1BSN, RN, Master Student, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2Cardiologist, Yazd Cardiovascular Research Center, and Assistant Professor, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 3BSN, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 4BS, Researcher, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 5MSc, Research Manager, Yazd Cardiovascular Research Center, and Doctoral Student, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
J Nurs Res. 2014 Mar;22(1):45-50. doi: 10.1097/jnr.0000000000000020.
Restoring patient homeostasis after coronary angiography, the gold standard diagnostic test for coronary heart disease is usually achieved by manual compression of the puncture site using a sandbag and prolonged bed rest. However, this process frequently results in patient complaints of back pain and discomfort.
The aim of study was to assess the effect of positioning on patient outcomes after coronary angiography.
This study used a single-blind randomized control trial approach. The sample consisted of 80 patients who had undergone a nonemergency coronary angiography via the femoral artery. Balanced block randomization was used to allocate participants into intervention and control groups. Routine care for the intervention group (n = 40) was adjusted to include the following: (1) intermittent changes to patient body and head position in bed during first 6 hours after catheterization, (2) reduction of sandbag compression time on the puncture site to 1 hour, and (3) regular examination for bleeding during the first 6 hours after catheterization. Intervention group participants were allowed to ambulate without restriction 6 hours after catheterization. Patients in the control group (n = 40) received routine care, consisting of (1) 6-24 hours of bed rest in the supine position with the affected leg fixed straight and immobilized and (2) sandbag compression on the puncture site for 6 hours. The main outcomes used in this study were level of back pain, discomfort, foot pain, bleeding, and hematoma.
Intervention group patients had significantly less back pain and foot pain and higher comfort than the control group at the second, third, and sixth hour after catheterization (p = .00). There was no significant difference between the two groups in terms of amount of bleeding and hematoma (p > .05).
Findings suggest that changes in patient position may be safer in the early period of postcatheterization bed rest than currently indicated in standard practice protocols. Furthermore, limiting sandbag compression to 1 hour has no measurable effect on the incidence and severity of vascular complications.
经皮冠状动脉造影术（诊断冠心病的金标准）后，患者的体内平衡通常通过使用沙袋手动按压穿刺部位和长时间卧床来恢复。然而，这一过程经常导致患者抱怨背部疼痛和不适。
本研究旨在评估经皮冠状动脉造影术后患者体位对其结果的影响。
本研究采用单盲随机对照试验方法。该样本由 80 名通过股动脉接受非紧急经皮冠状动脉造影术的患者组成。平衡块随机分组将参与者分配到干预组和对照组。干预组（n = 40）的常规护理调整包括：（1）在导管插入后 6 小时内，患者的身体和头部在床间断改变位置；（2）将穿刺部位沙袋压迫时间减少到 1 小时；（3）导管插入后 6 小时内定期检查出血情况。导管插入后 6 小时，干预组患者可不受限制地活动。对照组（n = 40）接受常规护理，包括：（1）患侧下肢伸直固定制动，在仰卧位休息 6-24 小时；（2）穿刺部位沙袋压迫 6 小时。本研究的主要结果是背部疼痛、不适、脚痛、出血和血肿程度。
与对照组相比，在导管插入后第二、第三和第六小时，干预组患者的背部疼痛和脚痛明显减轻，舒适度明显更高（p =.00）。两组患者的出血量和血肿量无显著差异（p >.05）。
研究结果表明，与目前标准实践方案中建议的相比，在经皮冠状动脉造影术后早期改变患者体位可能更安全。此外，将沙袋压迫时间限制在 1 小时内对血管并发症的发生率和严重程度没有可衡量的影响。
