心脏中心一日病房模式行冠状动脉造影及血运重建术的探讨

Study on coronary artery angiography and revascularization in day care ward of heart center

目的 探讨心脏中心一日病房模式行冠状动脉造影必要时支架术,冠状动脉搭桥术的可行性、安全性以及对绩效指标的影响.方法 回顾性分析2014年10月至2016年12月在一日病房行冠状动脉造影必要时支架术并转入普通病房,或择期行冠状动脉搭桥术的128例患者手术成功率,术中及术后不良事件（死亡,心肌梗死及介入并发症：冠状动脉痉挛、夹层、穿孔和闭塞,造影剂过敏,患者上肢水肿,骨筋膜室综合征和桡动脉闭塞）,平均住院日,医疗费用.结果 一日病房行单纯冠状动脉造影者76例,行支架植入术者35例,冠状动脉搭桥术者17例,成功率为100%,不良事件主要为桡动脉痉挛5例,穿刺部位血肿3例和造影剂过敏1例;与同期普通病房相比,一日病房单纯造影者[（1.0±0.2）d比（3.0±1.2）d],行介入治疗者并转入普通病房者[（2.0±0.5）d比（4.0±1.5）d],转入普通病房择期行冠状动脉搭桥者[（9.0±2.2）d比（12.0±2.9）d]平均住院日显著缩短（P〈0.05）,住院医疗费用有下降趋势（P〉0.05）.结论 一日病房模式行冠状动脉造影及必要时血运重建术在诊疗技术成熟的心脏中心是安全可行的.

Objective To investigate the feasibility, safety and impact on performance indicators of coronary angio graphy, percutaneous coronary intervention and coronary artery bypass grafting （CABG） in day care ward of heart center. Methods 128 patients performing coronary angiography and receiving stent implantation or coronary artery bypass surgery when necessary from October 2014 to December 2016 were retrospectively analyzed. The success rate of procedure, intraoperative and postoperative adverse cardiac events （death, myocardial infarction and interventional complications： coronary artery spasm, dissection, perforation and occlusion, contrast agent allergy, upper extremity edema, patients with osteofascial compartment syndrome and radial artery occlusion）, average hospitalization days and medical expenses were compared with patients at the same period in general ward. Results Seventy-six cases underwent coronary angiography, among whom 35 cases received stent implantation and 17 cases received coronary artery bypass grafting. The success rate was 100%. Adverse events were radial artery spasm in 5 cases, puncture site hematoma in 3 cases and contrast agent allergy in 1 case. Day care ward significantly shortened the average hospitalization days （P〈0.05）; there was a downward trend, although there was no statistical difference in hospitalization expenses （P〉0.05）. Conclusions Coronary angiography and revascularization at the day care ward model is safe and feasible in the heart center if diagnostic and therapeutic techniques are mature.