皮下“Z”字缝合在心血管疾病大口径鞘管介入术后股静脉穿刺点止血中的应用

Subcutaneous“Z”suture for hemostasis at femoral vein puncture point after large sheath intervention for cardiovascular disease

目的评价皮下“Z”字缝合用于大口径鞘管撤除后股静脉穿刺点止血的安全性和有效性。方法选取2020年5月至2021年12月海军军医大学(第二军医大学)第一附属医院收治的263例行心房颤动冷冻消融或无导线心脏起搏器植入术的患者。心房颤动冷冻消融患者使用外径为16F的鞘管,无导线起搏器植入患者使用外径为27F的鞘管。采用信封法按照1∶1的比例将患者随机分为两组,分别通过“8”字缝合(132例)和皮下“Z”字缝合(131例)2种方式对股静脉穿刺点止血,比较两组患者的缝合操作时间、止血效果、并发症发生率及患者舒适度。结果两组患者的缝合操作时间、即刻止血成功率及并发症发生率差异均无统计学意义(均P>0.05)。皮下“Z”字缝合组术后Kolcaba的舒适状况量表的生理维度得分[(17.8±1.6)分vs(12.7±2.2)分]、心理维度得分[(33.1±2.7)分vs(26.4±3.5)分]及总分[(84.2±3.4)分vs(73.5±5.6)分]均高于“8”字缝合组,差异有统计学意义(均P<0.05)。结论皮下“Z”字缝合可实现大口径鞘管撤除后股静脉穿刺点的安全和有效止血,且患者的舒适度优于“8”字缝合。

Objective To evaluate the safety and effectiveness of subcutaneous“Z”suture for hemostasis at the femoral vein puncture point after removing large sheaths.Methods A total of 263 patients who were treated by atrial fibrillation cryoablation or leadless cardiac pacemaker(LCP)implantation in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from May 2020 to Dec.2021 were enrolled.A 16-French sheath catheter was used in patients treated with atrial fibrillation cryoablation,and a 27-French sheath catheter was used in patients treated with LCP implantation.According to envelope method,the patients were randomly assigned(1∶1)to 2 groups:figure-of-eight suture group(132 cases)or subcutaneous“Z”suture group(131 cases),for hemostasis at the femoral vein puncture point.The suture time,hemostasis effect,complication incidence,and patient comfort of the 2 groups were compared.Results There were no significant differences in the suture time,immediate hemostasis rate,or complication incidence between the 2 groups(all P>0.05).The physiological dimension score(17.8±1.6 vs 12.7±2.2),psychological dimension score(33.1±2.7 vs 26.4±3.5),and overall score(84.2±3.4 vs 73.5±5.6)of the Kolcaba’s comfort scale in the subcutaneous“Z”suture group were significantly higher than those in the figure-of-eight suture group(all P<0.05).Conclusion Subcutaneous“Z”suture can achieve safe and effective hemostasis at the femoral vein puncture point after removing large sheaths,and the comfort of patients is higher than those with figure-of-eight suture.