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使用血管封堵装置(AngioSeal)止血后,冠状动脉造影或经皮冠状动脉介入术后立即活动(MOBS研究)

Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study).

作者信息

Larsen Ellen Nyholm, Hansen Charlotte Bak, Thayssen Per, Jensen Lisette Okkels

机构信息

Department of Cardiology, Odense University Hospital, Denmark

Department of Cardiology, Odense University Hospital, Denmark.

出版信息

Eur J Cardiovasc Nurs. 2014 Oct;13(5):466-72. doi: 10.1177/1474515113516702. Epub 2013 Dec 13.

Abstract

BACKGROUND

In patients undergoing coronary angiography or percutaneous coronary intervention (PCI), the standard post procedure regime includes immobilization and bed rest despite the use of vascular closure devices.

AIM

In the Mobilization after Coronary Angiography or Percutaneous Coronary Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI).

METHODS

Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma <5 × 5 cm(2), oozing from the puncture site or minor bleeding that could be compressed manually).

RESULTS

In the MOBS I cohort (100 patients were mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161 patients followed standard care), major bleeding complication rates did not differ significantly between the two groups: immediate mobilization group 26.6% vs. standard care group 28.0%, p=0.78. The majority of bleeding complications were due to oozing: immediate mobilization group 22.8% vs. standard care group 20.5%, p=0.62.

CONCLUSIONS

Immediate mobilization after a coronary angiogram or PCI with the femoral access site closed by the closure device AngioSeal was not associated with increased bleeding risk compared to standard care with bed rest.

摘要

背景

在接受冠状动脉造影或经皮冠状动脉介入治疗(PCI)的患者中,尽管使用了血管闭合装置,但术后的标准方案仍包括制动和卧床休息。

目的

在冠状动脉造影或经皮冠状动脉介入治疗后活动(MOBS)研究中,我们比较了在血管造影检查台后立即活动或标准护理(诊断性血管造影后1小时(MOBS I)或PCI后活动前卧床休息2小时(MOBS II))经股动脉途径进行心导管检查后的出血并发症。

方法

出血并发症分为严重(需要股动脉手术、输血或延长住院时间)和轻微(血肿<5×5 cm²、穿刺部位渗血或可手动压迫的轻微出血)。

结果

在MOBS I队列中(100例患者立即活动,100例患者接受标准护理),未观察到严重出血并发症。立即活动组有2.0%发生轻微出血,而标准护理组为4.0%(p = 0.41)。在PCI后的MOBS II队列中(158例患者立即活动,161例患者接受标准护理),两组的严重出血并发症发生率无显著差异:立即活动组为26.6%,标准护理组为28.0%,p = 0.78。大多数出血并发症是由于渗血:立即活动组为22.8%,标准护理组为20.5%,p = 0.62。

结论

与标准卧床休息护理相比,使用血管闭合装置AngioSeal封闭股动脉穿刺部位后,冠状动脉造影或PCI后立即活动不会增加出血风险。

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