【摘要】 目的:评价冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)后人工压迫止血法和两种动脉穿刺闭合器(Angi-oseal和Perclose)在股动脉径路止血中的安全性和有效性及其影响因素。方法:366例经股动脉行选择性冠状动脉造影或介入治疗的患者,分为人工压迫止血组128例、Angioseal组128例和Perclose组110例,观察3种止血方法的有效性、安全性,并分析其影响因素。结果:止血成功率各组间无明显差异;即刻止血率Angioseal组明显高于Perclose组(P<0.01)。下肢制动时间和止血时间Angioseal组和Perclose组均明显短于人工压迫组(P<0.01)。血管迷走神经反射和严重并发症仅发生在人工压迫组;局部并发症Angioseal组和人工压迫组均明显低于Perclose组(P<0.01)。影响因素:术后使用肝素者血肿发生率高(OR=4.382,P<0.05);男性、PCI及术后使用氯吡格雷者渗血发生率高(P<0.05或P<0.01);年龄大及PCI者成功率低;术后使用低分子肝素和肝素者止血时间延长。结论:Angioseal、Perclose与人工压迫止血法均可有效用于心导管术后股动脉穿刺部位的止血。与Perclose相比,Angioseal止血时间更短、即刻止血率更高且局部并发症更少。更多还原

【Abstract】 Objective:To assess the safety and efficacy of the standard manual compression and 2 arterial puncture closing devices,Angioseal and Perclose,for hemostasis at the femoral artery access site in patients undergoing coronary angiography(CAG) or percutaneous coronary interventions(PCI).Methods: Totally 366 patients undergoing coronary angiography or PCI were assigned to receive either Angioseal(n=128),Perclose(n=110) or standard manual compression(n=128).The efficacy endpoint(immediate hemostasis,successful hemostasis rate,operating time,time of leg immobilization and time to hemostasis) and safety endpoint(vasovagal reflex,major complications,local complications,hematocrit drop,etc.) were evaluated.Risk factors(gender,age,body mass index,comorbid conditions,antiplatelet agents,and anticoagulant agents,etc.) were also analyzed.Results: The successful hemostasis rates were similar between Angioseal group and Perclose group,but the rate of immediate hemostasis of Angioseal group was higher than that of Perclose group(P<0.01).Time of leg immobilization and time to hemostasis in Angioseal group and Perclose group was shorter than those of manual compression group(P<0.01).Both vasovagal reflex(9.3%) and major complications(3.1%) were only noticed in manual compression group.The rates of local complications in manual compression group and Angioseal group were both lower than that of Perclose group(P<0.01).Post-procedure unfractionated heparin was associated with increased risk of hematoma(OR=4.382,P<0.05),post-procedure clopidogrel(OR=3.549,P<0.01) and interventional procedures(OR=6.584,P<0.05) were associated with increased risk of blood oozing,and female gender was associated with a reduced risk of blood oozing(OR=0.132,P<0.05).The successful hemostasis rates were lower in the elderly and those receiving PCI.Post-procedure unfractionated heparin and low molecular weight heparin was associated with longer hemostasis time.Conclusion: Perclose and Angioseal can be an alternative of standard manual compression for hemostasis of the femoral artery access site.Angioseal may be better than Perclose regarding the immediate hemostasis and local complications.更多还原