肝动脉化疗栓塞术后股动脉穿刺处加压包扎时间研究

肝动脉化疗栓塞术，广泛用于中晚期肝脏肿瘤的治疗，术后股动脉穿刺处出血为其主要并发症，为防止出血发生，常规采用宽胶布加压包扎２４ｈ。加压包扎可致局部皮肤损伤，并有术肢麻木不适感，严重者可发生下肢血栓形成，为探讨合适的加压包扎时间，以减少皮肤并发症、增加病人舒适感，将１８０ 例住院的肝癌病人在５６６ 次肝动脉化疗栓塞术后随机分为三组，分别用宽胶布加压包扎股动脉穿刺处２４ｈ、１０ｈ、６ｈ 的观察发现：随加压包扎时间的缩短，皮肤损伤发生率明显降低（ Ｐ＜ ０．０１） ，术肢麻木不适感明显减少（ Ｐ＜ ０．０１），而穿刺处出血发生率无明显差异（ Ｐ＞ ０．０５）。结论：肝动脉化疗栓塞术后股动脉穿刺处加压包扎６ｈ 即可达到止血目的，且皮肤损伤率明显降低，病人舒适感增加。

Study on Duration of Pressurized Puncture of Eemoral Artery after Transcatheter Arterial Embolization

Hepatic angiography and transcatheter arterial embolization (TAE) have been widely practiced in the diagnosis and treatment for hepatic neoplasms.Hemorrhage from the puncture of femoral artery is one of the major complications.In order to prevent bleeding,pressurized packing for the puncture and immobilization for 24 hours were routinely performed after operation.Owing to prolonged pressurized packing,skin lesion,numbness and even thrombosis of lower extremities may develop.Patients after TAE were randomly divided into three groups in this study,and they were packed for 24 hours,10 hours and 6 hours respectively.Clinical investigation of 566 cases showed that with the shortening of duration of packing,occurrence of skin lesion decreased significantly ( P< 0.01),and comfortableness of the patients increased( P< 0.01),while no difference of incidence of bleeding was observed.Conclusion:pressurized packing for the femoral puncture and immobilization after TAE for 6 hours was enough for hemostasis,and in the mean time other complications were minimized as well as comfortableness of the patients is enhanced. Author's address General Hospital of PLA,Beijing,100853