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目的:观察老年患者(≥60岁)接受桡动脉冠状动脉介入诊疗(TRI)术后桡动脉急性闭塞(RAO)的发生率,并探讨影响老年患者TRI术后发生RAO的相关因素。方法:选择2006年8月至2009年2月,于北京安贞医院12病房择期TRI≥60岁的老年患者1 256例,根据术后是否发生RAO分为正常组和RAO组,通过多因素Logistic回归分析与RAO有关的危险因素。记录手术相关参数,包括桡动脉穿刺次数、鞘管型号、手术时间、术中肝素用量及术后桡动脉压迫止血时间。疑有桡动脉闭塞的患者通过多普勒超声确诊。结果:1.1 256例TRI患者急性RAO发生率2.2%(28/1256例)。与正常组相比,RAO组患者中女性、糖尿病和既往行TRI患者的比例较高,RAO组术中平均肝素用量明显低于正常组〔(3 826±523)IU vs.(7 425±980)IU,P=0.008〕,术后压迫时间长于正常组〔(378.9±35.4)min vs.264.7±43.2)min,P=0.003〕,且RAO组患者应用7F动脉鞘的比例较高(10.7%vs.1.9%,P=0.029);Logistic回归分析显示,7F动脉鞘管、肝素用量偏低及术后桡动脉压迫时间过长,是影响RAO发生的独立危险因素。结论:老年患者TRI术中选择尺寸合适的动脉鞘管、足够强度的抗凝治疗、避免术后过长时间的压迫止血等均有利于减少RAO的发生。
Objective: To observe the incidence of acute radial artery occlusion (RAO) in elderly patients (≥60 years) undergoing radial artery coronary intervention (TRI) and to explore the related factors that affect the occurrence of RAO in elderly patients after TRI. Methods: From August 2006 to February 2009, 1256 elderly patients with TRI ≥60 years old in 12 wards of Anzhen Hospital were randomly divided into normal group and RAO group according to whether or not RAO occurred after operation. Multivariate Logistic Regression analysis of RAO-related risk factors. Surgical parameters including the number of radial artery puncture, sheath type, operation time, intraoperative heparin dosage and postoperative radial artery compression hemostasis time were recorded. Patients suspected of radial artery occlusion were diagnosed by Doppler ultrasound. Results: The incidence of acute RAO in 1,256 TRI patients was 2.2% (28/1256 cases). Compared with the normal group, the RAO group had a higher proportion of women with diabetes and previous TRI. The mean heparin level in the RAO group was significantly lower than that in the normal group [(3 826 ± 523) IU vs. (7 425 ± 980) ) (IU, P = 0.008). The postoperative compression time was longer in the RAO group than in the normal group (378.9 ± 35.4 min vs.264.7 ± 43.2 min, P = 0.003) vs.1.9%, P = 0.029). Logistic regression analysis showed that low heparin and heparin dose in 7F and long time of radial artery compression were independent risk factors for RAO. CONCLUSIONS: In the elderly patients, choosing appropriate size of arterial sheath during TRI surgery, adequate anticoagulant therapy, and avoiding excessive hemostasis after the operation for a long time are helpful to reduce the incidence of RAO.