经股动脉脑血管造影术后改良下肢制动时间的临床观察

目的：探讨经股动脉行脑血管造影术后改良下肢制动时间的可行性和安全性。 方法：前瞻性收集河南省人民医院脑血管五病区2019年3月1日到2019年5月20日收治的100例经股动脉行脑血管造影患者，并对其术后下肢制动时间进行改良：下肢制动4 h后去除绷带，床上活动穿刺侧下肢2 h后可下床活动。观察的主要安全性指标是下肢活动后出现的皮下血肿、假性动脉瘤、动静脉瘘，次要安全性指标有穿刺点渗血、下肢深静脉血栓形成。 结果：所有患者活动后均未出现迟发的皮下血肿、假性动脉瘤、动静脉瘘。其他不良事件有：1例患者卧床制动2 h后弹力绷带松开，发现穿刺侧皮下淤血，但皮软、无硬结，考虑穿刺时皮下血肿扩散，给予继续弹力绷带加压包扎2 h后下床活动血肿无增大，24 h内超声未见假性动脉瘤；1例患者卧床制动4 h去除绷带后穿刺点少量渗血，无血肿，继续给予加压包扎4 h后下床活动，无渗血及血肿形成；1例术后常规超声发现皮下小血肿，但无肉眼可见血肿。所有患者24 h内下肢静脉超声未发现深静脉血栓。 结论：经股动脉脑血管造影术后下肢制动4 h，术后6 h下床活动是安全可行的，但仍需大宗病例的对照研究加以验证。

Clinical observation of modified lower limb immobilized time after transfemoral cerebral angiography

Objective:To explore the feasibility and safety of modified lower limb immobilized time after transfemoral cerebral angiography. Methods:A total of 100 cases of cerebrovascular angiography with modified lower limb immobilized time in the cerebrovascular disease fifth ward of Henan People's Hospital from March 1, 2019 to May 20, 2019 were prospectively collected. The modified lower limb immobilized time was defined as removing the bandage after 4 hours of lower limb immobilized, and getting out of bed to ambulate after 2 hours exercise of the punctured side lower limb on the bed. The primary safety observation indicators included subcutaneous hematoma, pseudoaneurysm, and arteriovenous fistula after lower limb excercise. Secondary safety indicators included puncture point oozing and deep venous thrombosis of the punctured lower limb. Results:All patients had no delayed subcutaneous hematoma, pseudoaneurysm and arteriovenous fistula. There were three other adverse events. One patient had subcutaneous congestion on the puncture side when the elastic bandage automatically released for 2 hours in bed, but the skin was soft and not indurated. The reason for subcutaneous blood stasis may be the spread of subcutaneous hematomas during puncture. The hematoma did not increase after the pressure bandage continued for 2 hours when patients were getting out of bed, and no pseudoaneurysm occurred within 24 hours. One patient developed a small amount of oozing, but no hematoma at the puncture site when the bandage removed after 4 hours of bed rest. No oozing and hematoma formation when patients continued to give another pressure 4 hours. One patient had a small subcutaneous hematoma after the conventional ultrasound, but no visible hematoma was visible to the naked eye. No deep vein thrombosis was found in all patients by ultrasound within 24 hours. Conclusions:It is safe and feasible to ambulate after immobilized the lower limbs for 4 hours and get out of bed for 6 hours after transfemoral cerebral angiography, but it still needs to be confirmed by large number of controlled studies.