桡动脉入路冠状动脉造影+支架植入术治疗老年冠状动脉粥样硬化性心脏病患者疗效及安全性

Efficacy and safety of radial artery approach coronary angiography+intracoronary stenting in the treatment of elderly patients with coronary atherosclerotic heart disease

目的探讨桡动脉入路冠状动脉造影+支架植入术治疗老年冠状动脉粥样硬化性心脏病患者的疗效及安全性。方法将360例老年冠状动脉粥样硬化性心脏病患者按手术入路方式不同分为两组,将193例选择桡动脉入路的患者设为研究组,将167例选择股动脉入路的患者设为对照组。两组给予冠状动脉造影+支架植入术治疗,比较两组手术时间、穿刺时间、造影时间、术后卧床时间,术前及术后3个月末比较两组心功能指标(左室射血分数、左室舒张末期内径),造影相关参数(采集帧数、透视时间、总剂量面积乘积、累积剂量),比较两组术后并发症发生率。结果两组手术时间、穿刺时间比较差异无统计学意义(P>0.05),研究组造影时间、术后卧床时间显著短于对照组(P<0.01)。术后3个月末两组左室射血分数均显著高于术前(P<0.01),左室舒张末期内径均显著小于术前(P<0.01),两组间比较差异无统计学意义(P>0.05)。两组采集帧数比较差异无统计学意义(P>0.05),研究组透视时间显著短于对照组(P<0.01),总剂量面积乘积显著小于对照组(P<0.01),累积剂量显著少于对照组(P<0.01),术后并发症发生率显著低于对照组(P<0.01)。结论桡动脉入路冠状动脉造影+支架植入术治疗老年冠状动脉粥样硬化性心脏病患者效果显著,对患者心功能影响较小,可缩短术后恢复时间,降低辐射影响及术后并发症发生率,可作为临床治疗首选方案。

Objective To investigate the efficacy and safety of radial artery approach coronary angiography(CAG)+intracoronary stenting(IS)in the treatment of elderly patients with coronary atherosclerotic heart disease(CAHD).Methods A total of 360 elderly CAHD patients were divided into two groups according to different surgical approaches.193 patients who chose radial artery approach were set as the study group,and 167 patients who chose femoral artery approach were set as the control group.Both groups were treated with CAG+IS.The operation time,puncture time,angiography time,and postoperative bed rest time of the two groups were compared,and cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)]and angiography-related parameters[number of acquisition frames,fluoroscopy time,total dose area product(DAP),cumulative dose(CD)]were compared between the two groups before operation and at the end of 3 months after operation.The incidence of postoperative complications was compared between the two groups.Results There was no significant difference in operation time and puncture time between the two groups(P>0.05).The contrast time and postoperative bed rest time in the study group were significantly shorter than those in the control group(P<0.01).The level of LVEF at 3 months after operation in the two groups was significantly higher than that before operation(P<0.01),and the level of LVEDD was lower than that before operation(P<0.01),and there was no significant difference between the two groups(P>0.05).There was no significant difference in the number of acquisition frames between the two groups(P>0.05).The fluoroscopy time in the study group was significantly shorter than that in the control group(P<0.01),DAP was significantly less than that in the control group(P<0.01),CD was significantly less than that in the control group(P<0.01),and the incidence of postoperative complications was significantly lower than that in the control group(P<0.01).Conclusions Radial artery approach CAG+IS has a significant effect in the treatment of elderly CAHD patients,and has little impact on the patient's cardiac function.It can shorten the postoperative recovery time,reduce the impact of radiation and the incidence of postoperative complications,and can be used as the first choice for clinical treatment.