经桡动脉与经股动脉PCI对老年急性ST段抬高型心肌梗死的临床效果比较
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摘要
目的比较经桡动脉和经股动脉经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)的临床效果。方法选取2016年7月至2017年10月于本院住院的88例行择期PCI的老年急性STEMI患者为研究对象,采用随机数表法将其分为桡动脉组和股动脉组,每组各44例。桡动脉组患者采用经桡动脉PCI,股动脉组采用经股动脉PCI,术后随访7个月,比较两组患者术后并发症发生情况、手术相关指标、简易精神状态检查(mini-mental state examination,MMSE)量表评分及预后。结果桡动脉组患者术后并发症发生率显著低于股动脉组(P<0.05),术后意识恢复时间及卧床时间均显著短于股动脉组(P_均<0.05)。桡动脉组患者术后6个月以上MMSE量表评分均显著高于股动脉组及本组术后意识清晰次日(P_均<0.05)。两组患者预后情况比较差异无显著性(P>0.05)。结论与经股动脉PCI相比,经桡动脉PCI可显著降低老年急性STEMI患者术后并发症发生率,缩短术后意识恢复时间及卧床时间,有助于提高患者术后的认知功能,但两种手术入路方式对患者预后影响无显著差异。
Objective To investigate the clinical effects of transradial and transfemoral percutaneous coronary intervention(PCI) in the treatment of elderly patients with acute ST-segment elevation myocardial infarction(STEMI). Method 88 elderly patients with acute STEMI admitted to our hospital from July 2016 to October 2017 were selected as the main observation subjects, they were randomly divided into radial artery group and femoral artery group, each group had 44 cases. Radial artery group patients were treated with PCI via radial artery and femoral artery group patients were treated with PCI via femoral artery. All patients were followed up for 7 months. Postoperative complications, surgery-related indicators, mini-mental state examination(MMSE) scores and prognosis were compared between the two groups. Result The incidence of complications in radial artery group was significantly lower than that in femoral artery group(P < 0.05). The postoperative consciousness recovery and bed-rest time in radial artery group were significantly lower than those in femoral artery group(P_(all)< 0.05). The MMSE scores of patients in radial artery group more than 6 months after operation were significantly higher than those in femoral artery group and the next day after the clear sense(P < 0.05). There was no significant difference in the prognosis between the two groups(P > 0.05). Conclusion Compared with PCI via femoral artery, PCI via radial artery can reduce the incidence of complications, shorten the time of consciousness recovery and bed-rest time, and improve the cognitive function of elderly patients with acute STEMI. But there is no difference in prognosis between the two ways.
Objective To investigate the clinical effects of transradial and transfemoral percutaneous coronary intervention(PCI) in the treatment of elderly patients with acute ST-segment elevation myocardial infarction(STEMI). Method 88 elderly patients with acute STEMI admitted to our hospital from July 2016 to October 2017 were selected as the main observation subjects, they were randomly divided into radial artery group and femoral artery group, each group had 44 cases. Radial artery group patients were treated with PCI via radial artery and femoral artery group patients were treated with PCI via femoral artery. All patients were followed up for 7 months. Postoperative complications, surgery-related indicators, mini-mental state examination(MMSE) scores and prognosis were compared between the two groups. Result The incidence of complications in radial artery group was significantly lower than that in femoral artery group(P < 0.05). The postoperative consciousness recovery and bed-rest time in radial artery group were significantly lower than those in femoral artery group(P_(all)< 0.05). The MMSE scores of patients in radial artery group more than 6 months after operation were significantly higher than those in femoral artery group and the next day after the clear sense(P < 0.05). There was no significant difference in the prognosis between the two groups(P > 0.05). Conclusion Compared with PCI via femoral artery, PCI via radial artery can reduce the incidence of complications, shorten the time of consciousness recovery and bed-rest time, and improve the cognitive function of elderly patients with acute STEMI. But there is no difference in prognosis between the two ways.
引文
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[6]李大严,李小华,黎福理,等.临床护理路径对急性ST段抬高型心肌梗死行PCI术患者情绪状态和生活质量的影响[J].广东医学,2018,39(10):1590-1592.
[7]汪勇.经桡动脉与股动脉行PCI治疗冠心病的疗效对比观察及评估[J].中国医药指南,2017,15(14):78-79.
[8]许连军,宋莹,许晶晶,等.动脉穿刺路径在冠状动脉介入治疗中的应用现状及对预后的影响:单中心10557例患者经验[J].中国循环杂志,2017,32(10):965-969.
[9]颜红兵,向定成,刘红梅,等.ST段抬高型急性心肌梗死院前溶栓治疗中国专家共识[J].中国医学前沿杂志(电子版),2018,10(4):1-10.
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[11]刘志锋,莫均荣,柴仁杰,等.急诊绿色通道在急性ST段抬高型心肌梗死患者救治中的应用价值[J].中国急救医学,2016,36(3):250-253.
