心脏起搏器安置术后沙袋压迫与弹力绷带压迫止血效果比较

Comparion of the effect of two methods of hemostasis by compression with sandbags and elastic bandage on pacemaker implantation

目的比较起搏器安置术后沙袋压迫与弹力绷带压迫止血的效果。方法选取2015年1月1日至2016年11月31日所有置入永久起搏器患者共301例,随机分为沙袋压迫组(沙袋组)151例和弹力绷带压迫组(绷带组)150例。沙袋组术后沙袋压迫6h,绷带组术后弹力绷带压迫24h。比较两组术后7天内伤口周围皮下淤血、血肿、颈肩痛及导线脱位的发生情况。结果两组患者术后伤口渗血、皮下瘀血、一般囊袋血肿、严重囊袋血肿发生情况及导线脱位情况无差异(P>0.05),但绷带组颈肩背痛发生率明显低于沙袋组(6%vs 25.8%,P<0.01)。多因素Logistics回归分析显示口服抗血小板/抗凝药(OR=10.47,95%CI 4.66~23.53)和除颤器置入(OR=8.38,95%CI 2.98~23.60)是术后出现出血并发症的独立危险因素(P<0.01)。结论使用弹力绷带加压包扎法压迫止血可减轻患者痛苦,并不增加出血风险,可作为常规术后止血方法。口服抗血小板/抗凝药和除颤器置入是术后出血独立危险因素。

Objective To compare the effect of two methods of hemostasis by compression with sandbags and elastic bandage in patients undergoing pacemaker implantation. Methods Three hundred and one patients from January 2015 to November 2016 were randomly divided into sandbags compression group （group sandbags, n = 151） and elastic bandages compression group （group bandages, n = 150）. Patients in group sandbags had been oppressed with sandbags for 6 hours,while patients in group bandages bad been compressed with elastic bandage for 24 hours. The occurrence of subcutaneous congestion around the wound, hematoma, cervicobrachialgia and lead dislocation within 7 days were compared between the two groups. Results There was no difference in the incidence of bleed ing, subcutaneous ecchymosis, mild hematoma of pocket, serious hematoma of pocket and wire dislocation between two groups （P 〉 0.05）. Compared with group sandbags, the proportion of cervicobrachialgia was significantly lower in group bandages （6% vs 25.8%, P〈0.01 ）. Logistics regression analysis showed that the oral antiplatelet or anticoagulation （0R=10.47, 95%CI 4.66-23.53） and the implantation of defibrillator （OR=8.38, 95%CI 2.98-23. 60） were the independent risk factors for hemorrhagic complications after operation （P〈0.01）. Conclusion The elastic bandage reducing the discormfort of patients without increasing the risk of bleeding can be used as a routine method during pacemaker implantation. Oral antiplatelet or anticoagulation medicine and the implantation of defibrillator are the independent risk factors of postoperative hemorrhage.