经皮桡动脉穿刺与股动脉穿刺在高龄冠心病患者冠脉介入治疗中的应用效果分析

摘要/Abstract

摘要： 目的比较高龄冠心病患者应用经皮桡动脉穿刺与股动脉穿刺行冠脉介入的应用效果。方法选择2021年6月至2023年11月我院收治的高龄冠心病患者开展研究,总病例210例,按照介入治疗采取穿刺方式的不同,分为桡动脉组和股动脉组,各105例。桡动脉组经皮行桡动脉穿刺,股动脉组经皮行股动脉穿刺。对比两组穿刺指标、手术情况、恢复情况及并发症发生情况。结果两组的穿刺指标对比：桡动脉组的平均穿刺次数更低,穿刺成功时间更长,鞘管植入时间和出血时间更短,差异有统计学意义（P均<0.05）;两组的手术情况对比：桡动脉组的一次性穿刺成功率、造影成功率、手术成功率均高于股动脉组,差异有统计学意义（P均<0.05）;两组恢复情况对比：桡动脉组术后第1 d、3 d的VAS评分和住院时间均低于股动脉组,差异有统计学意义（P均<0.05）;两组术后并发症发生率对比,桡动脉组（3.81%）低于对照组（11.43%）,差异有统计学意义（P<0.05）。结论经皮桡动脉穿刺与股动脉穿刺均可作为高龄冠心病患者的冠脉介入治疗手段,相较而言,经皮桡动脉穿刺在高龄冠心病患者中更具优势,具有一次性穿刺成功率高、鞘管植入时间和出血时间短、术后恢复快、并发症发生风险低等优点。

关键词: 冠心病, 高龄, 介入治疗, 经皮桡动脉穿刺, 股动脉穿刺

Abstract: Objective To investigate the application effect of percutaneous radial artery puncture versus femoral artery puncture in coronary intervention for elderly patients with coronary artery disease. Methods A total of 210 elderly patients with coronary artery disease who were admitted to Changle District People's Hospital from June 2021 to November 2023 were enrolled, and according to the procedure for puncture in interventional treatment, they were divided into radial artery group and femoral artery group, with 105 patients in each group. The patients in the radial artery group received radial artery puncture, and those in the femoral artery group received femoral artery puncture. The two groups were compared in terms of puncture indicators, surgical conditions, recovery, and complications. Results As for the puncture indicators, compared with the femoral artery group, the radial artery group had a significantly lower average number of punctures, a significantly longer time to successful puncture, a significantly shorter time of sheath implantation, and a significantly shorter bleeding time (all P<0.05). As for the surgical conditions, compared with the femoral artery group, the radial artery group had a significantly higher first-attempt success rate of puncture and significantly higher success rates of imaging and surgery (all P<0.05). As for the condition of recovery, compared with the femoral artery group, the radial artery group had a significantly lower Visual Analogue Scale score on days 1 and 3 after surgery and a significantly shorter length of hospital stay (all P<0.05). The radial artery group had a significantly lower incidence rate of postoperative complications than the femoral artery group (3.81% vs 11.43%, P<0.05). Conclusion Both percutaneous radial artery puncture and femoral artery puncture can be used in coronary intervention for elderly patients with coronary artery disease. In comparison, percutaneous radial artery puncture has more advantages in elderly patients with coronary artery disease, such as a high first-attempt success rate of puncture, a short time of sheath implantation and bleeding, fast postoperative recovery, and a low risk of complications.

Key words: Coronary artery, Elderly patients, Interventional therapy, Percutaneous radial artery puncture, Femoral artery puncture

罗学楚, 王国坤. 经皮桡动脉穿刺与股动脉穿刺在高龄冠心病患者冠脉介入治疗中的应用效果分析[J]. 心血管病防治知识, 2024, 14(1): 20-23.

Luo Xue-chu, Wang Guo-kun. Application Effect of Percutaneous Radial Artery Puncture versus Femoral Artery Puncture in Coronary Intervention for Elderly Patients with Coronary Artery Disease[J]. Prevention and Treatment of Cardiovascular Disease, 2024, 14(1): 20-23.

参考文献

[1] 曹保卫,赵秋燕,欧发邦,等. 改经股动脉径路穿刺与经桡动脉用双导丝进指引导管对冠状动脉介入的效果对比[J] . 心脑血管病防治,2020,20(2):195-197.
[2] 林咏泰,段金海. 经桡动脉入路行颈动脉狭窄支架植入术的安全性和可行性[J] . 中华老年医学杂志,2023,42(10):1269-1272.
[3] Li F, Shi GW, Zhang BF, et al. Recanalization of the occluded radial artery via distal transradial access in the anatomic snuffbox[J] .BMC Cardiovascular Disorders.2021,21(1):102-105.
[4] 孙琰,宋海彬,杜宗雷.冠心病患者经桡动脉介入治疗术后桡动脉闭塞的危险因素分析[J] .中外医疗,2023,42(6):22-26.
[5] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等. 稳定性冠心病基层诊疗指南(实践版2020)[J] .中华全科医师杂志,2021,20(3):274-280.
[6] 尉冠丽.观察经股动脉介入诊疗外周血管发生并发症的因素及针对性护理措施[J] .黑龙江中医药,2021,50(5):397-398.
[7] 邹常咏,侯利芳,朱乾坤,等. 经桡动脉与经股动脉行经导管动脉化疗栓塞术治疗原发性肝癌的疗效对比[J] . 哈尔滨医科大学学报,2022,56(3):263-266,270.
[8] 朱灿敏,常畅,王迪黎,等. 桡动脉入路与股动脉入路椎动脉起始部支架植入术的效果对比分析[J] . 中华神经医学杂志,2022,21(9):879-884.
[9] 侯春霞,杨菲菲,熊敏俊,等.超高龄冠心病患者冠状动脉介入术后的随访研究[J] .心脏杂志,2022,34(5):537-540,551.
[10] 胡晔,杨国华,陈莹,等. 不同入路方式经皮冠状动脉介入治疗后周围血管并发症的发生情况[J] . 血管与腔内血管外科杂志,2023,9(8):978-982.
[11] Coomes EA, Haghbayan H, Cheema AN. Distal transradial access for cardiac catheterization: A systematic scoPing review[J] .Catheterization and cardiovascular interventions: Official journal of the Society for Cardiac AngiograPhy & Interventions.2020,96(7).1381-1389.
[12] 颜志平,李佳睿,董伟华,等.经桡动脉入路外周介入中国专家共识[J] .介入放射学杂志,2023,32(3):205-214.
[13] 胡凌云,田杰,胡建川,等. 老年患者经桡动脉径路与股动脉径路行选择性冠状动脉和脑动脉联合造影的对比研究[J] . 中华老年心脑血管病杂志,2021,23(2):200-202.
[14] 刘玉文,钱进,王能,等.我国经皮冠状动脉介入治疗入路途径发展历程和研究现状及展望[J] .实用心脑肺血管病杂志,2020,28(6):105-109.
[15] 杨挺生,吴晓丹,王现涛. 经桡动脉路径冠状动脉介入术后桡动脉闭塞的研究进展[J] . 中华老年心脑血管病杂志,2023,25(5):545-547.