经桡动脉冠状脉介入术后三种压迫止血器对桡动脉局部并发症的影响随机对照研究  

Influence of 3 kinds of radial compression device for hemostasis on radial partial complications after transradial coronary intervention:a randomized controlled study

作　　者：刘丽丽[1] 郭金成[1] 杨连香 吴永霞 Liu Lili;Guo Jincheng;Yang Lianxiang;Wu Yongxia(Critical Care Unit,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China;不详)

机构地区：[1]首都医科大学附属北京潞河医院CCU,北京101149 [2]首都医科大学附属北京潞河医院导管室,北京101149

出　　处：《中国循证心血管医学杂志》2021年第8期990-993,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：2017年通州科技计划项目(KJ2017CX040-22)。

摘　　要：目的评价三种常用压迫止血器对经桡动脉行冠状动脉介入术(TRI)后桡动脉压迫止血的安全性。方法将2017年4月至2018年6月连续经桡动脉行TRI后使用桡动脉压迫器的480例患者随机(1:1:1)分为3组:平板加压压迫止血器(BT)组(n=157)、气囊式压迫止血器(TR)组(n=160)与旋钮式压迫止血器(RCD)组(n=159),主要研究终点是24 h桡动脉闭塞(RAO)发生率,次要终点是术后血肿、水疱发生率及术后30d RAO发生率。结果480例患者,平均年龄(60.71±11.58)岁,男性占(74.4)%,3组患者基线资料相似。术后24h RAO发生率BT组明显高于RCD组(16.6%vs.7.5%,P=0.013),TR组与BT组、RCD组相比无差异(10.0%vs.16.6%,P=0.08;10.0%vs.7.5%,P=0.40)。BT组、TR组和RCD组前臂血肿发生率相似(40.1%vs.38.1%vs.32.7%,P>0.05)。水疱发生率BT组明显高于RCD组(7.0%vs.1.3%,P=0.01)。30 d随访RAO发生率BT组7.1%,TR组3.8%和RCD组3.2%(P均>0.05)。多因素回归分析影响24 h RAO的因素是使用BT加压止血器、动脉内径与鞘管外径比值(RAID/SOD)<1和压迫止血时间>6 h。结论三种压迫止血器均可达到安全有效止血的目的;TR和RCD压迫止血器相较BT压迫止血器可降低桡动脉局部并发症的发生率。Objective To review radial compression hemostasis safety of common 3 kinds of radial compression devices(RCD)in patients after transradial coronary intervention(TRI).Methods The patients(n=480)used RCD after TRI from Apr.2017 to June 2018 were randomly divided into 3 groups(1:1:1):BT group(n=157),TR group(n=160)and RCD group(n=159).The major study endpoint was 24h incidence rate of radial artery occlusion(RAO),and secondary end point were incidence rates of postoperative hematoma and blisters,and RAO incidence rate after TRI for 30 d.Results The average age was(60.71±11.58)years old and male cases were accounted for 74.4%in 480 patients.The baseline materials were similar in 3 groups.The postoperative 24h incidence rate of RAO was significantly higher in BT group than that in RCD group(16.6%vs.7.5%,P=0.013),and had no difference between TR group and BT group(10.0%vs.16.6%,P=0.08)and between TR group and RCD group(10.0%vs.7.5%,P=0.40).The incidence rate of forearm hematoma was similar in BT group,TR group and RCD group(40.1%vs.38.1%vs.32.7%,P>0.05).The incidence rate of blisters was significantly higher in BT group than that in RCD group(7.0%vs.1.3%,P=0.01).The incidence rate of RAO was 7.1%in BT group,3.8%in TR group and 3.2%in RCD group during 30-d follow-up period(all P>0.05).The results of multi-factor regression analysis showed that the factors influencing 24h RAO included BT-RCD,ratio of artery inner diameter to outer diameter of sheath tube(RAID/SOD)<1 and compression hemostasis time>6 h.Conclusion The purpose of safe and effective hemostasis can be achieved by 3 kinds of RCD,and TR-RCD and RCD can reduce the incidence rates of radial partial complications compared with BT-RCD.

关 键 词：经桡动脉 压迫止血 冠脉造影 冠脉介入 

分 类 号：R816.2[医药卫生—放射医学]