Boztosun Bilal, Günes Yilmaz, Yildiz Ahmet, Bulut Mustafa, Saglam Mustafa, Kargin Ramazan, Kirma Cevat
Kosuyolu Heart and Research Centre, Cardiology Department, Istanbul, Turkey.
Angiology. 2007;58(6):743-6. doi: 10.1177/0003319707308890. Epub 2007 Nov 7.
The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs. We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications. Coronary angiography was performed through the femoral route via 6-Fr catheters. Homeostasis was achieved by manual compression and maintained with a compressive bandage. A total of 1,446 patients were ambulated at the second hour and 1,226 of them were discharged without complication. A total of 220 patients required further follow-up due to blood oozing; 154 patients were conventionally ambulated due to difficult arterial access, longer (>15 minutes) compression time, hematoma formation within 2 hours, or hypertensive state (blood pressure >180/100 mm Hg). Twenty-five (16%) of those patients developed minor bleeding after ambulation. No major bleeding or large hematoma was observed during in-hospital observation. Ecchymosis (10% [2-hour group] vs 21% [4-5 hour group]) and small hematomas (22% vs 9%) were the most frequent complications after discharge. Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates.
动脉介入手术后一般推荐的策略是卧床休息4至6小时,这会给患者带来不适并增加医疗成本。我们假设在术后第2小时对部分患者进行活动不会增加血管并发症。通过6F导管经股动脉途径进行冠状动脉造影。通过手动压迫实现止血,并使用压迫绷带维持。共有1446例患者在术后第2小时进行了活动,其中1226例患者顺利出院,无并发症。共有220例患者因渗血需要进一步随访;154例患者因动脉穿刺困难、压迫时间较长(>15分钟)、2小时内形成血肿或处于高血压状态(血压>180/100 mmHg)而按常规进行活动。其中25例(16%)患者在活动后出现轻微出血。住院观察期间未观察到严重出血或大血肿。瘀斑(10%[2小时组]对21%[4 - 5小时组])和小血肿(22%对9%)是出院后最常见的并发症。对于经6F导管经股动脉进行诊断性心导管检查的部分患者,早期活动是安全的,且出血并发症发生率可接受。