经皮血管缝合器与人工压迫法对股动脉拔管术后止血效果的比较

Comparison of the Efficacy of Femoral Hemostasis Ways After Sheath Removed of Cardiac Catheterazation Procedures

比较病人拔鞘管后应用经皮血管缝合器与人工压迫止血的安全性和疗效。 1 2 5例病人 (男 86例、女 39例 ,年龄 65 .7± 1 2 .3岁 ) ,在行心导管术后 ,分为人工压迫组 [Ⅰ组 ,63例 ,其中分为冠状动脉 (简称冠脉 )造影 (CAG)组35例 (IA) ,冠脉介入治疗术组 2 8例 (IB) ]和股动脉穿刺点经皮血管缝合组 [Ⅱ组 ,62例 ,CAG组 35例 (ⅡA) ,冠脉介入治疗术组 2 7例 (ⅡB) ]。在术后即刻应用经皮血管缝合器和依病人抗凝水平行人工压迫止血 ,观察止血时间 ,平卧时间和并发症。结果 :与人工压迫止血组时间比较 ,经皮血管缝合组止血时间和平卧时间有显著缩短。有 4例病人首次应用缝合器止血失效 ,首次成功率达 91 % ( 5 8/62 ) ;失败 2例 ,再用缝合器缝合获得成功 ,总成功率达96% ( 60 /62 )。在ⅠB组有 1例病人在血管成形术 3天后出现再次急性心肌梗死 ,给予静脉 (尿激酶 )溶栓后于穿刺伤口再出血而需压迫止血 1h。结论 :经皮血管缝合器应用的安全性优于人工压迫组 。

To assess the safety and efficacy of suture mediated closure device compared with manual compression in patients after sheath removed, one hundredand twenty five consecutive patients (86 male,39 female, 65.7±12.3 years) were treated with manual compression [ groupⅠ, n =63 ; 35 cases in coronary arteriography(CAG)(IA),28 cases in coronary interventional procedures (IB)]and suture mediated percutaneous closure of antegrade femoral access site [groupⅡ, n =62;35 cases in CAG(ⅡA), 27 cases in coronary interventional procedures (ⅡB)] in cardiac catheterazation procedures. Suture mediated closure or manual compression were procedure independent of the anticoagulation level after cardiac catheterazation procedures. Results: Compared with group Ⅰ,the time to achieve hemostasis and ambulation of group Ⅱ significantly decreased.There were four failures to achieve hemostasis using the device . 91%(58/62)of attempted users were successful, and by using a second device in two of the fail attempts, 96%(60/62)of the puncture sites were successfully closed using the device. There was one late rebleed that required 1 hr of groin clamp pressure in an angioplasty patient who with acute myocardial infarction again after three days had received venous urokinase(groupⅠB ).Conclusion: The use of a suture mediated closure device represents a safe alternative to manual compression,Hemostasis and ambulation can be achieved faster with the suturing device than with manual compression.