局部麻醉经皮穿刺与股动脉切开实施主动脉腔内修复术围术期情况比较

Percutaneous puncture and femoral artery incision for endovascular repair of aorta under local anesthesia comparison of perioperative nursing care

目的探讨局部麻醉经皮股动脉穿刺与股动脉切开行主动脉腔内修复术(EVAR)治疗急性主动脉综合征(AAS)的围手术期护理方法。方法回顾性分析2019年7月至2020年5月经胸腹主动脉成像(CTA)检查后确诊为AAS且行EVAR治疗的患者92例,根据EVAR中所采用手术入路股动脉处理方式,将患者分为常规切开组42例、局麻穿刺组50例,采用χ^(2)检验或Fisher确切概率法比较两组在院期间围术期护理不良临床事件的发生情况。结果两组间一般资料比较均无统计学差异(P值均>0.05)。住院期间,两组患者均无死亡,两组间临床新发急性肾功能衰竭、下肢异常及伤口延期愈合发生情况均无统计学差异(P值均>0.05)。局麻穿刺组患者手术时间(94.52±14.01)min明显低于常规切开组(118.40±8.72)min,差异具有统计学意义(t=9.595,P<0.001)。局麻穿刺组患者住院时间(6.84±2.32)d明显低于常规切开组(8.43±2.10)d,差异具有统计学意义(t=3.421,P=0.001)。结论采用局部麻醉经皮穿刺技术实施EVAR有利于缩短患者手术与住院时间,对降低术后护理难度和提高患者术后康复具有重要价值。

Objective To explore perioperative nursing comparision between local anesthesia percutaneous femoral artery puncture and endovascular aneurysm repair to treat acute aortic syndrome(AAS). Methods 92 patients, from July 2019 to May 2020, diagnosed with AAS after menstrual thoracicabdominal aortic imaging(CTA) examination and underwent EVAR treatment were retrospectively analyzed. According to the femoral artery treatment method used in the surgical approach in EVAR, the patients were divided into 42 cases in the routine incision group and 50 cases in the local anesthesia puncture group. The occurrence of adverse clinical events in the perioperative nursing care during the two groups was compared by χ^(2) test or Fisher’s exact probability method. Results There was no statistical difference in general information between the two groups(all P > 0.05). During the hospitalization period, there was no death in the two groups of patients. There was no significant difference in the occurrence of clinically new acute renal failure, lower limb abnormalities, and delayed wound healing between the two groups(all P > 0.05). The operation time of patients in the local anesthesia puncture group(94.52±14.01)min, was significantly lower than that of the conventional incision group(118.40±8.72) min, and the difference was statistically significant(t=9.595, P < 0.001). The hospitalization time of patients in the local anesthesia puncture group was(6.84±2.32) d, was significantly lower than that of the conventional incision group(8.43±2.10) d, and the difference was statistically significant(t=3.421, P=0.001). Conclusion Using local anesthesia percutaneous puncture technique to implement EVAR can reduce the difficulty of postoperative care and shorten the hospital stay, which is of great value to improve the postoperative rehabilitation of patients.