傅向华,耿巍,谷新顺,郝国贞,范卫泽,姜云发,李世强

• 1:河北医科大学第二医院心内科

摘要(Abstract)：

目的评价血管扩张药物干预下经桡动脉入径应用7 Fr指引导管治疗冠状动脉分叉病变的可行性与安全性。方法入选2012年1月至2014年7月经冠状动脉造影示分叉病变且适合行经皮冠状动脉介入治疗(PCI)的患者,随机分成经桡动脉6 Fr指引导管组(6 Fr组)和7 Fr指引导管组(7 Fr组)。对比观察两组患者动脉鞘管置入成功率、手术操作成功率、完成PCI操作时间、X线透视时间和对比剂用量。随访住院期间、术后30 d内的入径血管相关并发症及主要不良心血管事件。结果共纳入229例冠状动脉分叉病变患者,其中6 Fr组113例,7 Fr组116例。两组患者年龄、性别、体重指数、危险因素、临床特征、住院时间等方面比较,差异均无统计学意义。6 Fr组行常规鞘管置入;7 Fr组先行6 Fr鞘管置入,在充分局部麻醉并给予血管扩张药物的基础上更换为7 Fr动脉鞘管。6 Fr组有4例患者换用7 Fr指引导管进行手术操作;7 Fr组均成功完成PCI术,无患者转至6 Fr组。与6 Fr组相比,7 Fr组完成PCI操作时间更短[(52±9.2)min比(60±10.7)min,P<0.0001],球囊应用数量更少[(2.9±0.6)枚比(3.2±0.4)枚,P=0.002],X线透视时间更短[(24±8.2)min比(28±9.4)min,P=0.02]。两组对比剂用量比较,差异无统计学意义[(152±25.8)ml比(158±23.5)ml,P=0.20]。住院期间6 Fr组和7 Fr组前臂血肿[4/113例(3.5%)比6/116例(5.2%),P=0.76]及桡动脉闭塞[4/113例(3.5%)比9/116例(7.8%),P=0.26]的发生率分别比较,差异均无统计学意义。术后30 d随访,两组桡动脉闭塞的发生率相似[2/99例(2.0%)比4/103例(3.9%),P=0.70],且均未见掌弓循环障碍的临床表现。结论在血管扩张药物的作用下,桡动脉血管内径增大,可容性增强,利于7 Fr指引导管分叉病变治疗操作,安全可靠,且并未增加血管并发症发生率。

关键词(KeyWords)： 桡动脉入径;经皮冠状动脉介入治疗;冠状动脉分叉病变;7 Fr指引导管;血管扩张药

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 傅向华,耿巍,谷新顺,郝国贞,范卫泽,姜云发,李世强

参考文献(References)：

• [1]张慧平,孙福成.冠状动脉慢性完全闭塞病变的介入治疗现状.中国介入心脏病学杂志,2013,21:251-255.
• [2]Jolly SS,Yusuf S,Cairns J,et al.Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes(RIVAL):a randomised,parallel group,multicentre trial.Lancet,2011,377:1409-1420.
• [3]Al SJ,Yeh W,Cohen HA,et al.Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era(NHLBI dynamic registry).Am J Cardiol,2001,87:1139-1144.
• [4]Li L,Zeng ZY,Zhong JM,et al.Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention.Chin Med J(Engl),2013,126:1046-1052.
• [5]Chung S,Her SH,Song PS,et al.Trans-radial versus transfemoral intervention for the treatment of coronary bifurcations:results from Coronary Bifurcation Stenting Registry.J Korean Med Sci,2013,28:388-395.
• [6]Stella PR,Kiemeneij F,Laarman GJ,et al.Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.Cathet Cardiovasc Diagn,1997,40:156-158.
• [7]傅向华,马宁,刘君,等.选择性经皮尺动脉入径冠状动脉血管成形治疗的可行性研究.中华心血管病杂志,2003,31:337-340.
• [8]Aptecar E,Pernes JM,Chabane-Chaouch M,et al.Transulnar versus transradial artery approach for coronary angioplasty:the PCVI-CUBA study.Catheter Cardiovasc Interv,2006,67:711-720.
• [9]Li YZ,Zhou YJ,Zhao YX,et al.Safety and efficacy of transulnar approach for coronary angiography and intervention.Chin Med J(Engl),2010,123:1774-1779.Egred M.Feasibility and safety of 7-Fr radial approach for complex PCI.J Interv Cardiol,2011,24:383-388.
• [10]Egred M.Feasibility and safety of 7-Fr radial approach for complex PCI.J Interv Cardiol,2011,24:383-388.
• [11]Nie B,Zhou YJ,Yang Q,et al.Safety and feasibility of repeated percutaneous transradial coronary intervention in the same route.Chin Med J(Engl),2012,125:221-225.
• [12]Kwan TW,Cherukuri S,Huang Y,et al.Feasibility and safety of 7Fr sheathless guiding catheter during transradial coronary intervention.Catheter Cardiovasc Interv,2012,80:274-280.
• [13]傅向华,马宁,刘君,等.经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死的对比研究.中华心血管病杂志,2003,31:573-577.