经肱动脉入径行经皮冠状动脉介入治疗术后拔除鞘管时间与并发症相关性的研究  

Relationship between complications and the time of brachial artery sheath removal after percutaneous coronary intervention through brachial artery pathway

作　　者：张彬[1] 梁磊[1] 崔美平[1] 蒋文彬[1] 曲凤霞[1] 姜先雁[1] 王松涛[1] 朱明真[1] 

机构地区：[1]青岛阜外心血管病医院心脏中心,山东青岛266034

出　　处：《中国介入心脏病学杂志》2015年第12期682-684,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的观察经肱动脉入径行经皮冠状动脉介入治疗(PCI)术后不同的拔管时间与相关并发症的关系。方法选取2015年1月至2015年7月于青岛阜外心血管病医院经肱动脉入径行PCI的患者共160例为研究对象,根据动脉鞘管的拔除时间分为三组:即刻拔除鞘管组(A组)53例,术后2 h拔除鞘管组(B组)52例,术后4 h拔除鞘管组(C组)55例。观察三组间部分凝血酶原时间(APTT)、术后患者不适感、局部血肿、骨筋膜室综合征、正中神经损伤、假性动脉瘤、迷走神经反射、深静脉血栓、动静脉瘘等并发症的发生率。结果 C组患者APTT值显著小于A组和B组,且三组间比较差异均有统计学意义[(34.35±5.17)s比(118.46±3.89)s比(77.58±11.23)s,P<0.001];C组不舒适感最低,与A组或B组比较,差异均有统计学意义[56.36%比86.79%,P<0.01;56.36%比76.92%,P<0.05],但A组与B组比较差异无统计学意义(P>0.05);C组局部血肿发生率最低,与A组比较差异有统计学意义(1.82%比15.09%,P<0.05),其余组间比较差异均无统计学意义(均P>0.05);骨筋膜室综合征、正中神经损伤、迷走神经反射等并发症发生率C组均小于其他两组,但组间比较差异均无统计学意义(均P>0.05)。结论经肱动脉入径行PCI后4 h左右拔除鞘管可显著减少相关并发症的发生。Objective To observe the relationship between complications and the time of sheath removal after percutaneous coronary intervention through brachial artery pathway. Methods 160 patients from January 2015 to July 2015 who were admitted in our hospital and received PCI with brachial artery approach were enrolled. According to the time of sheath removal after PCI, all the patients were divided into three groups which were ： immediate removal group （ group A, n = 53 ）, removal after 2 hours group （ group B, n = 52） , and remaval after 4 hours group （ group C, n = 55 ） . The level of APTF, patients＇ comfort, rates of haematoma, osteofascial compartment syndrome, median nerve injury, pseudoaneurysm, vagus reflex, deep venous thrombosis and arteriovenous fistula after PCI were compared among the three groups. Results APTT in group C was the shortest among the 3 groups [ （34. 35 ± 5.17） s vs. （ 118.46 ± 3.89） s and （77.58 ± 11.23） s, P 〈0. 001 ]. Patients＇ complaint of discoMfort was least in Group C （56. 36% vs. 86. 79% and 76. 92%, P 〈 0.05）. The rates of local haematoma was lowest in group C （ 1.82% ） without significant difference across the 3 groups （ P 〉 0. 05 ） . The rates of osteofascial compartment syndrome, median nerve injury, vagus reflex were also lowest in group C without significant differences across the three groups. Conclusions Removal of brachial artery sheath 4 hous after PCI can reduce the rates of complications.

关 键 词：冠状动脉介入治疗 经肱动脉 拔管时间 并发症 

分 类 号：R541.4[医药卫生—心血管疾病]