两类桡动脉压迫止血器临床应用效果分析

The application of two kinds of radial artery compression hemostasis device:analysis of their clinical effect

目的比较旋钮式压迫止血器和气囊式压迫止血器在桡动脉途径介入治疗术中的临床应用效果。方法回顾性分析2015年2月至9月接受冠状动脉介入治疗的186例患者临床资料。其中105例患者选用旋钮式压迫止血器,81例患者选用气囊式压迫止血器,比较两组患者术后临床特征及血管并发症发生情况。根据术后穿刺点出血情况将患者分为出血组和不出血组,比较两组患者临床特点。结果使用气囊式压迫止血器患者术后手部肿胀率(P=0.001)、疼痛视觉模拟评分(VAS,P=0.02)均明显低于使用旋钮式压迫止血器患者;两者术后出血比例未见明显差异(17.3%对14.3%,P=0.55)。出血组患者活化部分凝血活酶时间(APTT,P=0.001)、国际标准化比值(INR,P=0.001)、术后使用低分子肝素或替罗非班比例(P=0.002)及疼痛VAS评分(P=0.001)均高于不出血组患者,诊断性造影比例低于不出血组患者(P=0.03)。结论旋钮式压迫止血器和气囊式压迫止血器止血效果相当,气囊式压迫止血器在舒适度及肿胀率方面优于旋钮式压迫止血器。术后穿刺点是否出血与压迫止血器类型无关,与患者APTT、INR、术后抗凝药物使用情况及是否植入支架相关。

Objective To compare the clinical effect of knob type compression hemostatic device and balloon-type compression hemostasis device in interventional treatment via radial artery access. Methods The clinical data of 186 patients, who received percutaneous coronary intervention at authors＇ hospital during the period from February 2015 to September 2015, were retrospectively analyzed. Among the 186 patients, knob type compression hemostatic device was used in 105 （group A） and balloon-type compression hemostasis device was employed in 81 （ group B ）. The postoperative clinical manifestations and the occurrence of vascular complications were compared between the two groups. According to the bleeding of puncture point the patients were divided into bleeding group and non-bleeding group, and the clinical characteristics of the two groups were compared. Results Both the hand swelling rate and pain visual analogue scale （VAS） of group B were significantly lower than those of group A （P= 0.001 and P=O.02 respectively） ; and no statistically significant difference in postoperative bleeding rate existed between the two groups （ 17.3% vs 14.3%, P= 0.55）. In the bleeding group, the activated partial thromboplastin time （ATPP, P = 0.001 ）, the international normalized ratio （INR, P= 0.001 ） , postoperative use of low molecular weight heparin or tirofiban （P = 0.002 ） and VAS score （P= 0.001 ） were all significantly higher than those in the non-bleeding group; the diagnostic angiography