冰袋冷敷预干预对经皮冠状动脉介入患者股动脉鞘管拔除相关疼痛和出血并发症的影响

Effect of Ice Bag on the Pain and Bleeding Complications Associated with Removal of A Femoral Artery Catheter after Percutaneous Coronary Intervention

目的:探讨冰袋冷敷预干预对经皮冠状动脉介入术(PCI)患者股动脉鞘管拔除相关疼痛和出血并发症的影响。方法:前瞻性纳入接受PCI患者60例,按随机数字表法分为常规组和冰袋组两组,每组各30例。常规组在股动脉鞘管拔除前,给予常规告知和心理护理。冰袋组在常规组基础上,于股动脉鞘管拔除前先给予股动脉穿刺局部20 min的冰袋冷敷处理。两组均在PCI术后4 h,由同一位经验丰富的护士予以拔除股动脉鞘管。采用NRS疼痛数字评价量表评估两组患者股动脉鞘管拔除前即刻(T_1)、拔除过程中(T_2)以及拔除后局部按压时(T_3)疼痛评分情况,记录比较两组止血时间、股动脉鞘管拔除后渗血、血肿并发症发生情况。结果:两组患者的一般指标和T_1时间点NRS疼痛数字评价量表等一般资料比较,差异均无统计学意义(P>0.05)。与常规组比较,冰袋组T_2[(3.2±1.6)分vs(5.8±2.5)分]、T_3[(3.4±1.5)分vs(5.9±2.7)分]NRS疼痛评分显著降低(t=4.798,P=0.000;t=4.433,P=0.000),止血时间显著缩短[(6.5±1.9)min vs(8.5±2.3)min,t=3.672,P=0.001],股动脉鞘拔除后渗血、血肿并发症发生率显著下降(3.3%vs 20.0%,x^2=4.043,P=0.044)。结论:局部冰袋冷敷预干预可以有效减轻PCI患者股动脉鞘管拔除相关疼痛,提高止血效果,降低出血相关并发症。

Objective:To investigate the effect of ice bag on the pain and bleeding complications associated with removal of the femoral artery catheter after percutaneous coronary intervention(PCI).Method:Sixty patients with PCI were prospectively enrolled and randomly divided into the routine group and the ice bag group,with 30 patients in each group.The routine group was given routine notification and psychological nursing before the removal of the femoral artery catheter after PCI.The ice bag group was given a cold application for 20minutes by placing an ice bag to the site of the femoral catheter before the removal of the catheter.The femoral catheter in the two groups were removed 4 hours after PCI by the same seasoned nurse.The numerical rating scale(NRS)was used to evaluate the pain levels at three times of immediately prior to catheter removal(T1),during catheter removal(T2),and while the nurse applied pressure on catheter site after removal(T3).The time to hemostasis after removal was recorded.The complications of bleeding and hematoma associated with removal were compared between the two groups.Result:There was no significant difference in the baseline data of general indexes and NRS score at T1 between the two groups(P>0.05).Compared with the routine group,the NRS score at[T2(3.2±1.6)score vs(5.8±2.5)score],and T3[(3.4±1.5)score vs(5.9±2.7)score]in the ice bag group was significantly decreased(t=4.798,P=0.000;t=4.433,P=0.000).The bleeding time in the ice bag group of(6.5±1.9)min was significantly shorter than the routine group of(8.5±2.3)min(t=3.672,P=0.001).The complications of bleeding and hematoma associated with removal was significantly decreased in the ice bag group(3.3%vs 20%,字2=4.043,P=0.044).Conclusion:Local ice bag application can effectively reduce pain associated with the removal of the femoral artery catheter after PCI,improving the hemostasis effect and reducing bleeding related complications.