经股动脉或股静脉路径行心导管介入诊疗的周围血管损伤并发症——附单中心2216例次临床分析  

Cardiac catheterization complication of peripheral vascular injury via femoral artery or vein approachclinical analysis of 2216 cases in single center

作　　者：李学香[1] 解强 LI Xue-xiang;XIE Qiang(Department of Cardiology,Laizhou People's Hospital,Laizhou 261400,China;Department of Cardiology,Panyu Central Hospital,Guangzhou 511400,China)

机构地区：[1]山东省莱州市人民医院心血管内科,山东莱州261400 [2]广东省广州市番禺中心医院心血管内科,广州511400

出　　处：《岭南心血管病杂志》2019年第4期416-420,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的研究经股动脉或股静脉入路行心导管介入诊疗后周围血管损伤并发症的发生率、发生危险因素和处理方法。方法对2006年9月至2017年8月期间在山东省莱州市人民医院心内科导管室2 216例次经股动脉或股静脉入路行心导管介入诊疗患者的周围血管损伤并发症及临床资料进行回顾性分析。结果共有168例患者发生周围血管损伤并发症,总发生率7.58%;其中出血性损伤并发症发生率远高于缺血闭塞性损伤并发症,差异有统计学意义[7.27%(161/2 216)vs. 0.31%(7/2 216),P<0.01];就并发症发生率而言,股动脉路径的明显高于股静脉路径,差异有统计学意义(10.64%vs. 1.25%,P<0.01);动脉介入治疗类手术要显著高于动脉造影类手术和静脉介入诊疗类手术,差异有统计学意义(12.51%vs. 5.6%,P<0.05;12.51%vs. 1.25%,P<0.01);具体为单纯血肿113例(5.1%),假性动脉瘤11例(0.5%),动静脉瘘4例(0.18%),穿刺部位外出血27例(1.22%),腹膜后血肿4例(0.18%),髂股动脉撕裂或夹层2例(0.09%),下肢动脉血栓形成2例(0.09%),下肢静脉血栓形成3例(0.14%),肺动脉栓塞2例(0.09%),周围血管损伤并发症病死率0.14%,需要外科处理的占0.05%。结论心导管介入诊疗后的周围血管损伤并发症在股动脉路径更常见,以出血性损伤并发症居多,但绝大多数患者经及时内科处理预后良好。Objectives To investigate the incidence,risk factors and management of complications of peripheral vascular injury after percutaneous cardiac catheterization through femoral artery or vein approach.Methods The complications and clinical data of 2 216 patients undergoing cardiac catheterization via femoral artery or vein approach from September 2006 to August 2017 in Laizhou People's Hospital were analyzed.Results A total of 168 patients had complications of peripheral vascular injury,with a total incidence of 7.58%.The incidence of hemorrhagic injury complications was much higher than that of ischemic occlusive injury complications[7.27%(161/2 216)vs.0.31%(7/2 216),P<0.01].Inci?dence of complication of femoral artery approach was significantly higher than that of femoral vein approach(10.64%vs.1.25%,P<0.01).Arterial interventional therapy was significantly higher than angiography and intravenous interventional therapy(12.51%vs.5.6%,P<0.05;12.51%vs.1.25%,P<0.01).Patients with simple haematoma was in 113 cases(5.1%),false aneurysm in 11 cases(0.5%),arteriovenous fistula in 4 cases(0.18%),puncture site bleeding in 27 cases(1.22%),retroperitoneal hematoma in 4 cases(0.18%)and iliac femoral artery tear in 2 cases(0.09%).Lower limb arterial thrombosis accounted for 2 cases(0.09%),lower limb venous thrombosis in 3 patients(0.14%)and pulmonary embolism in 2 cases(0.09%).Mortality rate was 0.14%,complications requiring surgical treatment accounted for 0.05%.Conclusions Complications of peripheral vascular injury after cardiac catheterization are common in the femoral artery approach,and hemorrhagic injury complications are the most common.Most patients have good prognosis after proper treatment.

关 键 词：周围血管并发症 股动脉或股静脉路径 心导管介入诊疗 血肿 血栓形成 

分 类 号：R654.4[医药卫生—外科学]