毕希乐,樊延明,汪雁博,肖宇杨,王庆胜,刘丽,傅向华

• 1:河北医科大学第二医院心内科
• 2:秦皇岛市第一医院心内科

摘要(Abstract)：

目的通过分析桡动脉闭塞的原因,指导临床釆取有效的预防措施。方法 2013年11月至2014年11月共入选河北医科大学第二医院669例患者,排除63例患者(24例不符合入选标准、31例经桡动脉穿刺失败交叉到其他路径、6例失访、2例死亡)。根据术后有无桡动脉闭塞分为桡动脉闭塞组和桡动脉未闭塞组。主要终点事件为术后1年桡动脉闭塞和术后出血。建立多因素Logistic回归分析模型评价性别、体重指数、糖尿病、高血压病、高脂血症、吸烟、桡动脉直径/鞘管外径比值、桡动脉痉挛、桡动脉穿刺点距桡骨茎突距离等危险因素对桡动脉闭塞的影响。结果最终纳入606例患者行冠状动脉造影及经皮冠状动脉介入治疗。1年随访中共发现56例桡动脉闭塞(桡动脉闭塞组),均为无症状桡动脉闭塞;未见桡动脉闭塞550例(桡动脉未闭塞组)。两组患者性别、年龄、体重指数、病变程度、危险因素、桡动脉痉挛、药物治疗、肝素剂量、术后出血及手术时间比较,差异均无统计学意义(均P>0.05)。但桡动脉闭塞组桡动脉直径/鞘管外径≤1患者的比例显著高于桡动脉未闭塞组(41.1%比23.6%,P=0.041),差异有统计学意义。桡动脉闭塞组在穿刺点距桡骨茎突0 cm处[28.6%(16/56)比9.3%(51/550),P=0.002],1 cm处[25.0%(14/56)比8.7%(48/550),P=0.001)]桡动脉闭塞发生率均显著高于桡动脉未闭塞组,但4 cm处[1.8%(1/56)比22.7%(125/550),P=0.001)]桡动脉闭塞发生率显著低于桡动脉未闭塞组,差异均有统计学意义。建立Logistic回归分析模型评估各危险因素对桡动脉闭塞的影响,对包括性别、体重指数、吸烟、高血压病、糖尿病、高脂血症、桡动脉穿刺点距桡骨茎突距离、桡动脉痉挛、桡动脉直径/鞘管外径比值≤1等因素进行初步筛选,结果显示桡动脉穿刺点在距桡骨茎突0 cm(OR 3.08 95%CI 1.65~5.76,P=0.002)、1cm(OR 2.86 95%CI1.49~5.52,P=0.001)和桡动脉直径/鞘管外径比值≤1(OR 1.74 95%CI 1.03~2.93,P=0.036)分别是发生桡动脉闭塞的危险因素,而桡动脉穿刺点在距桡骨茎突4 cm(OR 0.08 95%CI 0.01~0.57,P=0.001)为桡动脉闭塞的保护性因素。多因素Logistic回归分析结果显示桡动脉穿刺点距桡骨茎突0 cm(OR 9.65,95%CI 1.20~77.50,P=0.033)和1 cm(OR 8.90,95%CI 1.10~72.40,P=0.040)及桡动脉直径/鞘管外径比值≤1(OR 2.45,95%CI 1.30~4.51,P=0.004)是桡动脉闭塞发生的独立危险因素。结论穿刺点选择在距桡骨茎突0~1 cm时发生桡动脉闭塞风险增高。

关键词(KeyWords)： 经皮冠状动脉介入治疗;桡动脉;穿刺点;危险因素

Abstract:

Keywords:

基金项目(Foundation): 河北省医学科学研究重点课题计划(20170223)

作者(Author): 毕希乐,樊延明,汪雁博,肖宇杨,王庆胜,刘丽,傅向华

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