经股动脉入径行射频消融后加压包扎时间与并发症相关性研究

Relationship between complications and the time of the compression bandage after radiofrequency ablation through femoral artery

目的 观察经股动脉入径行射频消融术后加压包扎时间与并发症的相关关系.方法选取2015年10月至2016年3月在第四军医大学西京医院因阵发性心动过速行电生理检查证实为房室折返性心动过速（左侧旁路）和来源于左心室的室性心动过速/室性早搏,经股动脉入径行射频消融的患者122例为研究对象,根据术后加压包扎的时间分为2组：4 h组（A组）62例,8 h组（B组）60例.对比2组间活化凝血时间（ACT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）以及凝血酶原活动度（AT）、术后患者不适感、局部血肿、假性动脉瘤、动静脉瘘、血栓栓塞等并发症的发生率.结果 B组有1例假性动脉瘤发生,超声心动图指导下向假性动脉瘤囊腔内给予缓慢注射凝血酶,封闭瘤体后恢复正常;2组术后血凝全套、血小板及ACT均差异无统计学意义（P=0.05）,2组间局部血肿差异无统计学意义（3%对5%,P〉0.05）;B组不舒适感明显高于A组（5%对15%,P=0.022）.2组术后D二聚体、APTT水平均高于术前[（0.7±1.4）mg/L对（0.2±0.3）mg/L,P=0.035;（0.5±0.3）mg/L对（0.3±0.2）mg/L,P=0.021）（29.9±5.5）s对（26.7±6.9）s,P=0.024;（30.1±2.6）s对（26.2 ±6.4）.s （P=0.015）],但其他凝血相关指标均差异无统计学意义（P〉0.05）.结论 经股动脉射频消融术后穿刺局部加压4 h安全可靠,改善患者术后舒适度,不增加相关血管并发症的发生.

Objective To observe the correlation between complications and the time of compression bandage after radiofrequency ablation through femoral artery pathway.Methods Patients from October 2015 to March 2016 were admitted in our hospital and verified as atrioventricular reentrant tachycardia（left-sided accessory pathways）、 ventricular tachycardia or premature ventricular contraction arising from left ventricular by electrophysiology study（EPS）.According to the time of the compression bandage after operation,all the patients were divided into 2 groups which were 4h group（group A,n=62）and 8h group（group B,n=60）.The levels of ACT、APTT、PT、AT、TT、patients＇comfort、local hematoma、pseudoaneurysm、arterio-venous fistula and thromboembolism were compared between the two groups.Results After the intervention,the differences of APTT、PT、AT、TT、PLT and ACT between the two groups were non-significant.One case of pseudoaneurysm occurred in the group B,and was recovered after infusing thrombin via ultrasound guidance.There was no evident difference in local hematoma between the two groups（3% vs.5%,P〉0.05）.Furthermore,except D-Dimer and APTT[（0.7±1.4）mg/L vs.（0.2±0.3）mg/L,P=0.035;（0.5±0.3）mg/L vs.（0.3±0.2）mg/L,P=0.021）（29.9±5.5）s vs.（26.7±6.9）s,P=0.024;（30.1±2.6）s vs.（26.2 ±6.4）s,P=0.015）],there was no difference in the above items between pre-and post-intervention of each group（P〉0.05）.However,the patients＇discomfort was less in group A than that in group B（（5% vs.15%,P=0.022）.Conclusion The compression bandage for 4 hours after radiofrequency ablation through the femoral artery pathway is feasible,no more bleeding complications occurred,and the patients＇comfort improved.