老年冠状动脉支架术后两种止血方法止血效果及血管并发症的比较

Comparative study on the effect of hemostasia and vascular complications for patients after coronary stent implantation in elderly

目的比较老年冠状动脉(以下称冠脉)支架术后Perclosc缝合止血与手工压迫止血的止血效果及血管并发症情况,为老年冠脉支架术的护理工作提供指导。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、血管并发症发生率。结果缝合成功者止血时间、下肢制动时间明显较手工止血短,局部血肿发生率明显低,无假性动脉瘤、动静脉瘘发生,缝合失败者上述时间明显延长,血管并发症增加。结论Perclose缝合止血与手工止血同样安全有效;止血、下肢制动时间明显缩短,血管并发症发生率低,但费用昂贵,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 compare the effect and complications of hemostasis by Perclose device and manual method in the elderly. And to provide feasible guide for how to nurse the patients who underwent coronary stent implantation. Methods 324 elderly patients who underwent coronary stents implantation were divided two groups. 165 patients accepted Perclose device for hemostasis （device group）. 159 patients accepted manual method for hemostasis （handiwork group）. Time to achieve hemostasis and crura ambulation, vascular complications were compared. Resuits Time of achieve hemostasis and ambulation was lesser than that in handiwork group, the rate of local hematoma was lower, no pseudoaneurysm and arterio-venous fistula occurred in device group. Time of achieve hemostasis was longer and the local vascular complications were increased in failed hemostasis patients in device group. Conclusion The safety and efficacy of the two methods of hemostasis were same. The time to achieve hemostasis and crura ambulation was shortened, the rate of local vascular complications was lower, but the cost was very high, the femoral access site by manual method under heparinization after unsuccessful suturing, and this would increase complications rate of local vessel in device group, and aggravate the patient＇ burden of economy and psyche.