经远端桡动脉入路行冠状动脉介入治疗的学习曲线分析

Learning curve of the distal radial access for coronary intervention

目的探讨经远端桡动脉(DRA)行冠状动脉介入诊疗中操作数量与穿刺置管成功率的关系,并分析穿刺置管失败的危险因素。方法回顾性分析2021年1月—2022年12月北京潞河医院心内科单一术者经DRA入路行冠状动脉介入诊疗的患者1000例,根据操作时间和先后顺序分为10组,每100例为一个阶段,主要研究终点为每100例患者的穿刺置管成功率,次要研究终点为每100例患者的一次性穿刺成功率和穿刺置管时间。采用logistic回归分析研究DRA穿刺置管失败的相关因素。结果1000例患者中,DRA穿刺置管成功率为92.3%。200例操作后,DRA的穿刺置管成功率可达93.0%以上(P=0.075),一次性穿刺成功率从最初的74.0%增加至96.0%(P<0.001),穿刺置管中位时间从3.00 min减少到2.00 min(P<0.001)。Logistic回归分析显示,DRA直径(P=0.020)与左侧入路(P=0.046)均为DRA穿刺置管失败的影响因素。结论DRA路径需200例操作经验后穿刺置管成功率可达93.0%以上并维持稳定状态,小DRA直径和左侧入路是DRA穿刺置管失败的主要因素。

Objective To determine the correlation between operator experience in distal transradial coronary intervention(dTRI)and the successful cannulation rate of the distal radial artery(DRA),as well as to identify risk factors for puncture and cannulation failures.Methods From January 2021 to December 2022,1000 patients who underwent dTRI via DRA by a single interventionist in Beijing Luhe Hospital were retrospectively enrolled.These patients were chronologically ranked and divided into ten groups(100 cases each)according to operation time and order.The primary endpoint was the successful cannulation rate of DRA for every 100 cases,while the secondary endpoints were the success rate of one-time puncture catheterization and puncture catheterization time.Logistic regression analysis was carried out to identify predictors of unsuccessful DRA.Results A total of 1000 patients were enrolled,with a successful DRA cannulation rate of 92.3%.After 200 cases,this rate stabilized at 93.0%(P=0.075).The first attempt DRA puncture success rate improved from 74.0%to 96.0%,while the median sheath cannulation time decreased from 3.00 min to 2.00 min(P<0.001).Logistic regression analysis showed that a negative association between DRA diameter(P=0.020)and cannulation failure,and a positive association with left artery access(P=0.046).Conclusion Achieving over 93.0%success in DRA puncture and cannulation becomes consistent after 200 cases.Small DRA diameter and left-sided access are key predictors of failure.