的RAO发病率明显高于改良止血法组,差异有统计学意义[16.0%(24/150)vs.5.3%(8/150),P=0.003]。RAO的单变量预测因素是改良止血法(OR=0.30,95%CI:0.13~0.68,P=0.004),高脂血症(OR=0.46,95%CI:0.21~0.98,P=0.04),目前吸烟史(OR=2.65,95%CI:1.21~5.8,P=0.015)和手术时间长(OR=1.03,95%CI:1.01~1.05,P=0.003)。事件结束时ACT和RAO之间没有关联(OR=1.00,95%CI:0.9~1.01,P=1.00)。校正协变量后,与标准桡动脉压迫比较,改良止血法将RAO的风险减少了70%(OR=0.30,95%CI:0.12~0.77,P=0.12)。模型区分能力的c统计量的值是0.79(95%CI:0.71~0.86,P<0.001)。逆处理概率加权分析显示改良止血法是减少RAO的一种独立的预测因素(OR=0.38,95%CI:0.15~0.95,P=0.039)。结论改良止血法对预防ACS患者早期RAO是有效的。

Objectives To compare the effect of improved hemostasis and standard radial artery compression on reducing incidence of radial artery occlusion(RAO)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods Totally 300 patients from May 2016 to November 2018 in Foshan Hospital of Traditional Chinese Medicine treated by radial artery intervention were included in this study.The radial artery hemostasis was performed by standard radial artery compression(n=150)or improved hemostasis(n=150).We recorded the activated clotting time(ACT)at the end of the event and assessed the sheath removal within 24 hours by the reverse Barbeau test.Results Incidence of RAO in standard radial compression group was significantly higher than that in improved hemostasis group[16.0%(24/150)vs.5.3%(8/150),P=0.003].Improved hemostasis(OR=0.30,95%CI:0.13-0.68,P=0.004),hyperlipidemia(OR=0.46,95%CI:0.21-0.98,P=0.04),current prevalence of smoking(OR=2.65,95%CI:1.21-5.8,P=0.015)and longer operative duration(OR=1.03,95%CI:1.01-1.05,P=0.003)were univariate predictive factors of RAO.When the event ended,there was no association between ACT and RAO(OR=1.00,95%CI:0.9-1.01,P=1.00).After adjustment for covariates,improved hemostasis reduced the risk of RAO by 70%(OR=0.30,95%CI:0.12-0.77,P=0.12)when compared to that of standard radial artery compression.The value of the c statistic of the model distinguishing ability was 0.79(95%CI:0.71-0.86,P<0.001).We also demonstrated that improved hemostasis method was an independent predictor of reducing RAO(OR=0.38,95%CI:0.15-0.95,P=0.039)by inverse treatment probability-weighted analysis.Conclusions Improved hemostasis is effective in preventing early RAO in patients with ACS.