【摘要】 目的:观察开展经桡动脉途径行急性ST段抬高性心肌梗死(STEMI)直接经皮冠状动脉介入术(primary per-cutaneous coronary intervention,PCI)治疗的有效性和安全性。方法:我院2003年1月~2005年8月收治的40例(23例男性)诊断明确、有急诊PCI适应症的STEMI患者中,血流动力学稳定、桡动脉搏动良好、Allen试验阳性的14例纳入经桡动脉PCI组(A组),其余26例包括:血流动力学不稳定可能需行主动脉内球囊反搏(IABP)或临时起搏器置入术、桡动脉搏动弱或Allen试验阴性者纳入经股动脉PCI组(B组)。结果:PCI临床成功率100%,PCI操作成功率A组92.9%(13/14),B组92.3%(24/26),P>0.05,无统计学意义。鞘管置入时间分别为10.31±4.53min、9.69±5.31min,P>0.05;手术时间分别为60.25±24.37min、59.69±25.18min,P>0.05,无统计学意义。随访1月A组无手术侧手臂缺血症状,未发生桡动脉闭塞,无血肿、假性动脉瘤、局部皮肤破溃感染;B组出现2例血肿、1例假性动脉瘤、1例局部皮肤破溃感染、3例高迷走神经反射。结论:经桡动脉途径急诊PCI治疗STEMI是一种安全、有效、更容易被患者接受的方法,对血流动力学稳定、Allen试验阳性、桡动脉搏动良好患者可首选。更多还原

【Abstract】 Objectives:To investigate the availability and safety of PCI via transradial approach in treatment of cases of acute myocardial infarction with ST segment elevation(STEMI).Methods:From January 2003 to August 2005,40 patients(23 male)who were diagnosed as STEMI with the indication of PCI were included in the study.The transradial approach was used in 14 patients(Group A) with stable hemodynamically,strong palpable radial pulse and positive Allen test.The transfemoral approach was used in the other 26 patients(Group B) with unstable hemodynamically who might have required a second vascular access site for intraaortic balloon pumping(IABP) or a transvenous temporary pacemaker,weak palpable radial pulse or negative Allen test.Results:Overall success rate of PCI was 100%(IRA operation reached clinical success).The success rate was 92.9%(13/14) in Group A and 92.3%(24/26)in Group B.The cannulation time[(10.31±4.53)min versus(9.69±5.31)min,P>0.05]and the total procedure time [(60.25±24.37)min versus(59.69±25.18)min,P>0.05]were not significantly different between Group A and Group B.During one month follow-up period,there was not forearm ischemia,losing of radial pulse,hematoma,pseudoaneurgsms and partial derma rupture tainted in Group A.However,there were two cases of hematoma,one case of pseudoaneurysms,one case of partial derma rupture tainted and three cases of high vagas nerve reflect.Conclusions:PCI via transradial approach is a safe,available and easier accepted by patients method to cure STEMI,and it also can be used widely in Southwest China.It mutually complements with traditional transfemora approach and has higher operational success rate and more effect than the latter.It is the first alternative for the patients who have stable hemodynamically,positive ALLEN test and strong palpable radial pulse.更多还原