张在勇,解强,宋明才

• 1:广州市番禺中心医院心血管内科广州市番禺区心血管病研究所
• 2:华南师范大学生命科学学院

摘要(Abstract)：

目的回顾性分析在急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术中应用单指引导管技术对患者入门至球囊扩张(D2B)时间及导管使用数量的影响。方法回顾性分析广州市番禺区中心医院胸痛中心因STEMI行直接PCI的连续35例经桡动脉使用JL 3.5单指引导管(美敦力,美国)完成手术(单指引导管组)及同一时期经桡动脉入径用传统方式完成手术35例患者(传统手术组);记录两组D2B时间及穿刺至球囊扩张(P2B)时间等临床参数。结果虽然两组患者在进导管室至穿刺时间比较,差异无统计学意义[(42.6±5.8)min比(41.5±6.2)min,P=0.441],但单指引导管组D2B时间[(61.4±9.3)min比(69.1±9.7)min,P=0.001]、P2B时间[(18.7±7.2)min比(27.4±7.9)min,P=0.001]较传统手术组减少,差异均有统计学意义。单指引导管组与传统手术组患者在使用诊断导管数量0条(91.4%比0.0,P<0.001)、2条(0.0比85.7%,P<0.001)及使用总导管数量1条(91.4%比0.0,P<0.001)、3条(0.0比85.7%,P<0.001)比较,差异均有统计学意义。而X线总曝光时间、对比剂用量、肌酸激酶同工酶峰值、患者CCU住院时间、总住院时间等指标比较,差异均无统计学意义(均P>0.05)。本研究中两组均未发生术后30 d死亡或主要不良心血管事件。结论直接PCI术中使用单指引导管技术相对安全,可降低特定STEMI患者D2B时间、P2B时间及导管数量,对降低耗材费用,降低总手术费用有积极的意义,但是否值得进一步推广则需保持谨慎态度。

关键词(KeyWords)： 经皮冠状动脉介入治疗;ST段抬高型心肌梗死;指引导管

Abstract:

Keywords:

基金项目(Foundation): 广东省自然科学基金面上项目(2020A1515010277);; 广州市番禺区科技计划项目(2018-Z04-21、2018-Z04-51)

作者(Author): 张在勇,解强,宋明才

参考文献(References)：

• [1]Mc Namara RL,Wang Y,Herrin J,et al.Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction.J Am Coll Cardiol,2006,47(11):2180-2186.
• [2]Moon KW,Kim JH,Kim JY,et al.Reducing needle-to-balloon time by using a single guiding catheter during transradial primary coronary intervention.J Interv Cardiol,2012,25(4):330-336.
• [3]Chow J,Tan CH,Tin AS,et al.Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST elevation myocardial infarction.J Interv Cardiol,2012,25(3):235-244.
• [4]Ibanez B,James S,Agewall S,et al.2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC).Eur Heart J,2018,39(2):119-177.
• [5]Vorobcsuk A,Konyi A,Aradi D,et al.Transradial versus transfemoral percutaneous coronary intervention in acute myocardial infarction Systematic overview and Meta-analysis.Am Heart J,2009,158(5):814-821.
• [6]Kolkailah AA,Alreshq RS,Muhammed AM,et al.Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease.Cochrane Database Syst Rev,2018,4(4):CD012318.
• [7]Kim SM,Kim DK,Kim DI,et al.Novel diagnostic catheter specifically designed for both coronary arteries via the right transradial approach.A prospective,randomized trial of TigerⅡvs.Judkins catheters.Int J Cardiovasc Imaging,2006,22(3-4):295-303.
• [8]Caputo RP,Tremmel JA,Rao S,et al.Transradial arterial access for coronary and peripheral procedures:executive summary by the transradial committee of the SCAI.Catheter Cardiovasc Interv,2011,78(6):823-839.
• [9]Horie K,Tada N,Isawa T,et al.A randomised comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using6.5 Fr Sheath Less Eaucath Guiding Catheter vs.6.0 Fr Glidesheath Slender.Euro Intervention,2018,13(17):2018-2025.
• [10]Guo J,Chen W,Wang G,et al.Safety and efficacy of using a single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST elevation myocardial infarction.JInterv Cardiol,2017,30(1):33-42.
• [11]刘肖，李树仁，高楠，等.急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗术后发生院内死亡的危险因素分析.中国介入心脏病学杂志，2019,27(12):685-692.
• [12]Iantorno M,Shlofmitz E,Rogers T,et al.Should nonST-elevation myocardial infarction be treated like ST-elevation myocardial infarction with shorter door-to-balloon time?Am JCardiol,2020,125(2):165-168.
• [13]Murphy AC,Yudi MB,Farouque O,et al.Impact of gender and door-to-balloon times on long-term mortality in patients presenting with ST-elevation myocardial infarction.Am J Cardiol,2019,124(6):833-841.
• [14]Torii S,Fujii T,Murakami T,et al.Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction.Cardiovasc Interv Ther,2017,32(2):114-119.
• [15]Youssef AA,Hsieh YK,Cheng CI,et al.A single transradial guiding catheter f or right and lef t coronary angiography and intervention.Euro Intervention,2008,3(4):475-481.
• [16]Yokoi K,Mizote I,Shiraki T,et al.Mechanism of good backup support with a deep-seated guiding catheter during percutaneous coronary intervention.Circ J,2019,83(8):1763.
• [17]Yokoi K,Shiraki T,Mizote I,et al.Differences in guiding catheter positions according to left and right radial approaches.JACCCardiovasc Interv,2018,11(20):e163-e165.
• [18]Al Halabi S,Burke L,Hussain F,et al.Radial versus femoral approach in women undergoing coronary angiography:a metaanalysis of randomized controlled trials.J Invasive Cardiol,2019,31(11):335-340.
• [19]Blake SR,Shahzad A,Aggarwal SK,et al.Radial versus femoral vascular access in ST-elevation myocardial infarction:Are the results of femoral operators unfairly represented in observational research?Am Heart J,2019,210:81-87.
• [20]Mohandes M,Rojas S,Guarinos J,et al.Procedure time comparison between radial versus femoral access in ST-segment elevation acute myocardial infarction patients undergoing emergent percutaneous coronary intervention:A meta-analysis of controlled randomized trials.Heart Views,2018,19(1):1-7.
• [21]Milford BM,Cohen MG.Coronary cannulation:tips for success in transradial angiography and interventions.Interv Cardiol Clin,2020,9(1):21-31.
• [22]图尔荪江·纳曼，李国庆，程慧.桡动脉造影验证桡动脉变异的发生及其预测因素.中国介入心脏病学杂志，2018,26(2):100-105.