曾广忠 林婷 刘高 张瑶

*基金项目：萍乡市科技计划项目（2022PY001）

【摘要】 目的：探讨经远端桡动脉穿刺行经皮冠脉介入治疗（percutaneous coronary intervention，PCI）在冠心病合并肾功能不全患者中的应用。方法：选取萍乡市人民医院自2022年7月—2023年6月收治的60例冠心病合并肾功能不全患者，采用随机数字表法分为对照组和观察组，各30例。对照组进行桡动脉穿刺PCI手术，观察组采用经远端桡动脉穿刺PCI手术。比较两组一次穿刺和手术的成功率、临床相关指标、数字评价量表（numerical rating scale，NRS）评分、住院时间及手术并发症发生情况。结果：两组一次穿刺和手术成功率进行比较，差异均无统计学意义（P>0.05）。观察组穿刺时间较对照组长，术后压迫止血时间较对照组短，差异均有统计学意义（P<0.05）；两组手术时间比较，差异无统计学意义（P>0.05）。观察组NRS评分显著低于对照组，差异有统计学意义（P<0.05）。两组住院时间比较，差异无统计学意义（P>0.05）。观察组的手术并发症发生率相较于对照组低，差异有统计学意义（P<0.05）。结论：经远端桡动脉穿刺行PCI在冠心病合并肾功能不全患者中应用效果较好，有较高的一次穿刺成功率和手术成功率，能显著缩短术后压迫止血时间并有效缓解患者疼痛，同时显著降低手术并发症，安全性较好。

【关键词】 冠心病 肾功能不全 远端桡动脉穿刺 经皮冠脉介入治疗

Application of Percutaneous Coronary Intervention via Distal Radial Artery Puncture in Patients with Coronary Heart Disease and Renal Insufficiency/ZENG Guangzhong， LIN Ting， LIU Gao， ZHANG Yao. //Medical Innovation of China， 2024， 21（14）： 0-081

[Abstract] Objective： To investigate the application of percutaneous coronary intervention （PCI） via distal radial artery puncture in patients with coronary heart disease and renal insufficiency. Method： A total of 60 patients with coronary heart disease and renal insufficiency who were admitted to Pingxiang People's Hospital from July 2022 to June 2023 were selected， and divided into the control group and the observation group by random number table method， with 30 cases in each group. The control group underwent PCI via radial artery puncture， while the observation group underwent PCI via distal radial artery puncture. The success rates of one-time puncture and operation， clinical related indicators， numerical rating scale （NRS） score， length of hospital stay， and incidence of operation complications were compared between the two groups. Result： There were no statistically significant differences in the success rates of one-time puncture and operation between the two groups （P>0.05）. Puncture time in the observation group was longer than that in the control group， and the time for postoperative hemostasis by compression was shorter than that in the control group， the differences were statistically significant （P<0.05）; there was no statistically significant difference in operation time between the two groups （P>0.05）. The NRS score of the observation group was significantly lower than that of the control group， the difference was statistically significant （P<0.05）. There was no statistically significant difference in the length of hospital stay between the two groups （P>0.05）. The incidence of operation complications in the observation group was significantly lower than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： PCI via distal radial artery puncture is effective in patients with coronary heart disease and renal insufficiency， can achieve relatively high success rates of one-time puncture and operation， significantly shortening the time for postoperative hemostasis by compression， effectively alleviate pain， and significantly reduce operation complications， with good safety.

[Key words] Coronary heart disease Renal insufficiency Distal radial artery puncture Percutaneous coronary intervention

First-author's address： Department of Cardiovascular Medicine， Pingxiang People's Hospital， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2024.14.019

目前，心血管疾病为常见的临床疾病之一，包括冠心病、心肌梗死、心力衰竭等多种类型，患者常伴随心绞痛、心律失常、胸闷等症状，可能会导致患者出现心肌梗死、脑卒中等严重的并发症，直接威胁患者生命安全[1]。当前临床行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）主要穿刺路径为桡动脉，桡动脉位置表浅，搏动易触及，周围无重要静脉、神经毗邻，血管直径相对较大，因此在进行穿刺时可以更容易地控制出血和避免损伤血管神经[2-3]。但对合并慢性肾功能不全的患者，当疾病……