抗凝和抗血小板治疗对血管缝合器有效性和安全性的影响  

The effects of applying percutaneous suture-mediated closure device (perclose) to the effecacy and safety after the treatment of anticoagulation and antiplatelet

作　　者：李伟明[1] 徐亚伟[1] 陈艳清[1] W.Bojara 杨海燕[1] 徐剑钢[1] 张戟[1] 韩雪根[1] 范雪华[1] 

机构地区：[1]同济大学附属第十人民医院心内科,上海市200072 [2]Department of Cardiology,Bergmannsheil Universitaetsklinik,Bochum,Germany

出　　处：《中国介入心脏病学杂志》2005年第4期236-238,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨抗凝和抗血小板治疗对血管缝合器临床应用有效性和安全性的影响。方法回顾性分析抗凝和抗血小板治疗后进行冠状动脉(冠脉)造影(CAG)和或冠心病介入治疗(PCI)并采用徒手压迫或血管缝合止血的成功率、失败率以及血管并发症等。CAG组仅接受常规的抗凝和抗血小板治疗,而PCI组接受强化的抗凝和抗血小板治疗,包括术前使用噻氯匹定或氯吡格雷,术中使用肝素。结果共完成股动脉血管缝合218例,其中CAG组120例,PCI组98例,血管缝合成功率分别高达91.7%和90.8%(组间差异无统计学意义,P>0.05),均低于徒手压迫的成功率(P<0.05),而且分别有8.3%和9.2%的失败率,但其血管并发症仅见小血肿伴股动脉感染,发生率仅为1%,甚至低于徒手压迫;而且血管缝合不受是否已用抗凝剂和抗血小板药物的制约,可以在CAG和或PCI术后即刻拔鞘,止血方法简便,而且省时省力,患者也易于接受。结论常规或强化的抗凝和抗血小板治疗后应用血管缝合器即刻止血有效而安全,其血管并发症与徒手压迫相似甚至更低。Objective To discuss the effects of applying percutaneous suture-mediated closure device （Perclose） to the effecacy and safety after the treatment of anticoagulation and antiplatelet. Methods Retrospective analysis of the success rate, failure rate and the vascular complications of manual compression and the Perclose after coronary angiography （CAG） and percutaneous coronary intervention （PCI） with anticoagulation and antiplatelet treatment. The CAG group only received routire anticoagulation and antiplatelet, and the PCI group received intensive anticoagulation and antiplatelet treatment, including ticlid or plavix before PCI and heparin during the PCI. Results 218 patients were performed with the Percloses. There were 120 patients in the CAG group and 98 in the PCI group. The success rates were 91.7% and 90.8% respectively （ P 〉 0.05）, which were lower than that with manual compression. The failure rates were 8.3% and 9.2% respectively, but the vascular complications were less than 1%. Hematoma and femoral artery infection were seen in the PCI group, but happened less compared with manual compression. The removing of the arterial sheaths will not be limited by the anticoagulation and antiplatelet therapies, and it could be performed immediately after CAG and PCI, making hemostasis more easy to archeive. It could also reduce the burden of the medical staff, and be accepted by the patients, Conclusion Femoral arterial closure following PCI using regular and intensive anticoagulation and antiplatelet therapies could be safe and effective with vascular complication rates similar to or lower than with manual pressure.

关 键 词：冠状血管造影术 血管成形术 经腔 经皮冠状动脉 缝合技术 抗血小板治疗 血管缝合器 抗凝剂 安全性 血管缝合止血 血管并发症 冠心病介入治疗 

分 类 号：R543.3[医药卫生—心血管疾病] R473.6[医药卫生—内科学]