Application of different methods of ischemic preconditioning in radial artery in elderly patients undergoing transradial coronary intervention
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摘要:目的
观察不同方式缺血预处理(IPC)在经桡动脉冠状动脉介入治疗(TRI)老年患者中的应用效果。
方法选取行择期TRI老年患者459例，随机分为A组、B组和C组，每组153例。其中, A组有3例患者不能耐受IPC, 中途退出，最终纳入150例。A组采用缺血预适应训练仪对双上肢进行IPC, 袖带压力为200 mmHg; B组、C组分别用缺血预适应训练仪、定制智能血压计对双上肢进行IPC, 袖带压力均高于双侧肱动脉收缩压50 mmHg。比较3组患者手部发绀时间、护士操作时间、麻木评分和上臂皮下出血点、术中心绞痛、ST段偏移>1 mm的发生率及心率、术后手部肿胀、疼痛评分、出院前桡动脉狭窄情况。
结果IPC期间, B组、C组患者手部发绀时间晚于A组，麻木评分、上臂皮下出血点发生率低于A组，差异有统计学意义(P < 0.05); A组、C组护士操作时间短于B组，且C组短于A组，差异有统计学意义(P < 0.05)。术中, A组、C组患者心绞痛、ST段偏移>1 mm发生率和心率低于B组，差异有统计学意义(P < 0.05)。A组、C组患者术后手部肿胀、疼痛评分低于B组，出院前桡动脉狭窄率低于B组，差异有统计学意义(P < 0.05)。
结论术前应用定制智能血压计实施高于肱动脉收缩压50 mmHg的IPC, 在减少工作量同时, IPC效果与200 mmHg高压力相近，并提高了患者舒适性，减少了毛细血管损伤。
Abstract:ObjectiveTo observe the effect of different methods of ischemic preconditioning (IPC) in elderly patients undergoing transradial coronary intervention (TRI).
MethodsA total of 459 elderly patients with elective TRI were randomly divided into A group, B group and C group, with 153 cases in each group. Among them, 3 patients in the A group could not tolerate IPC and withdrew halfway, and 150 patients were eventually included. In group A, IPC was performed on both upper limbs with an ischemic preconditioning trainer, and the cuff pressure was 200 mmHg; the IPC was performed on both upper limbs of group B and C with ischemic preconditioning trainer and customized intelligent sphygmomanometer, respectively, and the cuff pressure was higher than the bilateral brachial artery systolic pressure (50 mmHg). Cyanosis time of hand, nurse operation time, numbness score, the incidence of subcutaneous hemorrhagic spots on upper arm, angina during operation as well as ST segment deviation >1 mm, heart rate, postoperative hand swelling, pain score and radial artery stenosis before discharge of three groups were compared.
ResultsDuring IPC, the cyanosis time of hands in the B group and C group was significantly later than that in the A group, and the numbness score and incidence of subcutaneous hemorrhagic spots on upper arm were significantly lower than those in the A group (P < 0.05); the operation time of nurses in the A group and C group was significantly shorter than that in the B group, and that in the C group was significantly shorter than that in the A group (P < 0.05). During the operation, the incidence of angina pectoris, ST segment deviation >1 mm and heart rate in the A group and C group were significantly lower than those in the B group (P < 0.05). The scores of postoperative hand swelling and pain in the A group and C group were lower than that in the B group, and the rate of radial artery stenosis before discharge was lower than that in the B group (P < 0.05).
ConclusionThe application of customized intelligent sphygmomanometer to perform IPC higher than 50 mmHg of brachial artery systolic pressure before surgery has the same effect as the high pressure of 200 mmHg, which reduces the workload, improves the patients' comfort, and reduces the blood capillary injury.
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表 1 3组患者一般资料比较(x±s)[n(%)]
组别 年龄/岁 女性 高血压 糖尿病 血脂异常 收缩压/mmHg 体质量指数/(kg/m2) 病变血管支数 单支 双支 3支 A组(n=150) 70.10±6.52 49(32.67) 107(71.33) 60(40.00) 77(51.33) 118.90±10.22 24.17±3.24 27(18.00) 58(38.67) 65(43.33) B组(n=153) 70.31±6.12 50(32.68) 112(73.20) 69(45.10) 74(48.37) 119.13±10.58 24.24±3.36 35(22.87) 63(41.18) 55(35.95) C组(n=153) 69.05±5.68 36(23.53) 106(69.28) 50(32.67) 81(52.94) 118.55±10.15 24.14±3.05 33(21.57) 58(37.91) 62(40.52) 
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表 2 3组手部发绀时间、麻木时间、上臂皮下出血点发生率及护士操作时间比较(x±s)[M(P25, P75)][n(%)]
组别 手部出现发绀时间/s 麻木评分/分 上臂皮下出血点 护士操作时间/s 中指指尖 手掌末端 A组(n=150) 79.73±5.34 115.62±9.12 7.00(6.00，7.00) 59(39.33) 32.36±5.96# B组(n=153) 97.31±6.05* 157.76±10.01* 5.00(5.00，6.00)* 27(17.64)* 86.53±6.14 C组(n=153) 96.86±5.85* 155.69±9.79* 6.00(5.00，6.00)* 30(19.61)* 21.63±5.68*# 与A组比较, *P < 0.05; 与B组比较, #P < 0.05。
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表 3 3组术中心绞痛、ST段偏移>1 mm发生情况及心率比较(x±s)[n(%)]
组别 心绞痛 ST段偏移>1 mm 心率/(次/min) IPC前 术中 A组(n=150) 44(29.33)* 29(19.33)* 79.76±12.85 74.49±10.37* B组(n=153) 69(45.10) 51(33.33) 78.42±11.41 77.06±11.29 C组(n=153) 41(26.80)* 31(20.26)* 77.78±11.97 73.90±11.38* 与B组比较, *P < 0.05。
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表 4 3组术后手部肿胀、疼痛评分与出院前桡动脉狭窄比较(x±s)[M(P25, P75)][n(%)]
组别 手部肿胀/g 疼痛评分/分 桡动脉狭窄 术前 术后 A组(n=150) 255.67±31.75 262.33±33.45* 3.00(2.00, 4.00)* 31(20.67)* B组(n=153) 258.84±33.09 272.53±32.71 4.00(4.00, 5.00) 58(37.91) C组(n=153) 255.41±33.14 260.30±33.22* 3.00(3.00, 4.00)* 28(18.30)* 与B组比较, *P < 0.05。
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