经桡动脉途径冠状动脉介入治疗术后术肢血肿、肿胀的观察

Limb Hematoma and Swelling after Transradial Coronary Intervention

目的总结经桡动脉途径冠状动脉介入治疗(TRI)的临床经验。方法对42例TRI术后发生术肢血肿、肿胀患者的临床资料进行回顾性分析。结果 42例患者中发生前臂血肿5例(11.9%),其中3例由于导丝损伤小分支血管,2例由于桡动脉痉挛,拔出导管或鞘管时损伤血管内皮。术肢肿胀37例(88.1%),其中19例与术程较长、肝素用量加大,止血器压力过大、压迫时间延长有关;12例因桡动脉血管细小、痉挛,多次、多部位穿刺,止血器压迫桡动脉鞘管穿刺点及其他穿刺点渗血引起;4例与术后患者过早活动术肢不当有关;2例与止血器压迫位置不当引起。所有TRI术后术肢血肿、肿胀患者均予以恰当处理,未发生骨筋膜间隔综合征,均康复出院。结论熟练的桡动脉穿刺技术、严格的手术操作流程及认真的术后护理能有效地预防和减少TRI术后术肢血肿、肿胀的发生。

Objective To summarize our clinical experience with transradial coronary intervention （TRI）. Methods The clinical data of 42 patients with limb hematoma and swelling following TRI were analyzed retrospectively. Results Five of the 42 patients（11.9%） had forearm hematoma. Among them, the hematoma was caused by guide wire-induced small branch vessel injury in 3,and by radial artery spasm and vascular endothelial injury during catheter or sheath withdrawal in 2. Thirty-seven of the 42 patients（88.1%） had ipsilateral limb swelling.Among them,the swelling was caused by the longer operative duration, increased heparin dosage,excessive hemostat pressure and prolonged oppression time in 19,by radial artery spasm,multiple punctures,hemostatic compression of the radial artery sheath puncture site and errhysis of other puncture sites in 12, by early postoperative activity in 4, and by improper hemostat oppression position in 2. All patients with postoperative limb hematoma and swelling were treated appropriately and discharged from hospital without the occurrence of osteofascial compartment syndrome. Conclusion The skillful radial artery puncture technique,strict surgical process and careful postoperative nursing can effectively prevent and reduce limb hematoma and swelling after TRi.