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目的探讨经桡动脉穿刺介入治疗老年急性冠脉综合征(ACS)合并2型糖尿病(DM)患者的可能性和安全性。方法98例患者分为ACS合并糖尿病的老年患者经桡动脉经皮冠状动脉介入(PCI)治疗(A组,56例)与ACS未合并糖尿病的老年患者行PCI治疗(B组,42例),观察两组手术成功率和手术后并发症。结果两组患者接受PCI的成功率差异无统计学意义;A组单支、双支、三支和左主干等部位发生病变的患者数均较B组多,两组间差异有统计学意义(P=0.001 2)。冠状动脉病变以左前降支最多,其次为右冠状动脉、左旋支和左主干。两组间血管病变程度差异有统计学意义(P=0.01)。A组A型、B型、C型也较B组高,两组间血管病变类型比较差异有统计学意义(P=0.005)。右前臂血肿发生率(A组4例,B组1例)、假性动脉瘤(A组2例,B组无)、术侧肢体肿胀(A组3例,B组2例)、动静脉瘘(A组无,B组1例)均有差异但差异无统计学意义;两组均无远端肢体缺血。结论老年ACS伴2型DM患者的冠脉病变均较非糖尿病组严重,经桡动脉途径行PCI治疗术中老年ACS糖尿病患者痛苦小且安全,患者容易接受。
Objective To investigate the feasibility and safety of transradial approach for the treatment of elderly patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM). Methods A total of 98 patients were enrolled in this study. Elderly patients with ACS complicated with diabetes underwent percutaneous coronary intervention (PCI) in group A (n = 56) and elderly patients without diabetes (group B, n = 42) The success rate of operation and postoperative complications were observed. Results There was no significant difference in the success rate of PCI between the two groups. In group A, the number of patients with single, double, triple and left main stem lesions was more than that in group B, with significant difference between the two groups P = 0.001 2). Coronary artery lesions in the left anterior descending branch, followed by the right coronary artery, left circumflex artery and left main. The degree of vascular lesions between the two groups was statistically significant (P = 0.01). Type A, type B and type C in group A were also higher than those in group B. There was significant difference in the type of vascular lesions between the two groups (P = 0.005). The incidence of right forearm hematoma (4 in group A and 1 in group B), false aneurysms (2 in group A and 2 in group B), swelling of the limbs in the right limb (3 in group A and 2 in group B) Fistula (no in group A, and group B in 1 case), but the difference was not statistically significant; neither group had distal limb ischemia. Conclusions Coronary lesions in elderly patients with ACS and type 2 DM are more severe than those in non-diabetic patients. Percutaneous transradial PCI in patients with ACS is less painful and safe and the patients are easy to accept.