经皮冠状动脉介入治疗后血管缝合器 应用的方法学探讨

目的探讨缝合器止血的合理使用方法，提高操作成功率。方法使用美国ABOTT公司生产的percloser血管缝合器，对80例冠脉介入治疗后患者血管穿刺部位进行缝合止血，观察股动脉不同穿刺部位、多次介入治疗的股动脉以及股动脉造影的投照角度选择对缝合效果的影响。结果80例患者中76例缝合成功，成功率97．37％，2例失败，2例放弃缝合术。两种造影角度中，选择后前位法造影血管分支重叠64例(重叠率80％)，右前斜30。投照角度血管重叠8例(重叠率10％)。腹股沟上位点穿刺法50例，成功缝合49例，1例失败；腹股沟下位点缝合法30例，成功缝合27例，1例失败，2例放弃缝合术。结论应用percloser缝合器止血是一种安全有效的方法。观察穿刺部位的血管解剖关系时，右前斜30。可作为常规投照角度，穿刺点可优先选择腹股沟韧带上穿刺位点，其次选择腹股沟韧带下穿刺位点，对多次进行过介入治疗的股动脉不宜在重复部位行缝合治疗。

Suture mediated puncture closure in femoral arterial puncture management after percutaneous coronary intervention

Objective To study the methodology of suture mediated puncture closure in femoral arterial puncture management after percutaneous coronary intervention (PCI). Methods Eighty patients were employed in the mediated puncture closure (ABOTT, USA) hemostasia treatment after PCI. The relationship between the suture effect and puncture site, number of femoral puncture, and the angiography angle was observed. Results The suture with mediated puncture closure was successful in 76 cases (97.37%), two cases failed and 2 cases given up suture treatment. In anteroposterior angle angiography, the blood vessels overlapped in 64 cases (overlap rate 80%), but in RAO 30 angle angiography, the blood vessels overlapped in 8 cases (overlap rate 10%). Groin epigyny puncture site was used in 50 cases and successful suture was achieved in 49 cases, with 1 case failed. Groin hypogyny puncture site was used in 30 cases and successful suture was seen in 27 cases, with 1 case failed and 2 cases gave up. Conclusion The mediated puncture closure device is safe and effective. In order to observe the anatomy of puncture site vessels, RAO 30° can be used as a routine angiography angle. Groin epigyny puncture site should be the first choice, then the groin hypogyny puncture site. The femoral arterial suture treatment is not suitable in patients with multiple interventions.