冠状动脉介入术桡动脉穿刺点不同压迫止血方案效果的比较

Efficacy of different compression methods for hemostasis at the radial artery puncture point after percutaneous coronary intervention

目的比较不同压迫止血方案用于经桡动脉行冠状动脉介入术(TRI)后的止血效果及患者舒适度。方法选取2018年10月至2020年2月在杭州师范大学附属医院接受TRI治疗的患者160例为研究对象,其中80例(A组)采用螺旋式压迫穿刺点止血(术后2 h开始松解1圈、间隔1 h旋转1周,减压至完全解压),另外80例(B组)采用螺旋式压迫穿刺点止血(术后2 h开始松解1圈、间隔2 h旋转1周,减压至完全解压)。比较两组术后不同时间点的术侧肢体经皮血氧饱和度(SpO2)、心率(HR)、疼痛程度评分、术后2 h、12 h的疼痛及舒适度评分。结果A组患者的术后4 h、术后12 h的SpO2值分别为(96.6±0.7)%、(97.8±0.5)%,均高于B组的(96.2±0.6)%、(97.6±0.7)%(t=3.88、2.08,均P<0.05);术后2 h,A组和B组患者Kolcaba舒适状况量表总分及各维度评分比较,均差异无统计学意义(均P>0.05);术后12 h,A组患者的心理、生理及Kolcaba舒适状况量表总分分别为(23.64±3.02)分、(12.64±2.05)分、(68.25±6.04)分,均高于B组的(22.20±2.96)分、(11.38±2.47)分、(64.42±6.71)分(t=3.05、3.51、3.79,均P<0.05);术后2 h,A组和B组患者数字评价量表(NRS)评分比较,差异无统计学意义(P>0.05);术后4 h、12 h,A组患者的NRS评分分别为(2.51±0.58)分、(1.75±0.76)分,均低于B组的(2.95±0.63)分、(2.31±0.71)分(t=-4.59、-4.82,均P<0.05);术后观察,A组的并发症发生率为8.75%,低于B组的20.00%(χ^(2)=4.11,P<0.05)。结论TRI术后采取2 h开始松解1圈、间隔1 h旋转1周减压至完全解压的方式压迫止血效果较好,可有效减轻疼痛,保证术侧肢体供氧,改善患者的舒适度。

Objective To compare the hemostatic effects and patient comfort of different compression methods for hemostasis after transradial coronary intervention.Methods A total of 160 patients who received transradial coronary intervention in The Affiliated Hospital of Hangzhou Normal University from October 2018 to February 2020 were included in this study.In group A(n=80),patients underwent spiral compression at the puncture point(release for 1 turn at 2 hours after surgery,rotation for 1 circle after 1 hour,and full decompression).In group B(n=80),patients underwent spiral compression at the puncture point(release for 1 turn at 2 hours after surgery,rotation for 1 circle after 2 hours,and full decompression).Percutaneous arterial oxygen saturation value in the affected limb,heart rate,and Visual Analog Scale score at different times after surgery,pain and comfort score at 2 and 12 hours post-surgery were compared between the two groups.Results Percutaneous arterial oxygen saturation value at 4 and 12 hours post-surgery in group A was(96.6±0.7)%and(97.8±0.5)%,respectively,which was significantly higher than that in group B[(96.2±0.6)%,(97.6±0.7)%,t=3.88,2.08,both P<0.05].There were no significant differences in total score and subscale score of the General Comfort Questionnaire at 2 hours post-surgery between groups A and B(both P<0.05).At 12 hours post-surgery,scores of psychological and physical subscales and total score of the General Comfort Questionnaire in group A were(23.64±3.02)points,(12.64±2.05)points,(68.25±6.04)points,which were significantly higher than those in group B[(22.20±2.96)points,(11.38±2.47)points,(64.42±6.71)points,t=3.05,3.51,3.79,all P<0.05].At 2 hours post-surgery,there was no significant difference in Numerical Rating Scale score between groups A and B(P>0.05).At 4 and 12 hours post-surgery,Numerical Rating Scale score in group A was(2.51±0.58)points and(1.75±0.76)points,respectively,which was significantly lower than that in group B[(2.95±0.63)points,(2.31±0.71)points,t=-4.59,-4.82,both P<0.05).The incidence of complications was significantly lower in group A than in group B(8.75%vs.20.00%,χ^(2)=4.11,P<0.05).Conclusion Compression for hemostasis is highly effective by releasing for 1 turn at 2 hours after transradial coronary intervention,rotating for 1 circle after 1 hour,and full compression because it can greatly mitigate pain,ensure the oxygen supply to the affected limbs,and improve patient comfort.