比较血管闭合装置与人工压迫止血在股动脉穿刺止血中的作用  

Efficacy of vascular closure devices for femoral artery hemostasis

作　　者：洪彪 叶猛[2] 王炜 王希栩 张皓[2] 赵意平[2] 施娅雪[2] 

机构地区：[1]上海同仁医院血管外科,上海200050 [2]上海交通大学医学院附属仁济医院血管外科,上海200001

出　　处：《影像诊断与介入放射学》2011年第6期447-450,共4页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨经股动脉血管造影和血管腔内治疗后运用三种血管闭合装置进行止血的安全性和有效性,并与传统人工压迫止血进行比较。方法 2010年2月～2011年3月,495例患者接受了经股动脉血管造影和血管腔内治疗。其中男274例,女221例,平均年龄65.7±11.4岁。根据拔鞘后止血方法 ,患者分为4组。人工压迫止血组386例,Angio-Seal封堵器组21例,Proglide缝合器组45例,Starelose闭合器组43例。观察记录各组止血、制动时间及术后并发症,比较各组的特点。结果血管闭合器组平均压迫时间(3.4±0.7 min)及制动时间(2 h)均较人工压迫组平均压迫时间(16.2±1.8min)及制动时间(8 h)有显著缩短(P<0.01),而术后各类并发症无明显增加。三类血管闭合装置的止血时间、技术成功率及术后并发症无显著性统计学差异(P>0.05)。3例10F以上血管鞘通过2把Proglide血管缝合器完成皮下穿刺点缝合。结论运用血管闭合装置可有效减少止血和制动时间,其术后并发症较人工压迫无明显增加。另外运用多把Proglide可完成对≥10F血管鞘的闭合止血。由于三种血管闭合装置在操作方法、适应范围上各具特点,可针对不同患者的血管特点及血管鞘直径,合理选择各类血管闭合装置。Objective To evaluate the safety and efficacy of vascular closure devices in comparison with manual compression for hemostasis after transfemoral angiography and/or angioplasty. Methods From February 2010 to March 2011, 495 patients underwent transfemoral angiography and/or angioplasty using manual compression （386） and vascular closure devices including Angio-Seal （21）, Proglide （45）, and Starciose （43） for femoral artery hemostasis. The time for hemostasis, immobilization time, vascular complications and device failure were recorded and compared. Results Patients treated with vascular closure devices experienced shorter hemostasis and immobilization time（P 〈 0.01 ） without increased vascular complications. There was no significant difference （P 〉 0.05） among the vascular closure devices in hemostasis time, immobilization time, technique success and complication rates. Three accesses with /〉 10Fr sheath were closed percutaneously using 2 pieces of Proglide devices without surgical repair. Conclusion All three vascular closure devices are similar in safety and efficacy for femoral artery hemostasis with reduced hemostasis and immobilization time compared to manual compression. Proglide device is effective for percutaneous closure of large （≥ lOFr） femoral artery access sites.

关 键 词：血管闭合器 介入疗法 止血 

分 类 号：R816.2[医药卫生—放射医学]