血氧饱和度监测在经桡动脉冠状动脉介入术后预防桡动脉闭塞中的应用

Regulating radial compression guided by oxygen saturation to prevent radial artery occlusion after transradial coronary intervention

目的探讨经桡动脉冠状动脉(下称冠脉)介入术后,监测经皮血氧饱和度(SpO2)对于预防桡动脉闭塞的效果。方法将2012年7～8月经桡动脉行冠脉介入术的101例患者随机分为观察组(n=50)和对照组(n=51)。术毕,确认患者术侧手端未因桡动脉压迫止血过度而出现缺血症状或特殊不适后,压迫同侧尺动脉并监测该侧拇指的SpO2。观察组:若SpO2低于95%时,即刻给予桡动脉压迫止血器缓慢松解减压,直至SpO2上升到95%或以上,并确认穿刺点无出血。对照组仅记录拇指SpO2。两组在后续时间段按止血器说明书中的方法定时给予松解减压。术后24h观察两组桡动脉闭塞率。结果与对照组相比,观察组通过调整桡动脉压迫止血器的压迫强度,均可使术侧拇指的SpO2达95%或以上,并能显著减少术后24h桡动脉闭塞的发生率(χ2=5.826,P=0.016)。结论经桡动脉冠脉介入术后,通过压迫术侧尺动脉监测拇指SpO2调节桡动脉止血器的压迫强度,可以显著降低桡动脉闭塞的发生率。这种方法简便有效,值得在临床中推广应用。

Objective To evaluate the efficacy of regulating radial compression guided by the value of transcutaneous oxygen saturation（SpO2） in preventing radial artery occlusion after transradial coronary intervention （TRI）. Methods Totally 101 patients with undergoing TRI were randomly divided into the experimental group（n=50） and the control group（n=51）. After TRI,the operation side ulnar artery was pressed and the value of SpO2 of the same side thumb was monitored after confirming the operation side thumb didn＇t exhibit symptomatic ischemia or other discomfort due to over-pressed. For the patients in the experimental group,the pressure of radial hemostat was gradually reduced when the value of SpO2 was lower than 95%. The incidence of radial artery occlusion after 24 hours was compared between the two groups. Results Compared to the control group,the value of SpO2 in the experimental group could be back up to 95% by regulating pressure of radial hemostat,and the incidence of radial artery occlusion was significantly lower （15.69% vs. 2.00%,P=0.016）. Conclusion After TRI,the incidence of radial artery occlusion can be reduced by regulating radial compression guided by the value of SpO2. This method is simple and efficient,which is worth being popularized in clinical practice.