经股动脉行介入诊疗术后股动脉止血贴的应用

Clinical use of femoral artery hemostasis sticking after interventional procedure via femoral artery access

目的观察经股动脉行介入诊疗术后股动脉穿刺点应用股动脉止血贴(V+PAD)的临床效果。方法应用随机排列表随机入选80例行冠状动脉介入诊疗的患者,其中偶数应用止血贴共40例作为试验组,奇数应用徒手压迫不使用止血贴共40例作为对照组。所有患者均签订知情同意书。观察两组的按压时间、止血后穿刺点的处理、患者卧床姿势、下床活动时间、患者的舒适度、出院前穿刺点并发症情况。结果两组患者年龄、性别构成比、激活凝血时间和血压差异均无统计学意义(P<0.05),但试验组和对照组的压迫时间分别为(7.9±0.5)min和(19.8±5.1)min,卧床时间分别为(6.1±5.0)h和(23.9±0.2)h,两组间差异均有统计学意义(P值均<0.01)。试验组所有患者在拔管后即刻均采用床头抬高30°卧位,1h后将床头抬高90°,常压包扎,不制动,所有患者舒适度明显提高。试验组有1例比较肥胖的女性发生假性动脉瘤,其余入选患者在住院期间均未出现穿刺处并发症。结论股动脉止血贴止血迅速,效果确切,患者舒适度明显提高,减轻了医护人员的工作量,可以在临床大规模推广应用。

Objective To observe the clinical effect of the use of femoral artery hemostasis sticking V＋PAD after the interventional procedure via femoral artery access. Methods By using random permutation list 80 patients, who decided to receive coronary angiography and pereutaneous transluminal coronary angioplasty, were randomly selected. Of the 80 patients, hemostasis sticking V ＋ PAD was employed in 40 patients with even numbers （trial group）, only manual compression was adopted to stop bleeding in another 40 patients with odd numbers （control group）. All the patients were informed about this trial and had to sign a consent letter. The pressure time, the treatment method of access site after hemostasis, the posture in bed, the immobilization time, the comfort degree of patients, the complications of access site prior to discharge, etc. were observed and the results were compared between two groups. Results There was no significant difference between two groups as respect to age, gender ratios, activated clotting time （ACT） value and blood pressure. However, significantly difference in the compression time and bed rest time existed between the two groups. The compression time in trial group and control group was （7.9±0.5） rain and （19.8±5.1 ） min respectively （P 〈 0.01）, while the bed rest time in trial group and control group was （6.1±5.0） hours and （23.9 ± 0.2） hours respectively （P 〈 0.01 ）. All patients in trial group was supine in bed with the head side of the bed raised at 30 immediately after the procedure, and the head side of the bed was further raised to 90° one hour later. The puncture site was bandaged with conventional compression and immobilization was not employed. Patients could lie in bed with free posture and the patient＇s comfort degree was greatly improved. During hospitalization no complications related to puncture site occurred in all patients except one / obese woman in trial group who developed pseudoaneurysm. Conclusion Femoral artery hemostasis sticking V ＋ PAD has quick hemostatic effect, it can also improve the degree of patient＇s comfort and lighten the clinical work load for medical staff. Therefore, it is worth popularizing hemostasis sticking V ＋ PAD in clinical practice.