【摘要】 目的观察经桡动脉径路,应用5F指引导管深插技术对冠状动脉慢性闭塞性病变(CTO)进行介入治疗的可行性、安全性和效果。方法回顾分析28例CTO病人(陈旧性心肌梗死13例,不稳定型心绞痛9例,稳定型心绞痛6例)经桡动脉行介入治疗(桡动脉组)的资料,并与40例CTO病人(陈旧性心肌梗死19例,不稳定型心绞痛14例,稳定型心绞痛7例)经股动脉介入治疗(股动脉组)效果进行比较。桡动脉组应用5F指引导管深插技术,对慢性闭塞血管行经皮冠状动脉腔内成形术(PTCA)和冠状动脉内支架植入;股动脉组行冠状动脉造影后介入治疗。比较两组病人穿刺成功率、手术时间、X线照射时间、手术成功率、住院时间及并发症发生率。结果桡动脉组23例(82.1%)获得成功,共植入支架35枚,5例未成功;无穿刺部位并发症。股动脉组33例(82.5%)获得成功,共植入支架62枚,7例未成功;术后发生股动脉假性动脉瘤1例,再次加压包扎后假性动脉瘤闭塞;局部血肿3例,经理疗后好转。两组病人穿刺成功率、手术成功率、手术时间、X线照射时间等差异无统计学意义(χ2=1.98、2.16,t=1.12、1.22,P>0.05);桡动脉组病人住院时间短于股动脉组(t=2.56,P<0.05)。结论经桡动脉5F指引导管深插技术治疗CTO安全方便,成功率较高,血管并发症少。更多还原

【Abstract】 Objective To evaluate the feasibility,safety and outcome of percutaneous coronary intervention using 5 French guiding catheters via trans-radial access in patients with chronic total coronary occlusion(CTCO). Methods Data of patients with CTCO undergoing trans-radial coronary artery interventional therapy(n=28),in which old myocardial infarction(n=13),instable angina(n=9),and stable angina(n=6) included,were analyzed retrospectively.A comparison with those treated by trans-femoral(TF,n=40) was made,including old myocardial infarction(n=19),instable angina(n=14) and stable angina(n=7).For trans-radial(TR) group,a 5 French guiding catheter was used for percutaneous transluminal coronary angioplasty and coronary artery stenting;For TF,the intervention was carried out after coronary arteriography.X-ray exposure time,operation time,puncture success rate as well as complications and hospital stay were compared between the two groups. Results The success of puncture was achieved in 23 patients in TR group and 35 stents inserted,five failed,no complications on the pucture sites were recorded;in TF group,the success of puncture was 33,62 stents inserted,seven failed.A false femoral aneurism occurred in one case,which was cured later by pressure pressing.Local hematoma seen in three cases that improved after physiotherapy.The differences were not significant between the two groups in terms of operation,puncture success rate,and X-ray exposure(χ2=1.98,2.16;t=1.12,1.22;P>0.05),but the hospital stay was shorter in TR(t=2.56,P<0.05). Conclusion By using trans-radial 5F guiding catheter technique for coronary interventional therapy is effective and safe for CTCO with less complications.更多还原