【作者】 文伟明；

【导师】 刘唐威；

【作者基本信息】 广西医科大学 ， 心血管内科， 2008， 硕士

【摘要】 目的系统评价国内经桡动脉路径行冠状动脉造影及介入治疗的可行性、安全性。背景国外已完成多个比较不同动脉路径进行冠状动脉介入诊疗的循证医学研究,进一步证实经桡动脉途径在保证较高手术成功率的同时,周围血管并发症明显少于经股动脉途径。由于国人桡动脉内径较细小,经桡动脉途径冠状动脉介入诊疗是否适于国人尚需进一步明确。方法计算机网络检索中国生物医学文献数据库、MEDLINE、EMBASE、Cochrane图书馆,检索年限为1989年～2008年。收集所有相关国内随机和非随机对照试验,质量评价后用Revman4.2.3软件进行Meta分析。结果未能获得国内随机对照试验,共纳入9个前瞻性对照研究,累计样本量2389例。结果显示:1、CAG成功率:3个试验(n=1013)的Meta分析结果显示,经桡动脉途径冠状动脉造影(TRA)成功率与经股动脉途径冠状动脉造影(TFA)相似[RR=0.98,95%CI(0.95,1.00)];2、PCI成功率:6个试验(n=1441)的Meta分析结果显示,经桡动脉途径冠状动脉介入手术(TRI)成功率与经股动脉途径冠状动脉造影(TFI)相似[RR=0.99,95%CI(0.97,1.01)];3、住院期间主要不良心脏事件(MACE):4个试验报道为0,有1个试验报道TRI组3例、TFI组有2例因术后出现急性冠脉闭塞死亡,其余试验未见相关研究。4、插管操作失败率:8个试验(n=2236)的Meta分析结果显示,经桡动脉途径的失败率要高于经股动脉途径,其差异有统计学意义[RR=1.59,95%CI(1.02,2.47)];5、外周血管并发症:9个试验(n=2389)的Meta分析结果显示,经桡动脉途径组的外周血管并发症明显少于经股动脉组,其差异有统计学意义[RR=0.50,95%CI(0.29,0.86)];6、住院时间:5个试验(n=1293)的Meta分析结果显示,经桡动脉途径组的住院时间明显少于经股动脉组,统计学有显著差异[WMD=-2.68,95%CI(-3.55,-1.81)]。另外造影剂使用量、X线曝光时间、动脉穿刺时间、手术时间,在多个研究合并效应量后没有统计学意义。结论国人在经桡动脉途径行冠心病介入诊疗与经股动脉途径行冠心病介入诊疗同样安全可行的。经桡动脉途径外周血管并发症少,尤其是出血性血管并发症,且卧床和住院时间短,是经股动脉途径所不可比拟的。但经桡动脉途径行冠心病介入诊疗操作难度较大,对术者技能要求高。此外,进一步提高经桡动脉介入器材的操作性能以及桡动脉易发生痉挛和闭塞的难题还有待解决。更多还原

【Abstract】 Background Overseas evidence based medicine researches about comparison of different approaches for percutaneous coronary diagnostic and interventional procedures have been finished, which confirmed that the radial approach can guarantee high success rate and reduce local vascular complications compared with the femoral approach. However, the inner diameter of Chinese radial arteries is small, so it is quite necessary to make sure that if the radial approach is also suit for Chinese people for coronary angiography and percutaneous coronary intervention.Objective To systematically review the feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) through the radial approach in China.Methods The papers from 1989 to 2008 were retrieved from biomedicine bibliographic database of China (CBM), MEDLINE, EMBASE, and Cochrane, which were about randomized controlled trials (RCT) and non-randomized controlled trials to compare the radial approach with the femoral approach. Software of Revman4.2.3 was used to carry out Meta-analysis after the quality of the papers was evaluated.Results In this field, RCT of China was not found, and 9 perspective controlled trials (n=2389) were included. (l)Meta-analysis of 3 trials (n=1013) showed that the success rate of CAG was similar for the radial versus femoral approach [RR=0.98, 95%CI(0.95, 1.00)]. (2)Meta-analysis of 6 trials (n=1441) showed that the success rate of PCI was similar for the radial versus femoral approach [RR=0.99, 95%CI (0.97, 1.01)]. (3)None of the major adverse cardiovascular events (MACE) was found in 4 trials. In one trial, 3 cases of transradial intervention (TRI) group and 2 cases of transfemoral intervention (TFI) group died of acute coronary obstruction. The other trials did not carry out research of this part. (4)Meta-analysis of 8 trials (n=2236) showed that the radial approach had a higher proportion of intubation failures than that of the transfemoral approach [RR=1.59, 95%CI (1.02, 2.47)]. (5)Meta-analysis of 9 trials (n=2389) showed that the rate of local vascular complications of TRI group was lowered than that of the TFI group [RR=0.50, 95%CI (0.29, 0.86)]. (6)Meta-analysis of 5 trials (n=1293) showed that the length of stay of TRI group was shorter than that of TFI group[WMD=-2.68, 95%CI (-3.55, -1.81)].(7) The doses of contrast agent, exposure time of X ray, time for arteriopuncture, time for PCI showed no significant differences between the TRI group and the TFI group.Conclusions In Chinese, the radial approach for coronary procedures appears as a safe alternative to femoral access. The lower rate of local vascular complications, especially hemorrhagic complications, the shorter time of lying in bed and staying in hospital through make the radial approach superior to the femoral approach. But it is more difficult to carry out PCI through radial approach. Moreover, it is necessary to improve the operability of equipment and supplies for radial approach and reduce the rate of arteriospasm and obstruction of radial artery.更多还原