静脉溶栓患者既有穿刺点出血并发症的风险评估与处理2例病例治疗体会  

Risk assessment and management of existing puncture bleeding complica-tions in patients with intravenous thrombolysis and treatment experience in two cases

作　　者：周婷 刘莉[2] 唐戈 刘曙东 史海洋 赵立波[1] 张莉莉 杨德雨[1] ZHOU Ting;LIU Li;TANG Ge;LIU Shudong;SHI Haiyang;ZHAO Libo;ZHANG Lili;YANG Deyu(Department of Neurology,Yongchuan Hospital of Chongqing Medical University,Chongqing402160,China;Department of Health Management,Yongchuan Hospital of Chongqing Medical University,Chongqing402160,China;Department of Neurology,Daping Hospital of Army Military Medical University,Chongqing400042,China)

机构地区：[1]重庆医科大学附属永川医院神经内科,重庆402160 [2]重庆医科大学附属永川医院健康管理科,重庆402160 [3]陆军军医大学大坪医院神经内科,重庆400042

出　　处：《中国医药导报》2023年第2期185-188,共4页China Medical Herald

基　　金：西藏自治区自然科学基金组团式援藏医学项目[Z2020ZR-ZY68(Z)];重庆市科卫联合医学科研项目(渝卫发[2019]35号—2019QNXM014)。

摘　　要：伴有易压迫处动脉穿刺点的急性脑梗死患者,静脉溶栓前该如何预防穿刺点出血并发症,目前指南没有阐述,也鲜见相关报道。本文报道了2例既有穿刺点的急性脑梗死患者行静脉溶栓的治疗经过。病例1静脉溶栓前1周行右侧桡动脉穿刺术,溶栓前2 h行左侧桡动脉穿刺采血,静脉溶栓后患者双侧桡动脉穿刺点均出现皮下血肿,且右侧桡动脉穿刺点并发假性动脉瘤,予以输注新鲜冰冻血浆、冷沉淀、弹力绷带及压迫器压迫桡动脉等方法综合处理后,控制了动脉穿刺处的出血并发症。病例2静脉溶栓前26 h行右侧桡动脉穿刺术,静脉溶栓前予以压迫器压迫桡动脉穿刺点,未出现穿刺点的出血并发症。近1周内有在易压迫止血部位的动脉穿刺虽然不是静脉溶栓的禁忌证,但应该评估患者接受静脉溶栓后发生穿刺点出血并发症的风险。对于风险较高的患者,可考虑溶栓前压迫穿刺点以预防穿刺点出血并发症。For patients with acute cerebral infarction with easily compressible arterial puncture points,how to prevent complications of puncture point bleeding before intravenous thrombolysis is not elaborated in the current guidelines,and relevant reports are rare.This article reported the two patients with acute cerebral infarction with existing puncture sites were treated pass with intravenous thrombolysis.In case one,right radial artery puncture was performed one week before intravenous thrombolysis,and left radial artery puncture was performed two hours before thrombolysis,after intravenous thrombolysis,subcutaneous hematoma was found at both radial artery puncture sites,and false aneurysm was complicated at the right radial artery puncture site.After comprehensive treatment,such as fresh frozen plasma infusion,cryoprecipitate,elastic bandage,and compression of the radial artery,bleeding complications at the artery puncture site were controlled.In case two,right radial artery puncture was performed 26 hours before intravenous thrombolysis,and the radial artery puncture site was compressed by a compressor before intravenous thrombolysis,and no bleeding complications occurred at the puncture site.Although it is not contraindicated to perform intravenous thrombolysis within the last one week,patients should be assessed for the risk of complications from bleeding at the puncture site after receiving intravenous thrombolysis.For patients at higher risk,compression of the puncture site before thrombolysis may be considered to prevent complications of puncture site bleeding.

关 键 词：脑梗死 静脉溶栓 穿刺点 并发症 

分 类 号：R542[医药卫生—心血管疾病]