外周球囊封堵术处理介入术中股动脉穿孔致腹膜后血肿的临床效果

摘要

Objective To compare the clinical effect of the peripheral balloon closure with surgical intervention for developed retroperitoneal hematoma(RPH) caused by femoral artery perforation .Methods A retrospecive analysis was performed on 2 492 consecutive patients underwent PCI from January 2005 to December 2013 in Guangdong people′s hospital .Twenty -four cases of developed RPH caused by femoral artery puncture operation for PCI were retrospectively analyzed ,13 cases of patients who took peripheral balloon closure were divided into balloon block group and the other 11 patients adopted surgery vascular repair process‐ing ,were enrolled in the surgical treatment group .Comparison was done among the hemostatic effect and the time ,and postoperative adverse events ,including lower limb blood supply obstacles for puncture side postoperative ,major adverse cardiovascular events (MACE) during hospitalization ,all‐cause mortality ;Multivariate logistic regression was used to assesse the RPH risk factors .Re‐sults The incidence of RPH caused by femoral artery perforation was about 0 .96% .During coronary intervention ,the following variables were found to be independent predictors of RPH caused by femoral artery perforation:female gender(OR=8 .94 ,95% CI:3 .75-21 .98 ,P< 0 .01) ,femoral artery ulcer(OR= 6 .43 ,P<0 .05) and multiple puncture (> 3 times) (OR= 7 .39 ,95% CI:2 .74-13 .76 ,P<0 .01) .Hemostatic success rates of the two groups were all 100% ;the average times of processing perforation were (76 .8 ± 34 .6) min and ((88 .5 ± 37 .3) min ,P<0 .05 ,the difference was statistically significant ;3 cases (23 .1% ) and 2 cases (18 .2% ) developed into postoperative severe anemia (Hgb<60 g/L) in each group ,P>0 .05;Each group had 1 case for in‐hospital MACE (7 .7% vs .9 .1 % ,P>0 .05);In the two groups ,there was no lower limb blood supply obstacles and death case .Conclusion For progress RPH caused by femoral artery perforation ,peripheral balloon closure can be a faster ,better sealing hemostatic ,and shorten the rescue time ,and the success rate is high ,and there is less postoperative adverse events .The safety and effectiveness be‐have good .%目的：探讨外周球囊封堵术处理介入术中股动脉穿孔致腹膜后血肿（RPH ）的临床效果。方法对广东省人民医院心内科2005年1月至2013年12月共2492例术中经股动脉穿刺进行冠状动脉介入治疗（PCI）的病例进行回顾性分析，并发股动脉穿孔致进展型RPH 24例，13例患者采取外周球囊封堵术设为球囊封堵组，另11例患者采取了外科血管修补术处理，设为外科手术组，比较两组止血时间以及止血效果，以及术后不良事件；采用多因素Logistic回归分析股动脉穿孔致RPH发生的危险因素。结果研究发现PCI治疗股动脉穿孔致进展型RPH发生率约为0．96％。PCI中股动脉穿孔致RPH的独立预测因素有3个，包括女性（OR＝8．94，95％ C I：3．75～21．98，P＜0．01）、股动脉溃疡（OR＝6．43，P＜0．05）及多次穿刺（＞3次）（OR＝7．39，95％ C I：2．74～13．76，P＜0．01）；球囊封堵组与外科手术组比较，止血抢救成功率均为100％；平均处理穿孔时间分别为（76．8±34．6）min及（88．5±37．3）min ，差异有统计学意义（P＜0．05）；术后重度贫血（Hgb＜60 g／L）分别为3例（23．1％）及2例（18．2％），差异无统计学意义（P＞0．05）；住院期间主要不良心血管事件（MACE）各有1例（7．7％ vs ．9．1％，P＞0．05）；两组均无穿刺侧下肢血运障碍以及死亡患者。结论对于股动脉穿孔致进展型的RPH ，外周球囊封堵术可较快、较好封堵止血，术后不良事件少，安全性及有效性好。