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目的 对急性心肌梗死经桡动脉途径介入治疗中桡动脉发生痉挛的危险因素进行分析总结.方法 选择符合纳入标准的2017年8月至2018年8月德阳市第二人民医院胸痛患者257例,采用统一标准行桡动脉入路经皮冠状动脉介入( percutaneous coronary intervention, PCI)治疗,按照术中患者有无桡动脉痉挛,将其分成两组,一组为桡动脉痉挛组( radial artery spasm,RAS),一组为非RAS组.采用SPSS19??0软件对数据进行统计学分析.结果 年龄、性别、糖尿病、高血压、高脂血症、吸烟史、桡动脉解剖异常、导管交换次数、桡动脉直径／身高、桡动脉直径／导管外径、焦虑、操作时间过长、术中中重度前臂疼痛、支架数目、桡动脉搏动的2、3、4级,RAS组与非RAS组相比,差异均有统计学意义(P均＜0??05).多因素分析显示:性别[OR(95%CI): 0??92(0??897～0??944),P＝0??043]、高脂血症[OR(95%CI): 3??249(2??508～4??208),P＝0??016]、桡动脉解剖情况[OR(95%CI): 5??19(2??090～12??886,P＝0??012]、导管交换次数[OR(95%CI): 6??19(3??087～12??413,P＝0??011]、桡动脉直径／身高[OR(95%CI): 3??56(1??527～8??302,P＝0??035]、桡动脉直径／导管外径[OR(95%CI): 2??968(1??665～5??291),P＝0??029]、术中中重度前臂疼痛[ OR(95%CI): 3??543(1??394～9??006),P＝0??039]和桡动脉途径介入治疗中诱发桡动脉痉挛均存在相关关系,为独立危险因素. ROC曲线分析显示:导管交换次数、桡动脉直径和身高比值、桡动脉直径和导管外径比值以及三者联合诊断在ROC曲线下面积分别为0??806、0??674、0??645、0??895.经比较,三者联合的AUC最高,其次为导管交换次数,桡动脉直径／身高与桡动脉直径／导管外径相对较低.导管交换次数的最佳诊断点为 11??585,其敏感度为0??86,特异性为0??58;桡动脉直径和身高比值最佳诊断点为11??145,敏感度为71??8%,特异性为0??56;桡动脉直径和导管外径比值的最佳诊断点为9??31,敏感度为95??3,特异性为32??0%;三者联合诊断的最佳诊断点为9??63,敏感度为0??72,特异度为0??88.结论 经桡动脉途径介入治疗中桡动脉发生痉挛的独立危险因素有导管交换次数、桡动脉解剖情况、桡动脉直径／身高、术中中重度前臂疼痛、高脂血症和性别,其中女性大于男性.

Objective To analyze and summarize the risk factors of radial artery spasm in patients with acute myocardial infarction treated by radial artery interventional therapy??Methods From August 2017 to August 2018,257 patients with chest pain in Deyang Second People＇s Hospital were selected and treated by percutaneous coronary intervention ( PCI) through radial artery approach??According to the presence or absence of radial artery spasm, the patients were divided into two groups??The radial artery fistula group (RAS) and the non?RAS group??All data were statistically analyzed using SPSS 19??0 software??Results The following indicators were statistically different between the RAS group and the non?RAS group: age,gender, diabetes,hypertension,hyperlipidemia,smoking history,radial artery anatomy,catheter exchange times,radial artery diameter／height, radial artery diameter／catheter diameter, anxiety, excessive operation time, intraoperative moderate to severe forearm pain, the number of stents, grade 2, 3, and 4 of radial artery pulsation??There were significant differences between two groups(all P＜0??05)??Multivariate analysis showed:gender(OR(95%CI): 0??92( 0??897－0??944),P＝0??043), hyperlipidemia ( OR ( 95%CI): 3??249 ( 2??508－4??208),P＝0??016),radial artery anatomy ( OR( 95%CI): 5??19 ( 2??090－12??886, P＝0??012), catheter exchange times( OR(95%CI): 6??19(3??087－12??413,P＝0??011),radial artery diameter／height( OR(95%CI): 3??56 ( 1??527－8??302, P＝0??035), radial artery diameter／catheter diameter ( OR ( 95%CI): 2??968 (1??665－5??291),P＝0??029),intraoperative moderate to severe forearm pain( OR(95%CI): 3??543(1??394－9??006), P ＝ 0??039 ) were independent risk factors for the induction of radial artery spasm in the interventional treatment of the radial artery??The difference between the two groups was statistically significant??ROC curve analysis showed that the area under the curve of the number of catheter exchanges, radial artery diameter／height, radial artery diameter／catheter diameter and the combined diagnosis were 0??806,0??674,0??645,and 0??895,respectively??By comparison,AUC of the combined diagnosis were highest, followed by catheter exchange times, radial artery diameter／height and radial artery diameter／catheter diameter were relatively lower??The best diagnostic point of catheter exchange times was 11??585, with a sensitivity of 0??86 and a specificity of 0??58??The best diagnostic point of radial artery diameter／height was 11??145,with a sensitivity of 71??8% and a specificity of 0??56??The best diagnostic point of arterial diameter／catheter diameter was 9??31,with a sensitivity of 95??3 and a specificity of 32??0%??The best diagnostic point of the combined diagnosis was 9??63, with a sensitivity of 0??72 and a specificity of 0??88??Conclusion Independent risk factors for radial artery spasm in the interventional treatment of the radial artery include catheter exchange times, radial artery anatomy, radial artery diameter／height, intraoperative moderate and severe forearm pain,hyperlipidemia,age and gender,and female incidence is greater than male??