经桡动脉冠状动脉介入治疗AMI 200例临床观察

目的通过采用经桡动脉冠脉介入治疗急性心肌梗死(AMI),观察其优缺点及临床上的可行性。方法临床确诊为AMI患者396例,随机分为经桡动脉介入(TRI)组200例和经股动脉介入(TFI)组196例,观察两组手术介入治疗时间、手术成功率、平均住院时间和并发症情况。结果TRI组200例患者中,单支病变126例(63%),多支病变74例(37%),其中完全闭塞性病变66例(33%);TFI组196例患者中,单支病变120例(61%),多支病变76例(39%),其中完全闭塞病变63例(32%),两组病例基本临床特征比较,差异无统计学意义(P>0.05);从局部麻醉到手术结束,TRI组为30.2±6.4min,TFI组为29.6±0.3min,两组比较差异无统计学意义(P>0.05);TRI组血管穿刺成功率和手术成功率均为98.9%,而TFI组血管穿刺成功率和手术成功率均为99.7%,两组比较差异无统计学意义(P>0.05);术后住院天数比较:TRI组为2.5±0.9天,而TFI为5.7±1.6天,两组差异性有统计学意义(P<0.05)。手术并发症比较:TRI组发生桡动脉痉挛6例,局部血肿4例;而TFI组出现局部血肿13例,动静脉瘘3例,假性动脉瘤4例,迷走神经反射16例,排尿困难18例,腰痛9例,两组差异性有统计学意义(P<0.05)。结论采用经桡动脉和经股动脉行冠状动脉介入治疗(PCI),均具有较高的成功率,但TRI组并发症发生率明显低于TFI组,且住院天数短,经济实惠,方便易行,故经桡动脉行PCI值得在临床上广泛推广。

Clinical Observation on Coronary Intervention through Radial Artery for 200 Patients with Acute Myocardial Infarction

Objective To observe the effect and clinical availability of coronary intervention through radial artery in the treatment of acute myocardial infarction(AMI).Method A total of 396 patients with AMI were randomly devided into two groups:transradial coronary intervention(TRI) group(n=200) and transfemoral coronary intervention(TFI) group(n=196).The times of operation and hospitalization,success rate and complications were obseved in two groups.Results There were 126 patients who had single vessel disease in TRI group,74 patients had multi-vessel disease.Among all of them,66 cases had complete coronary artery occlusion.In TFI group,there were 120 patients who had single vessel disease,76 patients had multi-vessel disease,among them,63 cases had complete coronary artery occlusion.And there were no significant differences in major clinical characteristics between two groups(P>0.05).There was no statistical difference in operation time and success rate between TRI group and TFI group(30.2±6.4min vs 29.6±0.3min,P>0.05;98.9% vs 99.7%,P>0.05).There were significant differences in hospitalization time between two groups(2.5±0.9 vs 5.7±1.6,P<0.05).Compared to transfemoral group,transradial group had less complications:4 cases occurred the spasm of radial artery,6 cases had hetoma.In TFI group,13 cases occurred hematoma,3 cases had arterial venous fistula,4 case had false aneurysm,16 cases had vagal reaction,18 cases had dysuria,9 cases had low back pain.And there was a statistical difference between two groups.Conclusions TRI and TDI show similar high success rate,but the incidence of complications and hospitalization time in TRI group were lower than those in TFI group.TRI is worth spreading.