脉搏血氧仪在经桡动脉入径行经皮冠状动脉介入治疗术后桡动脉压迫止血中的应用

Pulse oximeter in guidance of hemostasis after transradial coronary intervention

目的观察经桡动脉入径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者急性桡动脉闭塞(radial artery occlusion,RAO)的发生率,并探讨脉搏血氧仪监测在桡动脉压迫止血中的作用。方法选择2013年3月至2014年8月于华润武钢总医院心内科病房经桡动脉入径行PCI的患者502例,将术后常规使用桡动脉压迫器加压止血患者作为常规组(250例),在桡动脉压迫止血同时使用脉搏血氧仪监测血氧饱和度患者作为监测组(252例)。所有患者72 h内通过多普勒超声确诊有无RAO。结果所有患者中经超声检测证实发生急性RAO14例(2.8%),其中常规组13例(5.2%),监测组1例(0.4%),差异有统计学意义(P<0.01)。监测组中2例提前将桡动脉压迫器中气囊减压放气时,穿刺处出血,再次加压后脉搏血氧仪监测显示动脉血氧饱和度低下(<95%),退出监测组,进行直接纱布加压包扎止血,术后经超声检测未发生急性RAO。结论使用脉搏血氧仪监测下的压迫止血方法能显著降低RAO的发生率。

Objective To observe the incidence of acute radial artery occlusion（ RAO） and evaluate the efficacy of pulse oximeter in guiding hemostasis after transradial coronary intervention. Methods Five hundred and two consecutive patients undergoing transradial catheterization were prospectively enrolled in the study. Two hundred fifty patients were randomized to group Ⅰ,and underwent conventional pressure application for hemostasis. Two hundred fifty two patients were randomized to group Ⅱ and underwent pressure application confirming radial artery patency using a pulse oximeter in hemostasis. Radial artery patency was studied at 72 hr by Doppler ultrasound. Results Fourteen patients（ 13 patients in group Ⅰvs. 1 patient in group Ⅱ,P 0. 01） had evidence of radial artery occlusion at 24 hr. 2 patients had bleeding from puncture site during deflation of compression balloon but also presented Sp O2 95% when balloon inflated. Hemastasis was then archieved by compression bandage. Conclusions Patent hemostasis guided by pulse oximeter sensor is highly effective in reducing RAO after radial access.