延长压迫时间可降低老年人股动脉穿刺点出血风险

Extending compression time reduces bleeding risk of femoral artery puncture point in elderly

摘要:

目的 评价以Angioseal动脉闭合装置封闭老年人股动脉穿刺点后，延长加压包扎时间降低出血并发症。方法 连续入选接受冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）的老年患者728例，均以Angioseal封闭股动脉穿刺点，上述患者随机分为常规治疗组（术后直腿平卧6h后可活动，随后于2h内拆除加压包扎用弹力绷带）和延迟包扎组（直腿平卧6h后可活动，但于术后20～24h拆除加压包扎用弹力绷带），观察血管并发症及其时机。结果 两组患者发生股动脉穿刺点并发症发生率相比，差异具有统计学意义。常规治疗组的穿刺点出血、假性动脉瘤等发生率明显高于延迟包扎组（7.42% vs 1.78%，P＝0.001）。其中出血并发症增高主要表现为拆除加压包扎敷料后的出血并发症增多（常规治疗组6.14%，延迟包扎组0.59%，P＝0.001）。而因出血形成的假性动脉瘤发生率在常规治疗组明显增加（1.53% vs 0.00%，P＝0.033）；随着出血后局部压迫止血等措施的实施，静脉血栓虽有增加（0.77% vs 0.30%，P＝0.628），但差异无统计学意义。结论 股动脉穿刺点在应用Angioseal后的出血并发症除与穿刺技术相关外，PCI术后的抗凝、抗血小板药物治疗也是重要原因。在这些强化抗凝、抗血小板药物治疗的患者中适当延长压迫时间，减少早期活动是减少股动脉穿刺点出血并发症的重要手段。

Abstract:

Objective To evaluate the effect of prolonged compression bandaging time on bleeding Atotol of complications after closing the femoral artery puncture point with the Angioseal artery occluders in the elderly. Methods Totally 728 elderly patients were selected for coronary angiography and interventional treatment, whose femoral artery puncture points were closed with Angioseal. These patients were randomly divided into the conventional treatment group (keeping postoperative straight leg lie for 6 hours, and then elastic pressure bandage was removed within 2h) and delayed bandaging group (keeping postoperative straight leg lie for 6 hours, and then elastic pressure bandage was not removed until 20?24h). The vascular complications and occurrent time were observed. Results There was significant difference in femoral artery puncture site complications between two groups. The incidence of puncture site bleeding and pseudoaneurysm from conventional treatment group was significantly higher than that from delayed bandaging one (7.42% vs 1.78%, P＝0.001). And bleeding complications were manifested as increased hemorrhagic complications after removement of compression bandage (conventional treatment group, 6.14%, and delayed bandaging group, 0.59%, P＝0.001). The formation incidence of pseudoaneurysm due to hemorrhage increased significantly in the conventional treatment group (1.53% vs 0.00%, P＝0.033). Although incidence of venous thrombosis due to local pressed hemostasis after bleeding increased (0.77% vs 0.30%, P＝0.628), there was no statistical difference. Conclusion Bleeding complication of femoral artery puncture site with Angioseal not only related with the puncture technique, but also with PCI postoperative anticoagulation and antiplatelet treatment. Extending compression time and reducing the early activities appropriately are very important means of reducing femoral artery puncture site bleeding complications.