冠状动脉介入诊疗术后血管闭合装置与压迫止血效果比较

目的比较经皮冠状动脉介入性诊疗术后使用血管闭合装置与传统人工压迫止血方式对外周血管并发症的影响。方法选择冠状动脉介入性诊疗术后使用血管闭合装置的62例为观察对象（血管闭合装置组）,选择与之匹配的以人工压迫方式止血的68例患者作为对照（人工压迫组）,比较两组术后卧床时间及穿刺血管并发症发生率。结果血管闭合装置组患者术后卧床时间显著短于人工压迫组（P〈0.01）;两组穿刺血管并发症发生率比较,差异无显著性意义（均P〉0.05）。结论冠状动脉介入性诊疗术后使用外周血管闭合装置可缩短患者卧床时间,但是否能降低外周血管并发症的发生率尚需进一步研究。     

经桡动脉路径冠状动脉介入术后外周血管并发症的预防护理

目的 探讨经桡动脉路径冠状动脉介入术后外周血管并发症的预防护理方法.方法 分析采用常规方法护理的322例经桡动脉路径冠状动脉介入术后患者（对照组）中123例外周血管并发症的发生原因,并据此制定预防护理措施应用于350例经桡动脉路径冠状动脉介入术后患者（干预组）,包括规范使用TR-band止血器,加强医护沟通和患者的健康教育,规范减压及加强巡视观察等.结果 干预组止血器压迫时间显著短于对照组,沿桡动脉路径外周血管穿刺并发症发生率显著低于对照组（P＜0.05,P＜0.01）.结论 针对性的预防护理措施可有效提高经桡动脉路径冠状动脉介入术后患者压迫止血效果,减少穿刺血管并发症.     

不同止血方法对冠状动脉介入术后病人的影响

目的探讨血管缝合器对冠心病介入诊疗术后病人的影响。方法将 4 18例冠状动脉造影和介入治疗病人分为两组 ,观察组 2 0 8例术后应用血管缝合器止血 ,对照组 2 10例术后采用常规人工压迫止血 ,比较两组术后不良反应发生率。结果两组穿刺局部损伤、排尿困难、舒适度、失眠及焦虑发生率比较 ,差异有显著性意义 (均P <0 .0 1)。结论血管缝合器由于缩短了止血时间及卧床制动时间 ,不仅能减少穿刺局部的出血和血肿 ,尚能改善病人的焦虑心理、舒适度及睡眠 ,减轻排尿困难等不适。     

经桡动脉路径冠状动脉介入术后外周血管并发症的预防护理

目的探讨经桡动脉路径冠状动脉介入术后外周血管并发症的预防护理方法。方法分析采用常规方法护理的322例经桡动脉路径冠状动脉介入术后患者(对照组)中123例外周血管并发症的发生原因,并据此制定预防护理措施应用于350例经桡动脉路径冠状动脉介入术后患者(干预组),包括规范使用TR-band止血器,加强医护沟通和患者的健康教育,规范减压及加强巡视观察等。结果干预组止血器压迫时间显著短于对照组,沿桡动脉路径外周血管穿刺并发症发生率显著低于对照组(P0.05,P0.01)。结论针对性的预防护理措施可有效提高经桡动脉路径冠状动脉介入术后患者压迫止血效果,减少穿刺血管并发症。     

血管闭合器用于PCI术后止血效果观察

将 15 0例行经皮冠状动脉介入治疗 (PCI)的冠心病病人随机分为两组 ,对照组 75例术后采用外力压迫止血 ,观察组 75例采用Angio seal血管闭合器止血。结果观察组股动脉穿刺点血管并发症发生率显著低于对照组 (P <0 .0 1) ;下肢制动时间及止血时间显著少于对照组 (均P <0 .0 1)。提示血管闭合器比外力压迫止血更安全、有效。     

气囊压迫止血在冠状动脉介入诊疗术后的应用

目的 观察气囊压迫止血在冠状动脉介入诊疗术后的应用效果,减少局部并发症的发生.方法 将506例经股动脉穿刺行冠状动脉诊疗术的患者随机分为对照组(224例)和观察组(282例),对照组术后穿刺点用弹力胶布固定,沙袋压迫止血;观察组用自制气囊压迫止血.观察两组止血效果、局部并发症发生率和术侧肢体舒适度.结果 观察组出血2例(0.7%),无局部并发症发生,30例(10.6%)患者诉术侧肢体麻木;对照组出血190例(84.8%),131例(58.5%)局部皮肤发生并发症,219例(97.8%)诉术侧肢体麻木,两组比较,差异有显著性意义(均P＜0.01).结论气囊压迫止血对冠状动脉介入术后止血效果显著,减少了局部并发症的发生,增进了患者舒适感.     