[12]García-Blas S,Nú?ez J,Carrillo P,et al.Usefulness of sheathless guide catheter for the percutaneous coronary interve ntion of left main disease by radial approach[J].Int J Cardiol,2016,211:49-52.
[13]Schussler JM,Vasudevan A,von Bose LJ,et al.Comparative Efficacy of Transradial Versus Transfemoral Approach for Coronary Angiography and Percutaneous Coronary Intervention[J].Am J Cardiol,2016,118(4):482-488.
[14]Ruiz-Rodriguez E,Asfour A,Lolay G,et al.Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome[J].South Med J,2016,109(1):61-76.
[15]唐刚,郜攀,肖航,等.经桡动脉血栓抽吸治疗老年非ST段抬高型心肌梗死的临床效果及预后评价[J].中国医学前沿杂志(电子版),2016,8(7):58-61.
[16]Gu WJ,Wu XD,Wang F,et al.Ultrasound Guidance Facilitates Radial Artery Catheterization:A Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials[J].Chest,2016,149(1):166-179.
[17]金辰.经桡动脉与经股动脉路径进行冠状动脉介入治疗院内费用和预后差异的研究进展[J].中国循环杂志,2017,32(3):292-294.
[18]Buch A,Carmeli E,Boker L K,et al.Muscle function and fat content in relation to sarcopenia,obesity and frailty of old age--An overview[J].Exp Gerontol,2016,76:25-32.
[2]马云飞,王洪娟,王俊峰,等.急性心肌梗死患者PCI术后的心脏康复现状及进展[J].中国老年学杂志,2017,37(7):1778-1779.
[3]国家卫生计生委合理用药专家委员会,中国药师协会.急性ST段抬高型心肌梗死溶栓治疗的合理用药指南[J].中国医学前沿杂志(电子版),2016,8(8):25-41.
[4]Bleckwenn M,Kleineidam L,Wagner M,et al.Impact of coronary heart disease on cognitive decline in Alzheimer's disease:a prospective longitudinal cohort study in primary care[J].Br J Gen Pract,2017,67(655):e111-e117.
[5]刘茜,李瑜霞.社区老年人认知功能与日常活动能力相关性研究[J].中国现代医学杂志,2018,28(7):119-123.
[6]李大严,李小华,黎福理,等.临床护理路径对急性ST段抬高型心肌梗死行PCI术患者情绪状态和生活质量的影响[J].广东医学,2018,39(10):1590-1592.
[7]汪勇.经桡动脉与股动脉行PCI治疗冠心病的疗效对比观察及评估[J].中国医药指南,2017,15(14):78-79.
[8]许连军,宋莹,许晶晶,等.动脉穿刺路径在冠状动脉介入治疗中的应用现状及对预后的影响:单中心10557例患者经验[J].中国循环杂志,2017,32(10):965-969.
[9]颜红兵,向定成,刘红梅,等.ST段抬高型急性心肌梗死院前溶栓治疗中国专家共识[J].中国医学前沿杂志(电子版),2018,10(4):1-10.
[10]卢俊霖,廖雪梅.急性心肌梗死溶栓治疗研究进展[J].现代医药卫生,2016,32(21):3308-3311.
[11]刘志锋,莫均荣,柴仁杰,等.急诊绿色通道在急性ST段抬高型心肌梗死患者救治中的应用价值[J].中国急救医学,2016,36(3):250-253.
[12]García-Blas S,Nú?ez J,Carrillo P,et al.Usefulness of sheathless guide catheter for the percutaneous coronary interve ntion of left main disease by radial approach[J].Int J Cardiol,2016,211:49-52.
[13]Schussler JM,Vasudevan A,von Bose LJ,et al.Comparative Efficacy of Transradial Versus Transfemoral Approach for Coronary Angiography and Percutaneous Coronary Intervention[J].Am J Cardiol,2016,118(4):482-488.
[14]Ruiz-Rodriguez E,Asfour A,Lolay G,et al.Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome[J].South Med J,2016,109(1):61-76.
[15]唐刚,郜攀,肖航,等.经桡动脉血栓抽吸治疗老年非ST段抬高型心肌梗死的临床效果及预后评价[J].中国医学前沿杂志(电子版),2016,8(7):58-61.
[16]Gu WJ,Wu XD,Wang F,et al.Ultrasound Guidance Facilitates Radial Artery Catheterization:A Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials[J].Chest,2016,149(1):166-179.
[17]金辰.经桡动脉与经股动脉路径进行冠状动脉介入治疗院内费用和预后差异的研究进展[J].中国循环杂志,2017,32(3):292-294.
[18]Buch A,Carmeli E,Boker L K,et al.Muscle function and fat content in relation to sarcopenia,obesity and frailty of old age--An overview[J].Exp Gerontol,2016,76:25-32.