血管闭合装置在心血管介入治疗后股动脉止血中的应用:安全性、有效性及并发症发生率

Application of hemostasis device in femoral artery hemostasis following cardiovascular intervention: Safety, efficacy and complication incidence

背景:对比血管闭合装置在心血管介入诊疗手术后股动脉止血中的安全性、有效性、并发症发生率和舒适性。方法:由第一作者应用计算机检索维普数据库中与血管闭合器在心血管介入诊疗技术中应用有关的文献,检索时限为1998-01/2009-10。检索关键词:血管闭合器,冠状动脉造影,经皮冠状动脉介入治疗。纳入标准:①选取针对性强,相关度高的文献。②对同一领域的文献选择近期发表或权威杂志的文献。③排除较陈旧的理论观点以及一些重复性研究。对资料进行初审,并查看每篇文献后的引文。结果:计算机初检到72篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献20篇,内容重复性研究32篇,共20篇文献符合标准。目前冠状动脉介入诊断治疗后对股动脉穿刺点止血的方法主要有人工压迫止血、机械压迫止血及血管闭合装置。传统的人工或机械压迫的方法压迫和制动时间长,增加了并发症发生的危险,同时极大地增加了患者的痛苦和延长了住院时间。而近年来临床上应用的一些新型的针对穿刺点局部的缝合或封堵装置,如:Angio-Seal血管封堵器,Perclose血管缝合器等,不仅可以明显减少患者的卧床时间和住院时间,也可以减少对外周血管的损伤。结论:对于临床工作者,实际工作中在决定哪些患者使用血管闭合器时,既要考虑采用血管闭合器的安全性和有效性,也要兼顾血管闭合器处理动脉穿刺的费用和效益比,使患者达到最高的满意度。

OBJECTIVE： To compare the safety, efficacy, incidence of complication and comfort degree of various hemostasis device used in femoral artery hemostasis following cardiovascular intervention. METHODS： A computer-based online search of VIP was performed for articles related to hemostasis device in cardiovascular intervention published between January 1998 and October 2009 with the key words ＂hemostasis device, coronary angiography, percutaneous coronary intervention＂. Inclusion criteria： （1） articles with close correlation with the content; （2） articles in the same filed published recently or in authoritative journals; （3） old or repetitive articles. The data were primarily reviewed and the references of each articles were examined. RESULTS： A total of 72 articles were collected. After screening the titles and abstracts, 20 articles not related with the content, and 32 repetitive studies were excluded, and 20 were included. Currently, the hemostasis methods for femoral artery puncture site following coronary intervention included manually compressive hemostasis, mechanical compressive hemostasis and hemostasis device. Traditional manual or mechanical compression requires long periods of compression and braking, which increases risks for complications, and impairs the patients and prolongs the hospital stay. The novel suture or occlusion device for puncture site used in clinic, such as Angio-Seal or Perclose, significantly reduces bed lying and hospital stay of the patients, and attenuates peripheral vascular damages. CONCLUSION： For clinical physicians, it is necessary to consider the safety and efficacy, as well as the ratio of cost and quality for selection of hemostasis device, so that the patients can satisfy the clinical effects.