老年患者冠状动脉造影术后不同股动脉止血方法的效果比较

目的：评价冠状动脉造影及经皮冠状介入治疗术后老年患者股动脉穿刺部位不同止血方法的效果及安全性.方法：268例行冠状动脉造影及经皮冠状动脉介入治疗的老年患者,平均年龄63.8岁,根据不同股动脉止血方法分为3组.A组82例采用徒手压迫法止血 B组87例采用M-GU动脉压迫器止血 C组99例采用Angio血管闭合器止血.比较3组患者术后制动时间、止血效果及术后并发症发生率.结果：A组止血成功率为98.8%（81/82例）,B组为97.7%（85/87例）,C组为96.0%（95/99例）,3组间差异无统计学意义（P＞0.05）.止血和制动时间比较,C组[（4.3±1.1）min和（4.9±0.9）h]少于B组[（6.2±1.2）min和（12.2±1.5）h],B组少于A组[（23.2±3.6）min和（25.7±2.3）h].并发症的发生情况：3组间局部渗血和假性动脉瘤的发生率差异无显著性 尿潴留和腰痛并发症的发生率差异存在显著性,C组（2.0%和7.1%）低于A组（14.6%和42.7%）和B组（6.9%和20.7%）.结论：3种止血方法的止血效果无差异,但是应用血管闭合器止血可以有效缩短老年患者止血时间及下肢制动时间,减少并发症发生,患者易于接受.     

血管闭合器、血管压迫器和弹力绷带加压法3种止血方式用于周围血管介入术的对照研究

目的系统评价经股动脉穿刺后血管闭合器、血管压迫器、弹力绷带加压法3种止血方式的安全性及效果。方法选取2019年2月至2021年1月首都医科大学附属北京康复医院收治的121例行周围血管介入术的非下肢动脉病变患者,按照住院顺序号将患者分为血管闭合器组(n=42,应用血管闭合器进行股动脉穿刺部位止血)、血管压迫器组(n=40,应用股动脉电子压迫止血器进行股动脉穿刺部位止血)与弹力绷带压迫组(n=39,应用弹力绷带压迫进行股动脉穿刺部位止血)。比较3组患者术前、术后1 d及术后3个月手术穿刺部位及周围3 cm内股动脉最小内径及收缩期峰值血流速度,并观察其术后1 d轻度和严重并发症的发生情况。结果术后1 d,血管闭合器组患者的穿刺部位及周围3 cm内股动脉最小内径小于血管压迫器组和弹力绷带压迫组患者,且血管压迫器组患者的穿刺部位及周围3 cm内股动脉最小内径小于弹力绷带压迫组患者(P<0.05)。术后1 d,血管闭合器组、血管压迫器组患者穿刺处范围内最小内径处的收缩期峰值血流速度均低于弹力绷带压迫组患者(P<0.05)。术后3个月,血管闭合器组患者的穿刺部位及周围3 cm内股动脉最小内径小于弹力绷带压迫组患者;血管闭合器组患者穿刺处范围内最小内径处的收缩期峰值血流速度低于血管压迫器组、弹力绷带压迫组患者,且血管压迫器组患者穿刺处范围内最小内径处的收缩期峰值血流速度低于弹力绷带压迫组患者(P<0.05)。术后1 d,3组患者的轻度及严重并发症总发生率比较,差异均无统计学意义(P>0.05)。结论经股动脉穿刺后3种止血方式均影响穿刺部位附近的血管内径及收缩期峰值血流速度。血管闭合器对患者术后3个月预后情况的影响最大,其次是血管压迫器,弹力绷带加压法对患者术后3个月预后的影响最小。     

