冠状动脉造影和血管成形术诊治老年冠心病:经桡动脉与经股动脉途径对比

目的比较经桡动脉和经股动脉途径在冠状动脉造影和血管成形术中的优缺点,评价经桡动脉途径介入治疗老年冠心病的有效性与安全性。方法 60岁及以上冠心病或可疑冠心病患者1637例,按穿刺途径随机分为桡动脉组（n=909）和股动脉组（n=728）,比较两组间动脉穿刺成功时间、穿刺成功率、造影时间、X线曝光时间、经皮冠状动脉介入治疗（PCI）成功率、穿刺相关血管并发症、迷走反射发生率、平均住院时间及随访术后3个月主要心脏不良事件（MACE）发生情况。结果桡动脉组桡动脉穿刺成功897例（897/909,98.68%）,股动脉组股动脉穿刺成功722例（722/728,99.18%）。桡动脉组穿刺时间较股动脉组长（P〈0.05）。两组的穿刺成功率、PCI成功率,术后MACE等差异均无统计学意义（P〉0.05）。在造影时间、X线曝光时间、穿刺相关血管并发症、迷走反射发生率、平均住院时间等方面,桡动脉组明显低于股动脉组（P〈0.01）。结论经桡动脉途径行冠状动脉造影及PCI治疗老年冠心病安全可行,且易止血,术后无须卧床,并发症少,创伤小,可作为老年冠心病介入治疗的首选途径。

Comparison on transradial versus transfemoral approach for coronary angiography and angioplasty in the elderlys with coronary heart disease

Objective To compare the advantages and disadvantages of transradial and transfemoral approaches in coronary angiography and angioplasty, and to evaluate the curative efficacy and safety of transradial approach for the elderlys with coronary heart disease (CHD). Methods Totally 1637 patients over or equal to 60 years old with diagnosed CHD or suspected CHD were selected and randomly divided into transradial group (n=909) and transfemoral group (n=728). The time and success rate of puncture, time of angiography, X-ray exposure time of angiography, success rate of PCI, complications in puncture site, incidence of vagal reflex, average length of stay and major adverse cardiac events (MACE) 3 months after PCI were compared between the two groups. Results The puncture time of transradial group was longer than that of transfemoral group (P<0.05). There were 897 cases (897/909, 98.68%) with success puncture of radial artery in transradial group and 722 (722/728, 99.18%) with success puncture of femoral artery in transfemoral group. There was no difference in success rate of puncture, success rate of PCI and MACE 3 months after PCI between the two group (P>0.05), while the time of angiography, X-ray exposure time of angiography, complications in puncture site, incidence of vagal reflex and average length of stay in transradial group were all lower than those in transfemoral group (P<0.01). Conclusion Percutaneous radial artery approach is safe and feasible for PCI in the elderlys with CHD, without lying in bed, lower incidence of local complications and trauma, therefore can be used as the routine approach for PCI, especially for the elderlys.