合并慢性左心衰竭的老年冠心病患者经桡动脉介入治疗的临床评估

摘要

目的 探讨经桡动脉介入治疗老年冠心病合并慢性左心衰竭患者的临床疗效和安全性. 方法 120例老年冠心病合并慢性左心衰患者,根据介入治疗术式的不同分为经桡动脉治疗组64例,经股动脉治疗组56例；回顾性分析X线曝光时间,术后卧床时间及并发症发生率等. 结果 桡动脉组穿刺并介入治疗成功者60例,共成功扩张病变75处,其中前降支38处,回旋支19处,右冠状动脉18处,行支架置入73枚.股动脉组手术穿刺并介入治疗成功者54例,共成功扩张病变63处,其中前降支36处,回旋支12处,右冠状动脉15处,共行支架置人61枚.两组介入治疗情况及病变程度差异无统计学意义.桡动脉组较股动脉组穿刺至置管时间延长,平均卧床时间缩短,卧床期间急性左心衰发生率减少(均P＜0.01)；桡动脉组穿刺并发症、下肢深静脉血栓发生率、体循环和肺栓塞发生率均较股动脉组减少(均P＜0.05).股动脉组腰背疼痛、排尿困难、腹胀发生率明显高于桡动脉组(P＜0.05). 结论 经桡动脉介入治疗老年冠心病合并慢性左心衰竭安全性高,相比经股动脉径路占有诸多优势.%Objective To study the clinical efficacy and safety of pereutaneous coronary intervention (PCI) via radial artery in the elderly patients with coronary heart disease complicated by chronic left heart failure. Methods 120 cases with coronary heart disease complicated by chronic left heart were divided into two groups: group via radial artery (RA) (64 cases) and group via femoral artery (FA) (56 cases).The exposure time of X-ray,the time lying in bed after operation and the complication rates were retrospectively analyzed. Results There were 60 cases via RA-and 54 cases via FA-PCI treatment,75 and 63 lesions successfully expanded,including 38 and 36 cases of anterior descending,19 and 12 cases of circumflex branch,18 and 15 cases of right coronary artery,73 and 61 stent implanted in radial artery group and femoral artery group,respectively.The difference of treatment and pathological change between the two groups was not statistically significant.The time from puncture to reset tube was longer,average time lying in bed was shorter,and acute left heart failure less occurred in radial artery group compared with femoral artery group (all P＜0.01).The puncture complications and rates of lower limb deep vein thrombosis,and lung embolism were lower in radial artery group than in femoral artery group (all P＜0.05).The incidence rates of pain in back and loin,dysuresia and abdominal distension were higher in femoral artery group than in radial artery group(P＜0.05). Conclusions PCI shows more advantages via radial artery versus via femoral artery in treatment of the elderly coronary heart disease complicated with chronic left heart failure.