CAJ | 학술논문

目的评价经桡动脉直接介入治疗老年人急性心肌梗死的临床优势. 方法收集2008年1月至2011年10月因急性ST段抬高心肌梗死施行直接介入治疗的老年患者150例,平均年龄(70.4±7.2)岁,经股动脉路径介入治疗(股动脉组)91例,经桡动脉路径介入治疗(桡动脉组)59例,比较两组的穿刺至球囊打开时间、梗死相关血管的开通成功率、X线曝光时间、总手术时间、对比剂用量、平均住院天数、平均住院费用及术后并发症. 结果桡动脉组患者平均住院天数(9.3±0.5)d少于股动脉组与(12.8±0.7)d(P＜0.01)；桡动脉组的平均住院费用低于桡动脉组(44707.3±1009.3)元与(54047.8±1971.6)元(P＜0.05)；穿刺至球囊打开时间(26.7±0.8) min与(27.7±1.2)min(P＞0.05);梗死血管开通成功率98.3％(58/59)与96.7％ (88/91)(P＞0.05);X线曝光时间(10.8±0.9)min与(9.6±0.6)min(P＞0.05)；对比剂用量(223.9±9.2)ml与(229.8±7.5)ml(P＞0.05).两组术后外周血管并发症、住院期间心血管事件比较,差异无统计学意义(P＞0.05).股动脉组术后无尿潴留,桡动脉组组11例,两组比较差异有统计学意义(P＜0.01). 结论在老年急性心肌梗死患者中,桡动脉组具有与股动脉穿刺相同的开通梗死相关血管的可操作性和安全性,且患者术后有更好的舒适度,降低其住院天数和住院费用,具有良好的临床优势和社会经济效益.
목적 평개경뇨동맥직접개입치료노년인급성심기경사적림상우세. 방법 수집2008년1월지2011년10월인급성ST단태고심기경사시행직접개입치료적노년환자150례,평균년령(70.4±7.2)세,경고동맥로경개입치료(고동맥조)91례,경뇨동맥로경개입치료(뇨동맥조)59례,비교량조적천자지구낭타개시간、경사상관혈관적개통성공솔、X선폭광시간、총수술시간、대비제용량、평균주원천수、평균주원비용급술후병발증. 결과 뇨동맥조환자평균주원천수(9.3±0.5)d소우고동맥조여(12.8±0.7)d(P＜0.01)；뇨동맥조적평균주원비용저우뇨동맥조(44707.3±1009.3)원여(54047.8±1971.6)원(P＜0.05)；천자지구낭타개시간(26.7±0.8) min여(27.7±1.2)min(P＞0.05);경사혈관개통성공솔98.3％(58/59)여96.7％ (88/91)(P＞0.05);X선폭광시간(10.8±0.9)min여(9.6±0.6)min(P＞0.05)；대비제용량(223.9±9.2)ml여(229.8±7.5)ml(P＞0.05).량조술후외주혈관병발증、주원기간심혈관사건비교,차이무통계학의의(P＞0.05).고동맥조술후무뇨저류,뇨동맥조조11례,량조비교차이유통계학의의(P＜0.01). 결론 재노년급성심기경사환자중,뇨동맥조구유여고동맥천자상동적개통경사상관혈관적가조작성화안전성,차환자술후유경호적서괄도,강저기주원천수화주원비용,구유량호적림상우세화사회경제효익.
Objective To evaluate the clinical advantages of transradiai approach for percutaneous coronary intervention in elderly patients with acute myocardial infarction.Methods From January 2008 to October 2011,150 elderly patients (average age of 70.4±7.2 yrs) diagnosed with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary invention (PCI).They were divided into transfemoral intervention group (TFI group,n=91) and transradial intervention group (TRI group,n=59).The arrival time at the first balloon inflation,the success rate of reperfusion,the X ray exposure time,the total procedural time,contrast volume,the average in-hospital days,the mean hospital expenses and postoperative complications were compared between two groups.Results The average in-hospital days was shorter in TRI group than in TFI group [(9.3±0.5) days vs.(12.8±0.7) days,P＜0.01].The mean in-hospital expenses was less in TRIgroup than in TFI group [(44707.3±1009.3) RMB vs.(54047.8±1971.6) RMB,P＜0.05].There were no significant differences in the arrival time at the first balloon inflation,the success rate of reperfusion,the X-ray exposure time,the contrast volume between the two groups [(26.7±0.8)minutes vs.(27.7±1.2) minutes,98.3％ (58/59) vs.96.7％ (88/91),(10.8±0.9) minutes vs.(9.6±0.6) minutes,(223.9±9.2) ml vs.(229.8±7.5) ml,respectively,all P＞0.05].The postoperative complications including major bleeding,pseudoaneurysm,radial occlusion without ischemia and the incidence of major adverse cardiovascular events had no statistical differences between the two groups (P＞0.05).The cases of urethral catheterization caused by urinary retention were less in TRI group than in TFI (0 vs.11 cases,P＜0.01).Conclusions Compared with transfemoral approach,the transradial approach is feasible and safe for primary PCI in elderly patients with acute myocardial infarction,and has better clinical advantage and socioeconomic benefit.