不同途径介入治疗对高龄冠心病患者近期和远期预后影响的研究

摘要

目的：探讨经不同途径行经皮冠状动脉介入治疗( PCI)对高龄冠心病患者预后的影响，为高龄冠心病患者介入治疗提供参考依据。方法选择2011年3月至2013年8月收治的283例高龄冠心病患者，根据不同介入途径为经桡动脉组( n =159)和经股动脉组( n =124)，比较2组患者治疗效果、并发症发生率及心血管事件(CE)发生率。结果经桡动脉组更换介入途径比例为11.32%高于对照组的3.23%，差异有统计学意义(P<0.05)；2组患者术后心功能各项指标比较差异无统计学意义( P >0.05)；经桡动脉组卧床时间、住院时间、围术期TIMI小出血发生率、血管并发症发生率均低于经股动脉组，差异有统计学意义( P <0.05)；2组患者围术期TIMI大出血发生率、住院期间CE发生率、手术成功率及术后1年、2年CE发生率比较，差异无统计学意义( P >0.05)。结论经桡动脉行PCI的近期和远期疗效与经股动脉相当，但经桡动脉行PCI并发症发生率和心血管事件发生率较低，且术后卧床时间较短，但更换介入途径比例较高，值得临床重视。%Objective To investigate the effect of different ways of percutaneous coronary intervention ( PCI) on the short-term and long - term prognosis in advanced age patients with coronary heart disease ( CHD ) in order to provide reference for PCI treatment. Methods Two hundred and eighty-three elderly patients with CHD who were admitted and treated in our hospital from March 2011 to August 2013 were enrolled in the study. According to different intervention approaches, these patients were divided into trans -radial artery intervention group ( n =159 ) and trans -femoral artery intervention group ( n =124). The therapeutic effects,incidence rates of complications and cardiovascular events (CE) were observed and compared between two groups. Results The proportion in trans-radial artery intervention group was significantly higher than that in trans - femoral artery intervention group (11. 32% vs 3. 23%, P <0. 05). However there were no significant differences in the indexes of cardiac function after operation between two groups ( P >0. 05). The time of lying in bed, hospitalization time,incidence of TIMI small hemorrhage at perioperative period,incidence of vascular complications in trans-radial artery intervention group were significantly lower than those in transfemoral artery intervention group ( P <0. 05). there were no significant differences in incidence of TIMI large hemorrhage during perioperative period,the incidence of CE during hospital stay, success rate of operation and incidence of CE on 1 year,2 years after operation between two groups ( P >0. 05). Conclusion The short-term and long-term therapeutic effects by trans-radial artery PCI are similar to those of trans-femoral artery PCI, but the incidence rates of complications and cardiovascular events in trans-radial artery PCI are lower, moreover the time of lying in bed after operation is shorter,thus,we should pay much attention to it in clinical practice.