老年冠心病患者冠状动脉造影——经桡动脉通路与经股动脉通路对比研究

Coronary angiography transradial approach in the gerontal patients

目的 评价经桡动脉通路冠状动脉造影 (TRCA)在老年患者的应用优势。方法 将 40 0例老年冠心病患者随机分为 TRCA组及经股动脉通路冠状动脉造影 (TFCA)组 (TFCA组 )。研究第一终点为进入通路失败 ,包括穿刺失败和导管送入途中失败 ;第二终点为临床过程结束 ,各观察指标收集完全 ,指标包括 :穿刺时间、导管到位时间、更换导管时间、透视时间、压迫止血时间和卧床制动时间 ,以及穿刺部位并发症和全身并发症 (血管迷走神经反射、腰背不适等 )。结果 两组穿刺成功率 TRCA组 96.5% ,TFCA组 97.5% ,导管送入成功率 TRCA组 97.9% ,TFCA组1 0 0 % ,平均穿刺时间、右冠脉导管到位时间、更换导管时间、透视时间 TRCA组略长于 TFCA组 (仅 0 .5 min左右 )。止血包扎时间 TRCA组 0 .93±0 .1 min,TFCA组 2 6.0 8± 8.43min(P<0 .0 0 1 )和肢体制动时间 TRCA组 2 .91± 0 .42 h,TFCA组 2 2 .4± 1 .55h(P<0 .0 0 1 )。并发症的发生率 TR-CA组明显低于 TFCA组 ,仅有 9.5%发生桡动脉痉挛 ,3.2 %术后前臂肌肉疼痛 ,继之桡动脉闭塞 ,但无手部缺血表现。 TFCA组发生皮下瘀血1 1 .3% ,假性动脉瘤 1 .0 3% ,血管迷走神经反射 8.2 % ,腰、背及下肢的酸痛不适 95.9%。两组无心脏事件发生。结论 经过一定的学习过程后 ,TR-CA?

Objective To evaluate the advantages of coronary angiography transradial approach (TRCA) in the gerontal patients.Methods A series of 400 consecutive gerontal patients were randomised to radial (group A, n=200) versus femoral approach (group B, n=200) by two experienced operators. The primary endpoint of the study was the technical failures included puncture and deliver catheter. The secondary endpoint was the finish of the procedure while the data were collected. Results Technical success rate was not different between the two groups. The average times of puncture, of right coronary cannulation, of change catheters, of fluoroscopy were about 0.5min longer in group A than in group B. Contrary the average times of hemostasis and immobilization were obviously longer in group B (26.08±8.43 min and 22.4±1.55 h) than in group A (0.93±0.1 min and 2.91±0.42 h P<0.001). There were low rate of complication included merely 9.5% of the spasm, 3.2% of the forearm pain and the occlusion of the radial artery but without ischemia of hand in the group A. There were 11.3% of hematomas, 1.03% of pseudoaneurysm, 8.2% of vasovagal reflex and 95.9% of distress on the waist and lower limb. There was no the major adverse clinical event in two groups.Conclusions After the learning period, transradial coronary angiography can be performed with a high success rate, low rate of complication, and improves especially patients comfort to suit for gerontal patients.