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目的探讨经桡动脉路径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)血管通路痉挛应用PCI导丝和球囊辅助跨越痉挛段血管的安全性和可行性。方法回顾性分析2014年1月至2015年6月首都医科大学附属北京朝阳医院、临汾市人民医院、晋城心脑血管病医院、临汾市第二人民医院和烟台海港医院经桡动脉路径PCI伴有桡动脉和(或)肱动脉痉挛应用PCI导丝和球囊辅助成功越过痉挛段的33例冠心病患者(A组),并与同期其他术者用常规方法处理痉挛的38例患者(B组)进行比较。观察两种方法指引导管通过痉挛段的成功率以及并发症的发生率等指标,以了解两种方法的优劣。结果两组患者痉挛部位比较,差异无统计学意义(P=0.150),但肱动脉痉挛的发生率均较桡动脉高。A组指引导管通过率显著高于B组[33例(100.0%)比15例(39.5%),P=0.000];对于指引导管成功通过痉挛段的两组患者,A组较B组所需时间更短(P=0.000),A、B组指引导管通过时间≤5 min的患者分别为30例(90.9%)和2例(13.3%),5~15 min的患者分别为3例(9.1%)和7例(46.7%),>15 min的患者分别为0和6例(40.0%)。A组患者前臂血肿发生率较B组降低[(2例(6.1%)比7例(18.4%)],但差异无统计学意义(P=0.113)。结论经桡动脉路径PCI血管痉挛应用PCI导丝和球囊辅助可非常安全有效地使指引导管跨越痉挛和(或)夹层段,较应用抗痉挛药物这一常规方法更为安全可行。
Objective To investigate the safety and feasibility of percutaneous coronary intervention (PCI) of vascular access spasm via radial artery in the treatment of vascular bypass with spasticity by using PCI guide wire and balloon. Methods A retrospective analysis was performed between January 2014 and June 2015 in Beijing Chaoyang Hospital Affiliated to Capital Medical University, Linfen People’s Hospital, Jincheng Cardiovascular and Cerebrovascular Hospital, Linfen Second People’s Hospital and Yantai Harbor Hospital with radial artery PCI Thirty-three patients (group A) with radial artery and / or brachial artery spasm who successfully crossed the spasticity with PCI guidewire and balloon-assisted therapy and 38 patients with spasticity (B group) )Compare. To observe the two methods to guide the catheter through the success rate of spasticity and the incidence of complications such as indicators to understand the pros and cons of the two methods. Results There was no significant difference in the spasticity between the two groups (P = 0.150), but the incidence of brachial artery spasm was higher than that of the radial artery. The catheterization rate of group A was significantly higher than that of group B (33 cases (100.0%) vs 15 cases (39.5%), P = 0.000]; for the two groups of patients who successfully guided the catheterization through the spasticity group, (P = 0.000), 30 patients (90.9%) and 2 patients (13.3%) in group A and group B, respectively, which guide the catheter to pass the time ≤5 min, and 3 patients (9.1 %) And 7 patients (46.7%), 0 and 6 patients (40.0%) for> 15 min, respectively. The incidence of forearm hematoma in group A was lower than that in group B (2 cases (6.1%) vs 7 cases (18.4%)], but the difference was not statistically significant (P = 0.113) .Conclusion The transradial PCI angiospasm Guidewire and balloon assist can safely and effectively guide the catheter over spasms and / or dissections, making it safer and more practicable than the conventional methods of using antispasmodic drugs.