下腔静脉溶栓治疗术后应用血管缝合器的疗效观察

Clinical effect of vascular closure devices after thrombolytic therapy in inferior vena cava

目的探讨血管缝合器在下腔静脉溶栓治疗术后的应用效果。方法回顾性分析2019年7月至2021年6月在北京积水潭医院血管外科进行溶栓治疗的118例急性下腔静脉血栓患者,根据溶栓后穿刺点止血方法的不同分为观察组(56例)和对照组(62例),观察组穿刺点采用血管缝合器进行处理,对照组采用徒手压迫法止血。比较两组患者的止血效果、Kolcaba舒适量表评分、医用粘胶剂相关性皮肤损伤(medical adhesive related skin injury,MARSI)发生情况及术后并发症发生情况。结果两组患者均止血成功。术后6h和12h观察组Kolcaba舒适量表评分明显高于对照组,差异有显著性(P<0.05);术后24h两组Kolcaba舒适量表评分差异无显著性(P>0.05)。观察组2例(3.6%)发生MARSI,均位于大腿内侧,皮肤损伤程度较轻;对照组12例(19.4%)发生MARSI,其中11例位于大腿内侧。观察组MARSI发生率明显低于对照组,差异有显著性(P<0.05)。观察组术后并发症发生率为3.57%,明显低于对照组的14.52%,差异有显著性(P<0.05)。结论静脉溶栓治疗后应用血管缝合器止血效果良好,并发症发生率低,有利于患者康复,为临床静脉介入治疗后止血提供了新方法。

Objective To investigate the application effect of vascular closure devices after thrombolytic therapy in inferior vena cava.Method Retrospective analysis of 118 patients receiving thrombolytic therapy for acute inferior vena cava thrombosis in the department of Vascular Surgery,Beijing Jishuitan Hospital from July 2019 to June 2021 were divided into observation group(56 patients)and control group(62 patients)according to the different methods of hemostasis at the puncture points after thrombolysis,and the puncture points in the observation group were treated with vascular closure device,while the control group used freehand compression to stop bleeding.The hemostatic effect,Kolcaba comfort scale score,occurrence of medical adhesive-related skin injury and postoperative complications were compared between the two groups.Result Hemostasis was successful in both groups.The Kolcaba comfort scale scores in the observation group were significantly higher than those in the control group at 6h and 12h postoperatively(P<0.05);the difference between the Kolcaba comfort scale scores in the two groups at 24h postoperatively was not significant(P>0.05).Two cases(3.6%)of medical adhesive-related skin injury occurred in the observation group,all of which were located on the inner thigh,and the degree of skin injury was mild;12 cases(19.4%)of medical adhesive-related skin injury occurred in the control group,11 of which were located on the inner thigh;the incidence of medical adhesive-related skin injury in the observation group was significantly lower than that in the control group(P<0.05).The incidence rate of postoperative complications in the experimental group was 3.57%,which was significantly lower than the 14.52%in the control group(P<0.05).Conclusion Vascular closure device has good hemostatic effect and low postoperative complication rate after intravenous thrombolytic therapy,which is beneficial to the recovery of patients and provides a new method for clinical hemostasis after intravenous interventional therapy.