经皮股动脉冠状动脉造影术后6小时下地活动的可行性探讨

Six hours ambulation after coronary angiogram through femoral approach without pressure bandaging

目的观察经皮股动脉行冠状动脉造影、人工压迫止血后6h下地活动的可行性和安全性。方法377例非肝素化经皮股动脉行冠状动脉造影的患者在拔除动脉鞘管、人工压迫止血后无加压包扎,沙袋压迫10～30min,6h下地活动,观察患者舒适度及其穿刺部位并发症。结果人工压迫止血时间5～30(11.89±3.22)min,即刻止血成功率100%,沙袋压迫时间10～40(24.42±5.68)min。压迫止血后患肢床上活动时间2～6(4.12±0.66)h,下地活动时间4～8(6.10±0.78)h,58(15.4%)例患者出现腰痛不适,10(2.7%)例患者导尿,33(8.75%)例患者穿刺部位有出血并发症:轻微渗血11(2.92%)例、大血肿5(1.33%)例、小血肿15(3.98%)例、皮下淤斑25(6.63%)例、假性动脉瘤2(0.53%)例。随访1～3d,无严重出血并发症。结论使用6F动脉鞘、经皮股动脉穿刺、无肝素化冠状动脉造影、人工压迫止血后无加压包扎,6h下地活动是可行和安全的。

Objective To evaluate the efficacy and safety of ambulation 6 hours after coronary angiography by the femoral approach. Methods Totally 377 patients undergoing coronary anglography without heparin were enrolled in the study, MC was applied to achieve hemostasls after sheath removal, followed by sandbag over the puncture site for 30 minutes without dressing, in-bed ambulation 4 h after procedure and off-bed ambulation was attempted 6 hours after hemostasis. The efficacy endpolnt （time to hemostasis and ambulation） and safety endpoint（major complications, small hematoma, etc ） were evaluated. Results The mean manual compression time was 5-30 （11.89±3.22）min, hemostasis was achieved in all cases after MC. The mean sandbag compression time was 10-40 （24.42±5.68） rain. The time of moving the affected leg with bed elevated 30° and ambulation was 2-6 （4.12±0.66）h and 4-8 （6.10±0.78）h,respectively. backpain occurred in 15.4%.and bladder catheterizations were inserted into 10 cases. Bleeding complications of puncture site occurred in 33 cases： minor bleeding occurred in 11 cases, large and small hematoma in 5 and 15 cases, respectively, bruise in 25 cases, Femoral pseudoaneurysm in 2 cases, the local complications rate was 8.75%.No severe bleeding that need blood transfusion occurred at 1-3 days follow up. Conclusion It is feasible and safe to ambulate patients 6 hours after diagnostic anglography .