急诊经皮冠状动脉介入术后桡动脉止血器临床应用

摘要

目的：观察急性ST段抬高型心肌梗死患者直接PCI术后采用桡动脉止血器压迫止血的临床效果及安全性。方法选择124例成功进行急诊PCI采用桡动脉径路的患者，术前给予阿司匹林、硫酸氢氯吡格雷，直接PCI术后留置桡动脉鞘管6 h，应用瑞翁株式会社生产的RDP700前臂用直型桡动脉止血器压迫止血，评价其临床效果及安全性，观察性别、年龄、体重及替罗非班对止血器压迫时间及肢体远端肿胀消退时间的影响。结果124例桡动脉径路患者压迫止血器均可于术后即刻成功止血，平均止血压迫时间为（9.9±3.5）h，远端肿胀平均消退时间为（32.4±8.7）h。共有3例（2.4%）发生桡动脉闭塞，5例（4.0%）出现穿刺局部皮肤损害。与男性患者相比，女性患者直接PCI术后桡动脉止血器压迫时间显著延长，撤除止血器后远端组织肿胀消退时间亦明显延长（P均＜0.01）。年龄≥60岁、体重＜65 kg患者桡动脉止血器压迫时间及远端组织肿胀消退时间较年龄≥60岁、体重≥65 kg明显延长（P均＜0.01）。直接PCI术后应用盐酸替罗非班患者桡动脉止血器压迫时间较未应用者显著延长，撤除止血器后远端组织肿胀消退时间亦明显延长（P均＜0.01）。结论急诊桡动脉径路行PCI术患者应用桡动脉止血器压迫止血安全有效，性别、年龄、体重及应用盐酸替罗非班影响止血器压迫止血时间及远端组织肿胀消退时间。%Objective To observe the clinical efficacy and safety of radial hemostat for pressure hemostasis in patients with acute ST-segment elevation myocardial infarction (STEMI) after direct emergency percutaneous coronary intervention (PCI). Methods The patients (n=124) with successful emergency PCI by radial approach were given aspirin and clopidogrel loading before PCI and radial sheath was kept for 6 h after direct PCI. RDP700 forearm straight radial hemostat (produced by Zeon Corporation) was used for pressure hemostasis, and the clinical efficacy and safety were reviewed. The influences of sex, age, weight and tirofiban on pressure time of hemostat and swelling subsiding time of distal limb were observed. Results All 124 patients had successful immediate hemostasis, and the mean pressure time was (9.9±3.5) h and mean swelling subsiding time of distal limb was (32.4±8.7) h. There were 3 cases (2.4%) had radial occlusion and 5 (4.0%) had skin lesion at puncture focus. Compared with male patients, the pressure time of radial hemostat and swelling subsiding time of distal limb were significantly prolonged (all P<0.01). The pressure time of radial hemostat and swelling subsiding time of distal limb were significantly prolonged in patients aged≥60 and weighed<65 kg (all P<0.01), and also significantly prolonged in patients been given tirofiban compared with those without giving it after direct PCI (all P<0.01). Conclusion The radial hemostat for pressure hemostasis is safe and effective in patients with emergency PCI, and sex, age, weight and tirofiban have influences on pressure time of radial hemostat and swelling subsiding time of distal limb.