摘要
目的了解经桡动脉冠状动脉介入诊疗术后患者早期(2 h)拆除止血器穿刺部位出血的发生现状,进一步分析其出血的影响因素,为临床医护人员识别高出血风险人群及实施个性化桡动脉止血器拆除方案提供参考依据。方法选取2024年1月至11月中山大学附属第一医院心内科接受早期拆除止血器404例冠状动脉介入诊疗术后患者作为调查对象。收集患者的一般信息、疾病及手术相关资料,采用Christensons标准进行出血评估,将患者根据早期(2 h)拆除止血器后的穿刺部位情况分为出血组和无出血组,统计穿刺部位出血的发生率,采用单因素及多因素logistic回归方法分析穿刺部位出血的影响因素。结果404例患者中,18例出现穿刺部位出血,发生率为4.4%。单因素分析结果显示,两组患者手术类型、手术时间、肝素量比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,术前国际标准化比值(INR)(β=2.223,OR=9.239,95%CI:1.688~50.573)和手术时间(β=0.027,OR=1.028,95%CI:1.004~1.052)是冠状动脉介入诊疗术后早期(2 h)拆除止血器穿刺部位出血的独立危险因素(P<0.05)。结论早期(2 h)拆除止血器穿刺部位出血的发生率较低。对于无出血危险因素的患者,实施早期拆除止血器是安全的。术前INR值升高和手术延长是影响穿刺部位出血的影响因素,临床医护人员应关注高出血风险的患者,强化术前及术后综合评估,适当延长止血器的压迫时间,以预防穿刺部位出血的发生。
Objective To understand the puncture site bleeding status of early(2 h)removal of hemostatic device in patients after coronary interventional diagnosis and treatment,further analyze the influencing factors of bleeding,and provide a reference basis for clinical medical staff to identify the population with high bleeding risk and implement personalized radial hemostatic device removal plans.Methods A total of 404 patients who underwent coronary interventional diagnosis and treatment after early removal of hemostatic devices in the Department of Cardiology of the First Affiliated Hospital,Sun Yat-sen University from January to November 2024 were selected as the investigation subjects.General information,disease and surgery-related data of the patients were collected.Bleeding assessment was conducted using the Christensons criteria.The patients were divided into the bleeding group and the non-bleeding group based on the puncture site status after early(2 h)removal of hemostatic device.The incidence of bleeding at the puncture site was statistically analyzed.Univariate and multivariate logistic regression methods were used to analyze the influencing factors of bleeding at the puncture site.Results Among the 404 patients,18 cases had bleeding at the puncture site,with an incidence rate of 4.4%.The results of univariate analysis showed that there were statistically significant differences in the types of surgery,operation time,and heparin dosage between the two groups of patients(P<0.05).The results of multivariate logistic regression analysis showed that the preoperative international normalized ratio(INR)(β=2.223,OR=9.239,95%CI:1.688-50.573)and the operation time(β=0.027,OR=1.028,95%CI:1.004-1.052)were independent risk factors for puncture site bleeding of early(2 h)removal of hemostatic device after coronary interventional diagnosis and treatment(P<0.05).Conclusion The incidence of puncture site bleeding of early(2 h)removal of hemostatic device is relatively low.For patients without bleeding risk factors,early removal of hemostatic device is safe.Elevated preoperative INR values and prolonged surgery are influencing factors affecting bleeding at the puncture site.Clinical medical staff should pay attention to patients with a high risk of bleeding,strengthen comprehensive preoperative and postoperative assessment,and appropriately extend the compression time of the hemostatic device to prevent puncture site bleeding.
作者
张小勤
严凤娇
ZHANG Xiaoqin;YAN Fengjiao(The Third Department of Cardiology,the First Affiliated Hospital,Sun Yat-sen University,Guangdong Province,Guangzhou 510080,China)
出处
《中国当代医药》
2026年第3期105-109,共5页
China Modern Medicine
基金
中山大学附属第一医院首届柯麟护理人才培育计划项目(KLHL2023BB09)。
关键词
桡动脉
冠状动脉造影术
冠状动脉介入治疗
穿刺部位出血
影响因素
Radial artery
Coronary angiography
Percutaneous coronary intervention
Puncture site bleeding
Influencing factor
