经桡动脉行冠状动脉介入诊治术后局部出血影响因素

目的探讨经桡动脉行冠状动脉介入诊治术后穿刺口局部出血的影响因素,为制订术后预防穿刺口局部出血提供依据。方法选择2011年8～12月在本院心介入内科经桡动脉行冠状动脉介入诊治术后患者198例,采用前瞻性研究,以患者术后穿刺VI局部出血为结局,将患者分为发生出血组62例与未发生出血组136例。记录患者术前用药方案、止血器放置位置、术后腕关节伸直制动时间、第1—2次松止血器时间及圈数、解除压迫时间、全松止血器时间及实验室血液化验结果等,采用Cox回归分析筛查患者出血影响因素。结果术前应用双联抗血小板聚集药＋抗凝药方案、止血器居于前臂桡侧与尺侧中轴线上、止血器中点与腕第2横纹距离偏大、全松止血器时间早是影响经桡动脉行冠状动脉介入诊治术后穿刺口局部出血的因素,其RR值分别为2．001、3．521、1．470、0．999（均P〈0．05）。结论术前采用联合抗血小板聚集药和抗凝药方案、止血器压板中点居于前臂桡侧与尺侧中轴线上、止血器中点与腕第2横纹距离偏大为经桡动脉行冠状动脉介入诊治术后穿刺151局部出血的危险因素,延长全松止血器时间是经桡动脉行冠状动脉介入诊治术后穿刺口局部出血的保护因素。

Influencing factors of puncture site bleeding after trans-radial coronary intervention

Objective To investigate influencing factors of puncture site bleeding after trans-radial coronary intervention （TRI） in order to provide guidance for prevention of post-operative bleeding complications. Methods A total of 198 patients with TRI hospitalized at the department of interventional cardiology of our hospital from August, 2011 to December, 2011 were recruited in the study. In the prospective study, they were divided into two groups： bleeding group （n = 62） and non-bleeding group （n = 136）. The general status, medication, position of radial compressor, time of immobilization of the wTist joint, duration of loosing tourniquet between the first time and second time and number of laps, time for depression, duration for total release of compression device and laboratory testing were recorded as data. Cox regression analysis was done to explore factors influencing bleeding. Results The factors for puncture site bleeding after trans-radial coronary intervention included pre-operative medications, location of compression device at the midline of operated forearm, distance between the compression device midpoint and the second wrist crease, and time for total release of compression device, with their RR = 2.001, 3.521, 1.470 and 0.999, respectively. Conclusion Factors contributing to increased risk of local bleeding at puncture site following TRI included pre-operative medications, location of compression device at the midline of operated forearm, distance between the compression device midpoint and the second wrist crease; whereas the time for total release of compression device may be a protective factor.