心脏介入诊疗术后股动脉血管不同止血方法的并发症及防范.doc

心脏介入诊疗术后股动脉血管不同止血方法的并发症及防范
作者:王德荣,李金生,魏朝阳,程杨,屈丽琼
【摘要】目的通过对经股动脉行心脏介入诊疗术后采用不同止血方法患者的常见并发症观察,探讨其防范技巧。方法对283例经股动脉行心脏介入诊疗(选择性冠状动脉造影及支架植入术)术后采用常规绷带加压包扎、Angioseal血管缝合器及动脉压迫器止血后发生并发症的成因进行分析。结果经股动脉途径行心脏介入治疗术后并发症主要是穿刺部位出血,表现为出血、血肿,腹膜后出血或血肿,假性动脉瘤和动静脉瘘,主要原因是穿刺部位过高或过低,血管损伤,过度抗凝和压迫止血不当所致。结论股动脉准确穿刺、术中轻柔操作、准确压迫动脉鞘管进入血管口及松紧适度是减少并发症的主要预防措施,根据病人的具体情况选择适当的股动脉心脏介入诊疗术后压迫止血方法可以减少并发症的发生。
【关键词】冠状动脉疾病;介入治疗;股动脉;并发症
ABSTRACT Objective To observe plications of different femoral artery hemostasis methods after percutaneous coronary intervention and to discuss the causes and prevention countermeasures. Methodss pression bandage,Angioseal Suturing Apparatus and pressor were applied for hemostasis
to 283 patients having received percutaneous coronary intervention via femoral artery (selective coronary angiography or stent implantation); the causes of plications were analyzed. Results The plications were bleeding at the puncture sites,such as hemorrhage,hematoma and retroperitoneal hemorrhage,or hematoma,pseudoaneurysm and arteriovenous fistula; the main causes were as follows: the puncture sites too high or too low,blood injuries,over anticoagulation and pression hemostatsis. Conclusions Accurate puncture,gentle operation,accurate and pression to the cut of arterial sheath when entering the vessels are the main countermeasures; correct selection pressors for hemostasis may decrease the occurrence pli