三种止血方法在冠状动脉介入诊疗术后的应用  

A comparison of three hemostasis methods used after coronary angiography and/or percutaneous coronary intervention

作　　者：陈达开[1] 林捷[1] 张怀勤[1] 黄伟剑[1] 计光[1] 

机构地区：[1]温州医学院附属第一医院心内科,浙江温州325000

出　　处：《解放军医学杂志》2009年第7期891-893,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评价Perclose和Angio-Seal血管闭合器在冠脉介入诊疗术后止血的安全性、有效性和临床应用价值。方法根据术后止血方式,470例接受冠脉造影(CAG)或介入治疗(PCI)患者分为Perclose组(164例)、Angio-Seal组(143例)和手工压迫组(163例)。冠脉诊疗术后Perclose组、Angio-Seal组经股动脉造影后,分别用Perclose血管缝合器、Angio-Seal血管封堵器封闭股动脉穿刺点;手工压迫组行单纯CAG后立即手工压迫股动脉止血,PCI术后4～6h手工压迫股动脉止血。Perclose组、Angio-Seal组术前1～3d、术后3d用B超测量穿刺部位及附近3cm内股动脉或股浅动脉或股深动脉最小内径、收缩期血流峰速度、股动脉有无血栓。术后3～8个月进行电话或门诊随访有无不良反应。结果Perclose组160例(97.6%)、Angio-Seal组139例(97.2%)、手工压迫组163例(100%)止血成功,三组间比较无显著差异(P>0.05)。Perclose组、Angio-Seal组各有4例血管封闭失败。Perclose组、Angio-Seal组止血、下肢制动时间显著短于手工压迫组(P<0.001),外周血管并发症发生率显著低于手工压迫组(P<0.05)。Perclose组、Angio-Seal组止血、下肢制动时间及并发症发生率无显著差异(P>0.05),术前、术后穿刺动脉最小内径及收缩期血流峰速度均无明显变化(P>0.05),均未见血栓,且术后3～8个月电话或门诊随访均无不良反应。结论Perclose和Angio-Seal血管闭合器封闭股动脉穿刺点安全、有效,可能会减少外周血管并发症。Objective To explore the safety, efficacy and clinical application of arterial closure device Perclose and Anglo-Seal after coronary angiography （CAG） and/or percutaneous coronary intervention （PCI）, and compare their effect with conventional manual compression. Methods Four hundred and seventy patients were divided into Perclose group （164 patients）, Angio-Scal group （143 patients） and manual compression group （163 patients）. In Perclose group and Angio-Seal group, the punctured sites in femoral arteries were scaled immediately after CAG and/or PCI. In manual compression group, the punctured sites in femoral arteries were compressed by hands immediately after CAG or 4--6 hours after PCI. In Perclose group and Anglo-Seal group, ultrasound scanning to measure the intenal diameter of the femoral artery at the site or within 3cm of the puncture site was performed before and 3 days after the procedure. Parameters included peak systolic velocity, minimum intraluminal vessel diameter, and presence or absence of thrombus were recorded. Patients in Perclose group and Anglo-Seal group were followed up for 3 to 8 months after the procedure, and the adverse effects were observed. Results No significant difference existed in successful rate of hemostasis among the 3 groups （P〉0. 05）. Eight patients （4 in Perclose group, 4 in Angio-Scal group） failed to achieve hemostasis by arterial closure devices. The time to achieve hemostasis, the immobile time and vascular complications were significantly reduced in Perclose group and Anglo-Seal group compared with that in manual compression group （P〈 0. 001 or P〈0. 05）. There was no significant difference in the time to achieve hemostasis, the immobile time and vascular complications between Perclose group and Angio-Seal group （P〉0. 05）. No significant change was found in ultrasound examination in both Perclose and Anglo-Seal group （P〉0. 05）. Three to 8 months after the procedure, there were no adverse effects reported in the two groups

关 键 词：PERCLOSE血管缝合器 ANGIO-SEAL血管封堵器 冠状血管造影术 股动脉 

分 类 号：R541.4[医药卫生—心血管疾病]