三种股动脉血管封堵器应用疗效比较

Efficiency comparison of 3 kinds of arterial puncture closing devices

目的探讨3种股动脉血管封堵器应用效果和各自特点。方法回顾性分析1479例心导管术后患者,分徒手压迫、Angioseal封堵、Perclose封堵、Boomerang封堵等4种方式止血,观察记录实际制动时间、出血并发症和其他少见并发症情况,比较各自的特点。结果徒手压迫、Angioseal封堵、Perclose封堵、Boomerang封堵4组实际制动时间分别(21.4±2.7)h、(3.5±2.3)h、(3.7±2.6)h和(3.9±2.8)h,封堵器组明显减少制动时间。4组操作失败率依次为2.7%、1.4%、8.6%和3.5%。出血并发症发生率4组依次为9.2%、5.8%、12.6%和8.0%。除去操作失败病例,则4组出血并发症发病率差异无统计学意义。结论应用封堵器明显减少患者实际制动时间,但并不减少出血并发症。3种血管封堵器各具特点,应用时需严格掌握指征和选择合适患者。

Objective To evaluate the efficiencies of arterial puncture closing devices （APCDs） including Angioseal, Perclose and Boomerang in patients undergone coronary angiography or percutaneous vascular interventions. Methods 1497 patients underwent cardiac catheterization procedures were divided into manual compression group（639 cases） and APCDs closure group（576 cases with Angioseal, 151 cases Perclose and 113 cases of Boomerang）. The times of maneuver, hemorrhage complication and other rare complications were assessed, recorded and compared. Results The times for maneuver of standard manual compression group, Angioseal group, Perclose group and Boomerang group were （21.4 ± 2.7） h, （3.5 ± 2.3） h, （3.7 ± 2.6） h and （3.9 ± 2.8） h respectively. The APCDs could obviously reduce bed rest time in comparing to that of manual compression. The rates of failure of the operations were 2.7%（@）,1.4%（＊）,8.6%（@＊）and 3.5% （@P = 0.006, ＊P 〈 0.001 ）; and the rates of hemorrhage were 9.2%,5.8%（#）. 12.6%（#）and 8.0% respectively for each of the four mentioned groups （# P = 0.005 ）. Except the failure operations, the incidence of hemorrhage complications among the groups showed no significant differences. Conclusion Application of APCDs to close the puncture site can significantly reduce the bed rest time, but not the incidence of hemorrhage complications. （J Intervent Radiol, 2007, 16： 411-413）