不同穿刺点对脑血管介入患者疼痛程度影响的分析

Effect of different puncture sites on pain in patients undergoing cerebrovascular intervention

目的:对比分析经远端桡动脉(distal transradial access,dTRA)和股动脉(trans femoral access, TFA)途径在神经介入诊疗中不同穿刺点疼痛程度的差异。方法:收集从2022年8月至2023年4月,就诊于首都医科大学附属北京安贞医院脑血管病科,行脑血管造影或神经介入治疗的患者共145例。按照患者穿刺途径的不同分为dTRA组(40例)和TFA组(105例);对比两组患者的危险因素、化验指标、疼痛数字分级评分法(numerical rating scale,NRS)以及围术期不良事件。经过Logistic回归分析影响疼痛的因素。结果:TFA组高血压患者(81.9%vs. 57.5%)和高血脂患者(70.5%vs. 47.5%)占比高,其他危险因素和化验指标在两组间差异无统计学意义。dTRA组对比TFA组的疼痛NRS评分发现,无疼痛(0级)dTRA/TFA的比值为67.5%/39%,dTRA的轻度疼痛(1~3级)比TFA组显著降低(27.5%vs. 44.8%),而中度疼痛(4~6级)TFA占比为16.2%,dTRA组占比仅为5%。dTRA组患者术后疼痛显著低于TFA组,两组间差异有统计学意义。经过单因素和多因素Logistic回归分析结果显示,女性(OR=4.82,95%CI:1.41~16.472,P=0.012)和糖尿病(OR=5.644,95%CI:1.288~13.96,P=0.018)是影响疼痛程度的因素。结论:脑血管造影或神经介入治疗患者使用dTRA的疼痛程度低于传统TFA,女性和糖尿病是影响疼痛程度的因素。

Objective:To compare and analyze the difference in pain level of different puncture sites through distal transradial access(dTRA)and trans femoral access(TFA)during nerve intervention.Methods:This was a single-center,prospective cohort study.A total of 145 patients,112 males and 33 females,with a mean age of(64.1±8.4)years,were enrolled in the Department of Cerebrovascular Disease,Beijing Anzhen Hospital,from August 2022 to April 2023 for cerebrovascular angiography or neurointerventional therapy.Patients were divided into dTRA group(40 cases)and TFA group(105 cases)according to different types of puncture.The risk factors,laboratory indices,numerical rating scale(NRS),and perioperative adverse events of the two groups were compared for statistical analysis.The univariate and multivariate Logistic regression analysis to further analyze the influencing factors of pain level.Results:The comparison between the dTRA group and the TFA group showed that the proportion of patients with hypertension(81.9%vs.57.5%)and hyperlipidemia(70.5%vs.47.5%)was higher in the TFA group,and there were no significant differences in other risk factors and laboratory indicators between the two groups.The NRS scores of the dTRA group compared with the TFA group showed that the ratio of dTRA/TFA without pain(grade 0)was 67.5%/39%,the mild pain of dTRA(grade 1-3)was significantly lower than that of the TFA group(27.5%vs.44.8%),while the TFA ratio of moderate pain(grade 4-6)was 16.2%.The dTRA group accounted for only 5%.Postoperative pain in dTRA group was significantly lower than that in TFA group,and there was a statistically significant difference between the two groups.Multivariate Logistic regression analysis showed that female and diabetes were the risk factors for puncture pain level.Conclusions:The pain level of dTRA in patients undergoing cerebrovascular angiography or neurointerventional therapy is lower than that of traditional TFA.Female and diabetes were the risk factors for puncture pain level via Logistic regression analysis.