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目的观察冠状动脉介入治疗术后即刻股动脉穿刺部位应用Perclose A.T血管缝合器止血疗效、安全性及临床使用价值。方法对冠脉介入治疗术后的512例患者,所有患者均接受抗凝、抗血小板治疗,术中肝素化,分为经皮血管缝合器组及压迫止血组。缝合器组在冠脉介入治疗术后即刻拔除动脉鞘管选用Perclose A.T对穿刺部位动脉进行止血,人工压迫组在术后4～6h测活化凝血时间<180s后拔除鞘管采用手法压迫止血,比较止血时间、卧床制动时间及并发症的发生率。结果人工压迫止血组平均止血时间为(25±6.3)min,卧床制动时间为(36.5±8.9)h,与止血相关的并发症发生率为5.6%;血管缝合器组平均止血时间为(5±2.1)min,卧床制动时间为(4.5±1.9)h,与止血相关的并发症发生率为1.9%。血管缝合器组止血时间、卧床制动时间、并发症的发生率明显少于人工压迫组。结论血管缝合器PercloseA.T于PCI术后即刻止血迅速、有效,止血时间及卧床制动时间明显缩短,并发症少,操作简单易学,易于临床推广使用。
Objective To observe the curative effect, safety and clinical value of Perclose A.T vascular stapler on the site of femoral artery puncture immediately after coronary intervention. Methods A total of 512 patients after coronary intervention were enrolled in this study. All patients underwent anticoagulant and antiplatelet therapy and heparinization during operation. The patients were divided into percutaneous vascular stapler group and compression hemostasis group. Peripheral artery was punctured with Perclose AT immediately after percutaneous coronary intervention in the suture group. Artificial oppression group was activated at 4 ~ 6 hours postoperatively and coagulation time was less than 180 s. Bleeding time, bed brake time and the incidence of complications. Results The average hemostasis time of artificial hemostasis group was (25 ± 6.3) min, the immobilization time was (36.5 ± 8.9) h, and the complication rate of hemostasis was 5.6%. The mean time of hemostasis was (5 ± 2.1) min. The immobilization time was (4.5 ± 1.9) h, and the complication rate related to hemostasis was 1.9%. Blood vessel suture group bleeding time, bed brake time, the incidence of complications was significantly less than artificial compression group. Conclusion The percutaneous occluder PercloseA.T is quick and effective in stopping bleeding immediately after PCI. The bleeding time and bed braking time are obviously shortened. There are few complications and the operation is simple and easy to learn.