经桡动脉冠状动脉介入诊疗术后桡动脉损伤的影响因素分析

目的:探讨接受桡动脉冠状动脉介入诊疗患者术后,桡动脉损伤的情况及影响因素。方法:入选2008年5月至2009年10月,于安贞医院就诊拟行冠状动脉造影的患者966例,随机分为4F动脉鞘管组和6F动脉鞘管组。分析两组患者桡动脉并发症〔如桡动脉闭塞(RAO)、桡动脉痉挛(RAS)等〕的发生率,通过多因素Logistic回归分析RAO的危险因素。结果:4F鞘管组和6F鞘管组中,RAO(0.8%vs.2.9%,P=0.018),RAS(1.2%vs.3.5%,P=0.021),桡动脉内膜增厚率(1.0%vs.4.1%,P=0.002),前臂小血肿(0.6%vs.2.5%,P=0.020),患肢疼痛(1.2%vs.4.1%,P=0.006)等的发生率及压迫止血时间〔(4.62±0.98)vs.(6.36±0.93)h,P<0.001〕,4F组均低于6F组,差异有统计学意义。两组患者均未出现前臂大血肿、假性动脉瘤、动静脉瘘及骨筋膜室综合征。RAO经多因素回归分析显示,大尺径动脉鞘管、术后压迫止血时间过长是发生RAO的危险因素。结论:经桡动脉PCI中选择小直径动脉鞘管,避免术后长时间的压迫止血有利于降低RAO的发生率,同时减少桡动脉内膜损伤,提高患者舒适度。

Analysis of risk factors for access site-related complications after transradial coronary intervention

Objective:This study investigated the risk factors on access site-related complications after transradial coronary intervention.Methods: Between May 2008 to October 2009,966 patients undergoing transradial coronary angiography in Anzhen hospital were randomized to 4F or 6F introducer sheath groups.The incidence of access site complications(radial artery occlusion(RAO),radial artery spasm(RAS)) was studied.Risk factors of RAO were analyzed by logistic regression model.Results: The incidence of access site complications was lower in 4F group,RAO(0.8% vs.2.9%,P=0.018),RAS(1.2% vs.3.5%,P=0.021),intima-media thickening(1.0% vs.4.1%,P=0.002),small upper limb haematoma(0.6% vs.2.5%,P=0.020),local access site pain(1.2% vs.4.1%,P=0.006)and hemostasis duration((4.62±0.98)vs.(6.36±0.93)h,P<0.001).The complications of large upper limb haematoma,pseudoaneurysm,arteriovenous fistula and compartment syndrome were not observed in two groups.Multiple regression showed that larger sheath and long hemostasis duration were independent risk factors of RAO.Conclusion:The selection of smaller sheath and avoiding prolonged high-pressure hemostatic compression can minimize the incidence of RAO following the transradial coronary interention.Moreover,it can reduce injuries of intima-media thickening and local access site pain.