股动脉穿刺处严重出血的危险因素多元回归分析

Risk factors for major bleeding at femoral artery puncture sites: a multivariate regression analysis

目的探究介入治疗时股动脉穿刺处严重出血的相关危险因素。方法回顾性分析行股动脉穿刺的879例患者的临床资料,并依据是否出血分为严重出血组和未严重出血组,其中严重出血组23例,未严重出血组856例,对比两组患者的临床资料,同时采用Logistic回归方程分析股动脉穿刺处严重出血的危险因素。结果 879例患者中有23例发生严重出血症状,占2.6%。单因素分析显示:严重出血组和未严重出血组的年龄(34.8%vs7.9%)、急诊(26.1%vs11.4%)、血清肌酐浓度、伴有糖尿病、伴有压迫时间>4 h(30.4%vs9.7%)及血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班用量等因素与股动脉穿刺处出血存在相关性。多元回归分析显示年龄≥74岁(中位年龄)、急诊、伴有糖尿病及血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班用量与股动脉穿刺处出血密切相关(OR=2.187、2.231、1.485、1.792、0.742、2.741,P<0.05)。结论年龄≥74岁、急诊、伴有糖尿病及替罗非班用量是股动脉穿刺处严重出血的高危因素,临床上需重点干预这些患者,以降低出血率。

Objective To investigate the risk factors for major bleeding at femoral artery puncture sites during interventional treatment.Methods The clinical data of 879 patients who underwent femoral artery puncture were retrospectively analyzed,and according to the presence or absence of major bleeding,these patients were divided into major bleeding group（ 23 patients） and non-major bleeding group（ 856 patients）. The clinical data were compared between the two groups,and the logistic regression equation was used to analyze the risk factors for major bleeding at femoral artery puncture sites. Results Of the 879 patients,23（ 2. 6%） had the symptoms of major bleeding. The univariate analysis showed that in the major bleeding group and non-major bleeding group,the age（ 34. 8% vs7. 9%）,emergency treatment（ 26. 1% vs 11. 4%）,serum creatinine,diabetes,compression time 4 hours（ 30. 4% vs 9. 7%）,and high dose of the platelet membrane glycoprotein IIb / IIIa receptor antagonist tirofiban were associated with bleeding at femoral artery puncture sites. The multivariate regression analysis showed that age ≥74 years（ median age）,emergency treatment,diabetes,and high dose of the platelet membrane glycoprotein IIb / IIIa receptor antagonist tirofiban were closely associated with bleeding at femoral artery puncture sites（ OR = 2. 187,2. 231,1. 485,1. 792,0. 742,and 2. 741,P 0. 05）. Conclusions Age ≥74 years,emergency treatment,diabetes,and high dose of tirofiban are the high-risk factors for major bleeding at femoral artery puncture sites. Clinical intervention should be performed for such patients to reduce bleeding rate.