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)