股动脉穿刺冠状动脉造影术后8h下地活动的可行性探讨

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

目的观察股动脉穿刺行冠状动脉造影、人工压迫止血后8h下地活动的可行性和安全性。方法189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、8h后下地活动，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4—8（6．12±0．66）h，下地活动时间6—10（8．10±0．78）h，29（15．3％）例患者出现腰疼不适，10（2．7％）例患者导尿，16（8．47％）例患者穿刺部位有出血并发症：轻微渗血6（3．17％）例、大血肿2（1．06％）例、小血肿7（3．70％）例、皮下淤斑12（6．34％）例、假性动脉瘤1（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，8h下地活动是可行和安全的。

Objective To evaluate the efficacy hnd safety of ambulation 8 hours after coronary angiography by the femoral approach. Methods Totally 189 patients undergoing coronary angiography without heparin were enrolled in the study, MC was applied to achieve hemostasis 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 8 hours after hemostasis. The efficacy endpoint （ 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 com- pression time was 10 -40 （24.42 ±5.68） rain. The time of moving the affected leg with bed elevated 30 and ambulation was 4 -8 （6. 12 ±0.66） h and 6 - 10 （8. 10 ±0.78） h, respectively. Backpain occurred in 15.3% and bladder catheterizations were inserted into 5 cases. Bleeding complications of puncture site occurred in 16 cases： minor bleeding occurred in 6 cases, large and small hematoma in 2 and 7 cases, respectively. Bruise in 12 cases, Femoral pseudoaneurysm in 1 cases, the local complications rate was 8.47%. No severe bleeding that need blood transfusion occurred at 1 - 3 days follow up. Conclusion It is feasible and safe to ambulate patients 8 hours after diagnostic angiography.