老年患者经远端桡动脉与经典桡动脉行冠状动脉诊疗的临床疗效及安全性比较

目的对比分析经远端桡动脉与经典桡动脉途径在PCI中临床效果的差异。方法选择我院行冠状动脉造影检查和(或)PCI的老年患者200例,根据穿刺部位不同分为远端桡动脉组及经典桡动脉组,每组100例。比较2组血管内径、穿刺成功率、穿刺时间、置入支架数、手术时间及手术成功率;记录患者并发症发生情况。结果2组穿刺成功率、手术成功率、穿刺时间、手术时间及置入支架数比较,差异无统计学意义(P>0.05),虽然远端桡动脉组较经典桡动脉组血管内径略细,但2组比较差异无统计学意义[(2.4±0.2)mm vs(2.6±0.3)mm,P>0.05]。2组患者PCI术中无死亡及脑卒中发生。远端桡动脉组桡动脉痉挛(3.0%vs 9.0%,P=0.048)、桡动脉闭塞(1.0%vs 8.0%,P=0.031)、并发症发生率(6.0%vs 21.0%,P=0.013)明显低于经典桡动脉组,差异有统计学意义,2组局部血肿、动脉瘤、动静脉瘘发生率比较,差异无统计学意义(P>0.05)。结论远端桡动脉途径的桡动脉痉挛发生率及闭塞率更低,安全性好,可以作为经典桡动脉的替代途径应用于临床。

Clinical efficacy and safety of transdistal and classical radial artery approach for diagnosis and treatment in elderly patients

Objective To study the clinical efficiency of transdistal and classical radial artery approach for diagnosis and treatment of coronary artery disease in elderly patients on PCI.MethodsTwo hundred elderly patients who underwent coronary angiography and/or PCI in our hospital from December 2017 to June 2019 were divided into distal radial artery group(n=100)and classical radial artery group(n=100)according to their puncture site.The vascular diameter,success rate of vascular puncture,vascular puncture time,implanted stents,operation time,success rate of operation,and incidence of complications were recorded.Results No significant difference was detected in success rate of puncture and operation,puncture time,operation time,implanted stents between the two groups(P>0.05).The diameter of distal radial artery was shorter than that of classical radial artery,but no significant difference was detected between them(2.4±0.2 mm vs 2.6±0.3 mm,P>0.05).No death and cerebral stroke occurred in two groups during PCI.The incidence of radial artery spasm,occlusion and complication was significantly lower in distal radial artery group than in classical radial artery group(3.0%vs 9.0%,P=0.048;1.0%vs 8.0%,P=0.031;6.0%vs 21.0%,P=0.013).No significant difference was detected in incidence of local hematoma,arterial fistula and venous fistula between the two groups(P>0.05).Conclusion The incidence of radial artery spasm and occlusion is lower after PCI by distal radial artery approach than by classic radial artery approach.Distal radial artery approach can thus be used as an alternative procedure for PCI in clinical practice.