经股动脉入路和经桡动脉入路经皮冠状动脉介入术治疗老年冠心病合并慢性左心衰竭患者的临床效果比较

摘要

目的：比较经股动脉入路和经桡动脉入路经皮冠状动脉介入术（ PCI ）治疗老年冠心病合并慢性左心衰竭患者的临床效果。方法选取开封市第二人民医院心血管内科2013年5月—2014年7月收治的224例老年冠心病合并慢性左心衰竭患者，根据手术入路不同分为TFI组（121例）和TRI组（103例）。 TFI组患者行经股动脉入路PCI治疗， TRI组患者行经桡动脉入路PCI治疗，两组患者治疗后均随访6个月。比较两组患者手术情况（穿刺时间、 X线暴露时间、手术时间、术后卧床时间）、手术成功率、穿刺部位并发症发生率、术后并发症发生情况（下肢深静脉血栓形成、肺栓塞、体循环栓塞、左心衰竭、腰背疼痛、排尿困难、腹胀、肢体疼痛）及复发率。结果 TFI组患者穿刺时间、 X线暴露时间、手术时间均短于TRI组，术后卧床时间长于TRI组（ P＜0.05）。 TFI组患者手术成功率为95.87％， TRI组患者手术成功率为93.20％，差异无统计学意义（ P＞0.05）。 TFI组患者穿刺部位并发症发生率为32.23％，高于TRI组的18.45％（P＜0.05）。两组患者术后下肢深静脉血栓形成、肺栓塞、体循环栓塞、肢体疼痛发生率比较，差异无统计学意义（ P＞0.05）； TFI组患者术后左心衰竭、腰背疼痛、排尿困难、腹胀发生率均高于TRI组（P＜0.05）。 TFI组患者术后6个月复发率为14.05％，高于TRI组的5.83％（P＜0.05）。结论经桡动脉入路PCI治疗老年冠心病合并慢性左心衰竭患者的临床效果与经股动脉入路PCI相当，但手术时间较长，术后并发症发生率较低。%Objective To compare the clinical effect of PCI in treating aged coronary heart disease patients complicated with chronic left heart failure between transfemoral approach and transradial approach.Methods From May 2013 to July 2014, a total of 224 aged coronary heart disease patients complicated with chronic left heart failure were selected in the Department of Cardiology, the Second People′s Hospital of Kaifeng, and they were divided into A group (n=121) and B group (n=103) according to surgical approaches.Patients of A group were treated by PCI through transfemoral approach, while patients of B group were treated by PCI through transradial approach, patients of both groups were followed-up for 6 months after surgery.Surgery situation ( including puncture time, X-ray exposed time, surgery duration and postoperative in-bed time) , surgical successful rate, incidence of siteofparacentesis complications and postoperative complications ( including lower extremity deep venous thrombosis, pulmonary embolism, systemic emboli, left heart failure, lumbago and back pain, dysuria, abdominal distension and limb pain) , and recurrence rate were compared between the two groups.Results Puncture time, X-ray exposed time and surgery duration of A group were statistically significantly shorter than those of B group, while postoperative in-bed time of A group was statistically significantly longer than that of B group ( P <0.05 ) . The surgical successful rate of A group was 95.87%, that of B group was 93.20%, the difference was not statistically significantly different (P>0.05).The incidence of siteofparacentesis complications of A group was 32.23%, was statistically significantly higher than that of B group of 18.45% (P <0.05).No statistically significant differences of lower extremity deep venous thrombosis, pulmonary embolism, systemic emboli or limb pain was found between the two groups ( P>0.05 ) , while the incidence of left heart failure, lumbago and back pain, dysuria and abdominal distension of A group were statistically significantly higher than those of B group (P<0.05).The recurrence rate of A group was 14.05%, was statistically significantly higher than that of B group of 5.83% ( P <0.05 ) . Conclusion The clinical effect of PCI in treating aged coronary heart disease patients complicated with chronic left heart failure is similar between transfemoral approach and transradial approach, while the surgery duration of PCI through transradial approach is relatively longer, but the incidence of postoperative complications is relatively lower.