壳聚糖止血敷料止血装置在经桡动脉冠状动脉介入治疗术后的临床应用

目的 对比分析一种新型壳聚糖止血敷料止血装置在经桡动脉冠状动脉介入治疗（PCI）术后的临床应用.方法 选取2011年2月～2012年6月我院心内科因胸痛原因住院的患者包括急性冠脉综合征（不稳定性心绞痛、非ST段抬高心肌梗死、急性心肌梗死）、稳定心绞痛的患者3165例.其中冠脉造影1959例（其中经排除标准及经股动脉途径而不计入250例）,经桡动脉行介入治疗1206例（其中经排除标准及经股动脉途径和反关脉而不计入135例）,共计2780例入选.将入选病例随机分为2组,普通桡动脉止血板组1390例和壳聚糖止血敷料止血装置组1390例.观察术后即刻及出院时桡动脉主、次终点事件.主要终点包括：出血、血肿、假性动脉瘤、前臂疼痛或不适、桡动脉内膜损伤、桡动脉闭塞、桡动脉内膜直径等.次要终点包括压迫时间、压迫止血效果、患者依从性和满意度.结果 壳聚糖止血敷料止血装置组总血管并发症明显低于普通桡动脉止血板组（P＜0.01）,所需压迫时间明显缩短（P＜0.01）,治疗满意度明显较高（P＜0.01）.结论 壳聚糖止血敷料止血装置能够减少血管总并发症,减少压迫时间,提高患者术后满意度,对桡动脉内膜有一定保护作用.

The clinical application of the chitosan hemostatic device undergoing transradial catheterization

Objective The clinical application of the chitosan hemostatic device undergoing transradial catheterization.Methods From February 2011 to June 2012 in anzhen hospital,a total of 2780 patients undergoing transradial catheterization were conducted.6F and 7F sheaths were used,and the arterial sheaths were removed immediately after procedures.The patients were randomly divided into two groups,ordinary radial hemostatic plate device 1390 cases and chitosan hemostatic device 1390 cases.To observe the primary end point：hematoma,false aneurysm,pain or discomfort,forearm radial artery intimal injury,radial artery occlusion,radial artery intima diameter,etc.Secondary end points：oppression time,oppression hemostasis effect,patients compliance and satisfaction,etc.Results Although hematoma,pain or discomfort,forearm radial artery intimal injury,did not differ between the two groups,but the total vascular complications,chitosan hemostatic device group was significantly lower than the hemostatic plate group （P 〈 0.01）,especially compare with using GP Ⅱb/Ⅲb post the intervention,etc.The compression time,chitosan hemostatic devicewas significantly shorter （335.2 ± 60.4） min vs.（281.4 ± 63.9） min （P 〈 0.01）.In patients compliance and satisfaction,chitosan hemostatic device group was obviously higher（P 〈 0.01）.Conclusion Chitosan has a strong positive charge,but erythrocytes and platelets are negatively charged.During these agents,may result in a shorter time to hemostasis and reduce the complications however,it needs to be evaluated by larger number of patients.