McCabe P J, McPherson L A, Lohse C M, Weaver A L
Department of Nursing, Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minn., USA.
Am J Crit Care. 2001 Sep;10(5):330-40.
Restricting inpatients who have undergone a cardiac catheterization to 6 hours of flat bed rest to reduce the potential for bleeding from the femoral arteriotomy site is based on tradition rather than on research and is associated with discomfort for the patients.
To (1) determine the prevalence of femoral arteriotomy complications after diagnostic coronary angiography among inpatients after implementation of a guideline that included reduced duration of bed rest, elimination of sandbags at the arteriotomy site, and 30 degrees elevation of the head of the bed; (2) compare complication rates in this study with rates in previous studies; and (3) determine patient- or practice-related characteristics associated with complications.
Records of 306 inpatients were reviewed retrospectively to determine the prevalence of femoral arteriotomy complications and the presence of patient- or practice-related characteristics potentially associated with complications. Associations between each characteristic and the presence of a complication were evaluated by using the Wilcoxon rank sum test for continuous data and the chi 2 or Fisher exact test for nominal data.
Prevalences of complications were hematoma, 8.8%; bleeding, 4.5%; pseudoaneurysm, 1%; arteriovenous fistula, 0%; and thrombosis, 0%. No evidence indicated that the occurrence of a complication was related to any patient- or practice-related characteristic. Complication rates were comparable to those of previous studies.
The findings support continuation of the current guideline for patients' care after diagnostic coronary angiography. However, further prospective studies with larger samples of inpatients are warranted.
将接受心脏导管插入术的住院患者卧床休息时间限制为6小时以降低股动脉切开部位出血可能性，这是基于传统而非研究，且会给患者带来不适。
（1）在实施一项包括缩短卧床休息时间、取消动脉切开部位沙袋以及将床头抬高30度的指南后，确定住院患者诊断性冠状动脉造影术后股动脉切开并发症的发生率；（2）将本研究中的并发症发生率与既往研究中的发生率进行比较；（3）确定与并发症相关的患者或医疗实践相关特征。
回顾性审查306例住院患者的记录，以确定股动脉切开并发症的发生率以及可能与并发症相关的患者或医疗实践相关特征的存在情况。对于连续数据，使用Wilcoxon秩和检验评估每个特征与并发症存在之间的关联；对于名义数据，使用卡方检验或Fisher精确检验进行评估。
并发症发生率分别为：血肿8.8%；出血4.5%；假性动脉瘤1%；动静脉瘘0%；血栓形成0%。没有证据表明并发症的发生与任何患者或医疗实践相关特征有关。并发症发生率与既往研究相当。
这些发现支持继续采用目前诊断性冠状动脉造影术后患者护理指南。然而，有必要进行更大样本住院患者的进一步前瞻性研究。
