冠脉支架术后Perclose缝合与手工压迫止血的对比研究

Comparative study on the hemostasia by the suture hemostasis device Perclose and manual method after coronary stent implantation in the elderly

目的评价老年冠状动脉(以下称冠脉)支架术后Perclose缝合止血与手工压迫止血的优缺点,为老年冠脉支架术后处理穿刺血管提供参考。方法324例老年冠脉支架术后病人,165例Perclose缝合止血(缝合组),159例手工压迫止血(手工组)。比较止血时间、下肢制动时间、血管并发症、因卧床引起的不适发生率和止血后护理时间。结果两种止血方法同样安全有效。但是,缝合成功者止血时间、下肢制动时间和止血后护理时间明显较手工止血短,血管并发症及因卧床所致不适的发生率较手工止血低。缝合失败者上述时间明显延长,血管并发症及因卧床所致的不适程度增加。结论Perclose缝合止血的优点:(1)与手工止血同样安全有效;(2)止血、下肢制动和护理时间明显缩短,因卧床引起的不适和血管并发症发生率低。缺点:(1)费用昂贵;(2)一旦缝合失败,被迫在肝素化状态下压迫止血,导致血管并发症发生率增高,加重病人的经济和心理负担。

Objective To evaluate the advantage and disadvantage of hemostasis done by Perclose device and manual method. In order to provide feasible suggestion for how to treat with the arterial access site after coronary stent implantation in the elderly. Methods Three hundred and twenty-four elderly patients who underwent coronary stents implantation were divided into two groups. 165 patients accepted Perclose device for hemostasis （device group）, 159 patients accepted manual method for hemostasis （handwork group）, Time to achieve hemostasis and ambulation, complications, patients＇ discomfort, and nursing time after hemostasis were compared, Results The efficacy and safety of two methods of hemostasis were the same. Time to achieve hemostasis and ambulation, nursing time after hemostasis, complications rates at the femoral access site, and patients＇ discomfort rates from staying in bed in device group were lower than those in handwork group. But complications rates at the femoral access site were increased significantly in those patients who were treated with Perclose unsuccessfully. Conclusions The advantage of Perclose device hemostasis in elderly was ： （ 1 ） It was a safe and efficacious method of hemostasis. （2） It could shorten the time to achieve hemostasis and ambulation, it also shortened the nursing time ,decreased complications and patients＇ discomfort rates. The disadvantage was： （1） The cost was very high, （2） Doctors have to deal the femoral access site by manual method under hepafinization after unsuccessful suturing, and this would increase complications rate of the femoral access site. This would also aggravate the patients＇ burden of economy and psyche.