老年冠状动脉支架术后两种止血方法并发症的对比观察

Comparative Observation on the Complications from Two Methods of Hemostasis after Coronary Stent Implantation in Elderly Patients

目的观察老年冠状动脉支架术后Perc lose缝合止血与手工压迫止血的止血效果及并发症,为老年冠脉支架术宣教及康复提供指导。方法324例老年冠脉支架术后患者,165例应用Perc lose缝合止血(缝合组),159例应用手工压迫止血(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组短,血管并发症及因卧床所致的不适发生率较手工止血组低。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(1)Perc lose缝合止血与手工止血同样安全有效;(2)缝合组止血、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;(3)费用昂贵;(4)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,加重患者的经济和心理负担。

Objective To observe the efficacy and complications of hemostasis by Perclose device and manual method,so as to provide evidence to guide education and nursing care for the elderly patients who underwent coronary stent implantation. Methods 324 elderly patients who underwent coronary stent implantation were divided into 2 groups. The device group （ n = 165） accepted Perclose device for hemostasis. The handiwork group（ n = 159） accepted manual method for hemostasis. Time to achieve hemostasis, time of lower extremities immobilization, blood vein complications, incidence of discomfort from staying in bed, and nursing care time after hemostasis were compared between the 2 groups. Results Time to a- chieve hemostasis, time of immobilization, and nursing care time after hemostasis in the device group were significantly shorter than those in the handiwork group. Blood vein complications and incidence of discomfort from staying in bed in device group were less than those in the handiwork group. But complication rates at the femoral access site were increased significantly in the patients treated with Perclose unsuccessfully. Conclusion （ 1 ） The efficacy and safety of the two methods of hemostasis are the same. （2） The Perclose device could shorten the time to achieve hemostasis and ambulation. It could also shorten the nursing time, decreased complications and discomforts. （3）The cost is very high. （4）Doctors have to deal the femoral access site by manual method under heparinization after unsuccessful suturing. It would increase complication rates and aggravate the oatients＇ economic and mentnl hurden.