气囊压迫止血在冠状动脉介入诊疗术后的应用

目的观察气囊压迫止血在冠状动脉介入诊疗术后的应用效果,减少局部并发症的发生。方法将506例经股动脉穿刺行冠状动脉诊疗术的患者随机分为对照组（224例）和观察组（282例）,对照组术后穿刺点用弹力胶布固定,沙袋压迫止血;观察组用自制气囊压迫止血。观察两组止血效果、局部并发症发生率和术侧肢体舒适度。结果观察组出血2例（0.7%）,无局部并发症发生,30例（10.6%）患者诉术侧肢体麻木;对照组出血190例（84.8%）,131例（58.5%）局部皮肤发生并发症,219例（97.8%）诉术侧肢体麻木,两组比较,差异有显著性意义（均P〈0.01）。结论气囊压迫止血对冠状动脉介入术后止血效果显著,减少了局部并发症的发生,增进了患者舒适感。     

不同途径经皮冠状动脉心脏介入诊疗并发症的分析

目的 探讨经桡动脉和经股动脉途径行心脏介入诊疗相关并发症.方法 220例择期行心脏介入诊疗患者随机分为经桡动脉途径组(观察组)和经股动脉组组(对照组),观察两组止血压迫时间、住院时间和外周血管并发症.结果 两组病人一般情况无差异,但外周血管并发症、止血压迫时间和住院时间有显著性差异(P＜0.05).结论 经桡动脉途径行心脏介入诊疗优于经股动脉途径.     

Coronary Artery Bypass Following Percutaneous Transluminal Coronary Angioplasty

During a 4-year period, 286 patients underwent coronary artery bypass grafting (CABG) following percutaneous transluminal coronary angioplasty (PTCA). Seventy-three patients had single-vessel and 213 (74.5%) had multivessel coronary artery disease. Twenty-nine patients underwent PTCA because of an evolving acute myocardial infarction (MI). Forty-two patients had previously undergone 47 CABG procedures.One hundred fifteen patients underwent CABG on an emergency basis. Indications for emergency CABG after PTCA were prolonged chest pain (79.1%), worsening of coronary artery obstruction (59.1%), “current of injury” by electrocardiogram (31.3%), cardiogenic shock (27.8%), and, in a lesser incidence, ventricular fibrillation, coronary artery dissection (without obstruction), heart block, and intractable cardiac arrest. The 286 patients underwent 2.1 CABG procedures per patient with a thirty-day mortality of 6.3% (18 patients). The incidence of acute MI was 43.5 versus 4.1%; low cardiac output syndrome, 34.8 versus 7.0%; and operative death, 11.3 versus 2.9% in the emergency and nonemergency groups, respectively. Other significant predictors of operative death were previous CABG (16.7 versus 4.5%), multivessel coronary artery disease (8.0 versus 1.4%), and preoperative cardiogenic shock (15.6 versus 3.2%). Late follow-up reveals a mortality of 1.4% per year in those patients who were early survivors of CABG.     

Coronary reoperations

As coronary bypass surgery evolved from a procedure offered to good-risk patients into an intervention that is now applied to a spectrum of patients with many high-risk characteristics, so, too, reoperation for coronary surgery is now applied to an aging population with complicated atherosclerosis and abnormal left ventricular function. Despite our increased understanding of the factors that generate a need for reoperations and some potential avenues for preventing or delaying reoperations, the number of reoperations seems likely to increase. It is clear that the consistency of intraoperative myocardial protection must be improved; however, the favorable long-term results for these patients solidify the role of reoperation as an applicable intervention for patients with severe coronary atherosclerosis.     

Coronary endarterectomy

From July, 1984, to December, 1986, coronary bypass grafting was performed in 314 patients, 70 (22%) requiring coronary endarterectomy (RCA; 48 pts, LAD; 10 pts, LAD + RCA; 10 pts, Others; 2 pts). Coronary endarterectomy patients (END group) were younger and often with the risk factor of hyperlipidemia than non-endarterectomy patients (NON group). The over-all hospital mortality rate of END group was 7 per cent; perioperative myocardial infarction occurred in 7 per cent of patients. Early postoperative angiogram (4 weeks after the operation) was performed in 54 patients. The patency rate of RCA endarterectomy was 81.8 per cent, and that of LCA endarterectomy was 75 per cent. This result was poor compared with the patency rate of non-endarterectomy graft (86.6%). However without endarterectomy, with all likelihood the patency rate of those grafts would have been poorer. The results of right coronary endarterectomy are satisfactory and better than those of the left coronary artery system. This experience suggests that coronary endarterectomy is safe and an useful adjunct of saphenous vein bypass grafting procedures in the management of diffuse coronary disease, especially in RCA lesions.