经桡及经股动脉途径直接经皮冠状动脉介入治疗比较研究.doc

急性心肌梗死经桡及股动脉直接经皮冠状动脉介入治疗比较研究 叶慧明,(1)* 卢明瑜(1)，王伟民， 刘健， 赵红，马玉良，李琪，刘传芬 目的 对比经桡、股动脉路径行直接经皮冠状动脉介入治疗（PCI）的临床应用价值。方法 选择2009年1月～2010年12月连续的191例急性心肌梗死接受直接PCI（pPCI）术病例，依据手术穿刺路径分为经桡动脉组62例、经股动脉组129例，观察疗效、并发症及住院期间主要心脏不良事件（MACE）。结果 两组基线临床资料差异无统计学意义，两组造影提示梗死相关动脉分布、围术期间糖蛋白IIb/IIIa受体拮抗剂使用率、IABP使用率差异无统计学意义，两组有相同的手术操作成功率、操作时间和needle-to-balloon时间，而经桡动脉组出血并发症及住院期间死亡率有减少趋势，但均无统计学意义，造影剂使用量更少，差异有统计学意义（P=0.043)。结论 与经股动脉路径相比，经桡动脉路径pPCI，出血并发症及住院期间死亡率有减少趋势，造影剂使用量更少，在经验丰富的大中心可作为pPCI的选择血管路径。 【关键词】 桡动脉；股动脉；直接冠状动脉腔内成形术 Comparison of Primary Percutaneous Coronary Intervention Using Transradial Versus Transfemoral Approach in Patients Presenting with Acute Myocardial Infarction YE Hui-ming (1)*, LU Ming-yu(1), WANG Wei-min LIU Jian, ZHAO Hong, MA Yu-liang， LI Qi，LIU Chuan-fen Department of Cardiology, Peking University Affiliated People’s Hospital，Beijing(100044)，China Corresponding author :Lu Ming-yu E-mail: abc2625@ (1) Theses authors contributed equally to this work. Objective: To compare the clinical application value of transradial and transfemoral approach in acute myocardial infarction patients who accept primary percutaneous coronary intervention(pPCI). Method: From January 2009 to December 2010 ,191 consecutive patients who accepted pPCI were enrolled. Transradial approach group and transfemoral approach group had 62 and 129 patients respectively. The clinical efficacy, complications and major adverse cardiac event(MACE) of both group were studied. Results: The basic clinical conditions in both groups had no difference, and infarction related artery, using of glucose protein IIb/IIa receptor antagonist, IABP had no statistical difference too. There were alike procedural success ratio,procedural time and needle-to-balloon time in both groups .But there were tendency of less bleeding complications and death for the transradial group in hospital, but showed no statistical difference(P0.05), and angiographic contrast was less in transradial group (p=0.043). Conclusion: Compared with tr