目的 对比分析经鼻烟窝区远端桡动脉入径(dTRA)和常规桡动脉入径(TRA)行冠脉介入诊疗效果。方法 回顾性分析武警特色医学中心心血管病科2021-01至2022-12收治冠心病行CAG和(或)PCI诊疗的患者临床资料182例,筛选出145例,其中68例经鼻烟窝区远端桡动脉入径(dTRA组),77例经常规桡动脉入径(TRA组)。比较两组患者术前基线资料,术中一次性穿刺成功率、穿刺置管时长;术后穿刺部位加压止血时间、术区疼痛,肢体舒适度、术后并发症及患者满意度等观察指标。结果 两组患者的术前基线资料对比无统计学差异。dTRA组一次性穿刺成功56例(82.35%),TRA组成功71例(92.21%),两组一次性穿刺成功率差异无统计学意义(χ²=3.225,P=0.083)。与TRA组相比,dTRA组完成穿刺置管所需时间较长[(18.72±3.29)min vs.(8.87±2.72)min,t=-19.705,P＜0.001],但术后压迫止血时间明显减少[(2.40±0.49)h vs.(5.72±0.61)h,t=35.853,P＜0.001],差异均有统计学意义。与TRA组相比,dTRA组的术肢疼痛明显减轻(P＜0.001),术后并发症显著减少(P＜0.05),且主要表现为术后血肿,偶有假性动脉瘤,未发生桡动脉闭塞,患者对手术的满意度高于TRA组(非常满意,22.06% vs.1.30%;满意,75.00% vs.86.61%;不满意,2.94% vs.9.09%;P＜0.001),差异均有统计学意义(P<0.05)。结论 dTRA穿刺术式有利于患者的术后恢复、减少并减轻并发症,但因技术难度较高,在临床推广中需注意技术培训。

Objective To compare and analyze the effects of distal transradial artery access (dTRA) in the anatomical snuffbox and transradial artery access (TRA) for patients undergoing coronary intervention. Methods The clinical data of 182 patients with coronary heart disease who underwent CAG or PCI at Characteristics Medical Center of CPAPF from January 2017 to December 2018 were retrospectively analyzed, and then 145 cases were screened in the study, of which 68 cases underwent dTRA approach and 77 cases underwent TRA approach. We collected preoperative baseline characteristics of all patients, and compared the indicators of intraoperative one-time puncture success rate, duration of arterial punctures, postoperative compression time, pain in operative area, limb comfort, postoperative complications and patient satisfaction. Results There was no significant differences in preoperative baseline data between the two groups. Cases of one-time puncture success in dTRA group and TRA group were 56(82.35%) and 71(92.21%) respectively, and no significant difference was found (χ²=3.225, P=0.083). Compared with TRA group, , The duration of arterial punctures in dTRA group was prolonged [(18.72±3.29) min vs. (8.87±2.72) min, t=-19.705, P<0.001], but postoperative compression hemostasis time was significantly reduced [(2.40±0.49) h vs. (5.72±0.61) h, t=35. 853, P<0.001],. Comparative analysis of postoperative observation indicators showed that operative limb pain was alleviated (P<0.001) and postoperative complications was reduced (P<0.05) in dTRA group, mainly manifested as postoperative hematoma, occasional pseudoaneurysm, and no radial artery occlusion. The satisfaction of patients with surgery in dTRA group was higher than that in TRA group (Very satisfied, 22.06% vs. 1.30%; Satisfied, 75.00% vs. 86.61%; Not satisfied, 2.94% vs. 9.09%) (P<0.05). Conclusions The application of dTRA access is beneficial to postoperative recovery of patients, and reduces postoperative complications. However, because of high technical difficulty, skill training should be paid mor attention in its clinical promotion.