摘要
目的探讨分析神经介入术后股动脉穿刺处出血的危险因素并比较不同止血方法的有效性。方法回顾性收集2017年11月至2019年5月期间在南京医科大学第四附属医院神经内科接受全脑血管造影和脑血管介入治疗的患者。根据术后拔鞘后股动脉穿刺处情况分为出血组和非出血组,比较两组患者基线资料、实验室检查以及术中资料。应用多变量logistic回归分析确定股动脉穿刺处出血的独立危险因素。分析不同直径血管鞘(5 F、6 F或8 F)在不同止血方案(人工按压、血管缝合器、血管封堵器)下的止血时间。结果共纳入神经介入术721例,其中介入治疗264例,全脑血管造影457例。46例(6.4%)患者术后出现穿刺处出血,其中渗血25例(3.5%),血肿18例(2.5%),假性动脉瘤3例(0.4%)。多变量logistic回归分析显示,术中收缩压[优势比(odds ratio,OR)1.025,95%可信区间(confidence interval,CI)1.004~1.047;P=0.021]、穿刺次数(OR 1.075,95%CI 1.053~1.097;P<0.001)、肝素剂量(OR 2.142,95%CI 1.638~3.471;P<0.001)、手术时间(OR 3.727,95%CI 2.025~6.860;P<0.001)以及人工按压(OR 3.449,95%CI 1.230~9.669;P=0.019)是术后穿刺处出血的独立危险因素。无论采用何种止血方案,止血时间均随着血管鞘直径的增大而延长,但只有采用人工按压时不同血管鞘直径组止血时间存在显著统计学差异(P<0.05)。此外,无论血管鞘直径如何,采用血管缝合器和血管封堵器时的止血时间均较人工按压显著缩短,组间比较具有统计学意义(P<0.05)。结论减少穿刺次数、缩短手术时间以及针对不同直径血管鞘采用不同的止血方法,可降低股动脉穿刺处的出血发生率。
Objective To investigate the risk factors for bleeding at femoral artery puncture site after neurointervention and to compare the effectiveness of different hemostatic methods.Methods Patients underwent whole brain angiography and cerebrovascular interventional therapy in the Department of Neurology,the Fourth Affiliated Hospital of Nanjing Medical University from November 2017 to May 2019 were collected retrospectively.According to the situation of femoral artery puncture site after sheath removal,the patients were divided into bleeding group and non-bleeding group.The baseline data,laboratory tests,and intraoperative data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for bleeding at femoral artery puncture site.The hemostasis time of different diameter vascular sheath(5 F,6 F or 8 F)under different hemostasis schemes(manual compression,vascular stapler,and vascular occluder)were analyzed.Results A total of 721 patients performed neurointervention were included,including 264 interventional therapy and 457 whole brain angiography.Forty-six patients(6.4%)had bleeding at the puncture site after procedure,including 25 patients(3.5%)with oozing of blood,18(2.5%)with hematoma,and 3(0.4%)with pseudoaneurysm.Multivariate logistic regression analysis showed that intraoperative systolic blood pressure(odds ratio[OR]1.025,95%confidence interval[CI]1.004-1.047;P=0.021),number of punctures(OR 1.075,95%CI 1.053-1.097;P<0.001),heparin dose(OR 2.142,95%CI 1.638-3.471;P<0.001),operation time(OR 3.727,95%CI 2.025-6.860;P<0.001)and manual compression(OR 3.449,95%CI 1.230-9.669;P=0.019)were the independent risk factors for bleeding at the puncture site after operation.No matter which hemostasis scheme was used,the hemostasis time would be prolonged with the increase of the diameter of the vascular sheath,but there was a significant statistical difference in hemostasis time of different vascular sheath diameter groups only when using manual compressi
作者
田鸿福
王慧
邱峰
Tian Hongfu;Wang Hui;Qiu Feng(Department of Neurology,the Fourth Affiliated Hospital of Nanjing Medical University(Nanjing Pukou Hospital),Nanjing 210031,China;Operation Room,BenQ Medical Center,Nanjing 210019,China;Cerebrovascular Disease Treatment Center,Nanjing Brain Hospital,the Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《国际脑血管病杂志》
2020年第4期255-259,共5页
International Journal of Cerebrovascular Diseases
基金
南京市医学科技发展资金(QRX17086)。
关键词
脑血管障碍
血管内手术
脑血管造影术
股动脉
穿刺术
血肿
止血技术
危险因素
Cerebrovascular disorders
Endovascular procedures
Cerebral Angiography
Femoral artery
Punctures
Hematoma
Hemostatic techniques
Risk factors
