华法林抗凝达标患者行不同途径心脏起搏器植入并采用不同方法处理术后囊袋出血的比较

Comparison of different ways of cardiac pacemaker implantation and management of postoperative cystic hemorrhage in patients with warfarin anticoagulation

目的探讨华法林抗凝达标患者行心脏起搏器植入术不同穿刺径路及囊袋不同处理措施对术后囊袋出血的影响.方法对择期行心脏起搏器植入术且正在接受华法林抗凝治疗国际标准化比值(INR:2.0~3.0)达标的患者围术期继续使用华法林抗凝,按照随机分配原则分为行锁骨下静脉穿刺组(A组)和行腋静脉穿刺组(B、C组)植入心脏起搏器.A、B组电极周围组织采用荷包缝合,囊袋缝合前囊袋内给予8%去甲肾上腺素湿纱布预填塞,缝合时取出,内层缝合后囊袋内给予注射用血凝酶1 ku,术后A组囊袋上、B组血管穿刺点部位给与相应的方法加压包扎止血24 h,起搏器植入侧肢体制动24 h.C组常规固定电极,缝合囊袋.观察三组患者术后伤口出血情况、围术期囊袋血肿发生情况及住院天数.结果三组间临床资料比较差异无显著性(P均>0.05);术后住院天数[(8.0±4.6)天vs(8.0±3.2)天vs(10.0±5.5天)]、术后囊袋出血总发生率(14.8%vs 7%vs 31.7%)C组均显著高于A、B两组,且B组术后囊袋出血发生率最低,各项比较差异均具有显著性(P均<0.05).结论华法林抗凝达标患者行心脏起搏器植入术选择腋静脉穿刺径路及对囊袋综合处理可以减少术后囊袋出血.

Objective To investigate the effects of different puncture approaches and different management methods on postoperative cystic hemorrhage in patients with warfarin anticoagulation.Methods The patients who were undergoing elective cardiac pacemaker implantation and were receiving warfarin anticoagulation therapy were compared with the international normalized ratio(INR:2.0-3.0).The patients who met the criteria continued to use warfarin in the perioperative period and were randomly divided into two groups:subclavian vein puncture group(group A)and axillary vein puncture group(group B,group C).The tissues around the electrodes in group A and group B were sutured by purse bags,8%norepinephrine wet gauze was pre-filled in the bag before the bag was sutured,taken out during suture,1ku of hemagglutinase for injection was administered in the bag after the inner layer was sutured,After operation,the blood vessels in group A and group B were bound to hemostasis for 24 hours,and the limbs were immobilized with pacemaker for 24 hours.In group C,the conventional electrode was fixed and the capsule was sutured.The postoperative bleeding,perioperative bag hematoma and hospitalization days were observed in three groups.Results There was no significant difference in clinical data among the three groups(all P>0.05).Postoperative hospital stay[(8.0±4.6)days vs(8.0±3.2)days vs(10.0±5.5)days],the total incidence of postoperative bag hemorrhage in group C was significantly higher than that in group A and B.The incidence of bag hemorrhage in group B was the lowest.There were significant differences in all comparisons(all P<0.05).Conclusion The axillary vein puncture route and the comprehensive management of the capsule can reduce the postoperative capsule hemorrhage in patients with anticoagulation of warfarin.[Chinese Journal of Cardiac Pacing and Electroph ysiology,2023,37(3):219-223].