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经远端桡动脉与经常规桡动脉行急诊冠脉介入诊疗后穿刺部位血肿的对比

Access-site hematoma in distal and conventional transradial access in patients undergoing emergency coronary angiography or percutaneous coronary intervention
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摘要 目的通过对经远端桡动脉(dTRA)与常规桡动脉路径(cTRA)行急诊冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者发生穿刺部位血肿(ASH)的分析,探讨dTRA在急诊介入诊疗的安全性和可行性。方法这是一项单中心、前瞻性观察研究,选取2021年11月~2023年6月在徐州市中心医院因ACS行急诊冠状动脉造影和经皮冠状动脉介入治疗的患者,经筛查符合条件入选共289名患者,其中前10月入选135名患者经cTRA治疗,后10月入选154名患者经dTRA治疗。主要终点:改良的经桡动脉支架植入术后早期出院分级(mEASY)≥Ⅱ级以上穿刺部位血肿发生率,次要终点:术后1 d桡动脉闭塞率(RAO)、穿刺成功率、穿刺时间、压迫器去除时间、疼痛评分和其他并发症。结果dTRA组术后mEASYⅡ级以上ASH发生率明显低于cTRA组(3.2%vs 12.6%,P<0.05)。dTRA组术后1 d的RAO发生率、压迫器去除时间、疼痛评分均低于cTRA组[2.6%vs 9.6%;CAG(158.22±49.61)min vs(251.46±31.44)min;PCI(262.23±57.12)min vs(388.43±64.71)min;2.56±2.27 vs 4.78±3.83,均P<0.05],但穿刺时间更长,穿刺成功率略低[(3.93±5.25)min vs(1.58±1.45)min;87.0%vs 100%,均P<0.05]。多元logistic回归显示,dTRA和PCI术式是ACS患者急诊冠脉介入诊疗后mEASY≥Ⅱ级ASH的独立危险因素(OR=0.381,95%CI:0.214~0.837,P=0.018;OR 1.621,95%CI:1.243~2.625,P=0.036)。结论经远端桡动脉路径行急诊冠脉介入诊疗时,患者出血相关并发症的发生率更低,但对术者穿刺水平要求更高。 Objective To verify the effectiveness and safety of distal transradial access(dTRA)by analyzing the incidence of access-site hematoma(ASH)in distal and conventional transradial access(cTRA)in patients undergoing emergency coronary angiography(CAG)or percutaneous coronary intervention(PCI).Methods This single-center prospective observational study enrolled patients who underwent emergency CAG or PCI for acute coronary syndromes(ACS)via cTRA(n=135)during the first 10 months and with dTRA(n=154)during the next 10 months from November 2021 to June 2023 at Xuzhou Central Hospital.The primary endpoint was the modified early discharge after transradial stenting of coronary arteries(mEASY)grade≥ⅡASH.Radial artery occlusion(RAO)one day after procedure,success rate of puncture,puncture time,time to radial compression device removal,numeric rating scale score,and other complications were considered as secondary endpoints.Results Compared with the cTRA group,the rate of postoperative mEASY grade≥ⅡASH(3.2%vs 12.6%),the proximal RAO rate one day after procedure(2.6%vs 9.6%),the time to radial compression device removal[CAG:(158.22±49.61)min vs(251.46±31.44)min;PCI:(262.23±57.12)min vs(388.43±64.71)min],and the numeric rating scale score(2.56±2.27 vs 4.78±3.83)were significantly lower in the dTRA group(P<0.05 for all).However,the puncture time was longer and the puncture success rate was slightly lower than those of dTRA[(3.93±5.25)min vs(1.58±1.45)min;87.0%vs 100%,P<0.05 for both].Multivariate logistic regression analysis revealed that dTRA(odds ratio[OR]=0.381,95%confidence interval[CI]:0.214~0.837,P=0.018)and PCI(OR=1.621,95%CI:1.243~2.625,P=0.036)were independent risk factors for postoperative mEASY grade≥ⅡASH in ACS patients undergoing emergency coronary intervention procedure.Conclusion dTRA is associated with a lower incidence of bleeding-related complications and higher puncture ability requirement for the operator in patients undergoing emergency coronary intervention procedure.
作者 牟超鹏 宗斌 刘奕 史美英 徐杜娟 冯春光 Mou ChaoPeng;Zong Bin;Liu Yi;Shi Meiying;Xu Dujuan;Feng Chunguang(Affiliated Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China;Department of Cardiology,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Ultrasonic,Xuzhou Central Hospital,Xuzhou 221009,China)
出处 《中华临床医师杂志(电子版)》 CAS 2024年第3期275-282,共8页 Chinese Journal of Clinicians(Electronic Edition)
关键词 经远端桡动脉路径 急性冠脉综合征 冠状动脉造影 经皮冠状动脉介入治疗 Distal transradial access Acute coronary syndrome Coronary angiography Percutaneous coronary intervention
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  • 1许勇,罗晓辉,田巨龙,文亚红,徐大文,钱昌明,高红梅,唐永江.比较桡动脉、股动脉PCI治疗急性ST段抬高性心肌梗死的临床研究[J].四川省卫生管理干部学院学报,2006,25(2):89-91. 被引量:4
  • 2肖华,李志粱,陈爱华,宋旭东,傅强,缪绯,刘映峰.经皮桡动脉入路直接冠状动脉介入治疗急性心肌梗死[J].第二军医大学学报,2007,28(2):175-178. 被引量:20
  • 3任凤学 刘义修 吴永辉.经桡动脉途径急诊冠状动脉介入治疗的可行性研究.临床医学杂志,2007,9(24):57-58.
  • 4Kim MH,Cha KS,Kim HJ,et al.Primary stenting for acute myocardial infarction via the transradial approach:a safe and useful alternative to the transfemoral approach.J Invasive Cardiol,2000,12(6):292-293.
  • 5Agostoni P,Biondi-Zoccai GG,de Benedictis ML,et al.Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures,systematic overview and meta analysis of randomized trials.J Am Coll Cardiol,2004,44(2):349-356.
  • 6Saito S,Tanakas S,Hirore Y,et al.Comparative study on transradial approach vs transfemoral approach in primary stent implantation for patients with acute myocardial infarction:results of the test for myocardial infarction by prospective unicenter randomization for access sites(TEMURA)trial.J Catheter Cadiovasc Interv,2003,59(1):26-33.
  • 7孙玲,李艳华,张迪,王玲,孙晓东,郭群萍.经桡动脉途径的老年冠心病诊断和治疗[J].中国老年学杂志,2003,23(9):573-574. 被引量:15
  • 8严毓勤,吴士尧,任义荣,黄震华,周礼明,解玉水.经桡动脉途径急诊冠状动脉介入治疗的临床研究[J].上海医学,2003,26(9):684-685. 被引量:12

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