经股动脉途径进行冠状动脉造影或经皮冠状动脉介入治疗后手动压迫与血管止血装置的比较：一项随机对照试验的荟萃分析
Comparison of manual compression and vascular hemostasis devices after coronary angiography or percutaneous coronary intervention through femoral artery access: A meta-analysis of randomized controlled trials.
作者信息
Dahal Khagendra, Rijal Jharendra, Shahukhal Ravi, Sharma Sharan, Watti Hussam, Azrin Michael, Katikaneni Pavan, Jimenez Enrique, Tandon Neeraj, Modi Kalgi, Lee Juyong
机构信息
Division of Cardiology, Department of Medicine, Louisiana State University Health Science Center, Shreveport, LA, United States.
Division of Cardiology, Department of Medicine, Miriam Hospital, Alpert School of Brown University, Providence, RI, United States.
出版信息
Cardiovasc Revasc Med. 2018 Mar;19(2):151-162. doi: 10.1016/j.carrev.2017.08.009. Epub 2017 Aug 19.
OBJECTIVES
To compare the efficacy and safety of manual compression (MC) with vascular hemostasis devices (VHD) in patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) through femoral artery access.
INTRODUCTION
The use of femoral artery access for coronary procedures may result in access-related complications, prolonged immobility and discomfort for the patients. MC results in longer time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to VHDs but its role in access-related complications remains unclear in patients undergoing coronary procedures.
METHODS
We searched MEDLINE, EMBASE, Cochrane CENTRAL and relevant references for English language randomized controlled trials (RCT) from inception through September 30, 2016. We performed the meta-analysis using random effects model. The outcomes were time-to-hemostasis, time-to-ambulation, major bleeding, large hematoma >5cm, pseudoaneurysm and other adverse events.
RESULTS
The electronic database search resulted in a total of 44 RCTs with a total of 18,802 patients for analysis. MC, compared to VHD resulted in longer TTH [mean difference (MD): 11.21min; 95% confidence interval (CI) 8.13-14.29; P<0.00001] and TTA [standardized mean difference: 1.2 (0.79-1.62); P<0.00001] along with excess risk of hematoma >5cm formation [risk ratio (RR): 1.38 (1.15-1.67); P=0.0008]. MC resulted in similar risk of major bleeding [1.01 (0.64-1.60); P=0.95] pseudoaneurysm [0.99 (0.75-1.29); P=0.92], infections [0.52 (0.25-1.10); P=0.09], need of surgery [0.60 (0.29-1.22); P=0.16), AV fistula [0.93 (0.68-1.27); P=0.63] and ipsilateral leg ischemia [0.95 (0.57-1.60); P=0.86] compared to VHD.
CONCLUSION
Manual compression increase time-to-hemostasis, time-to-ambulation and risk of hematoma formation compared vascular hemostasis devices.
目的
比较手动压迫（MC）与血管止血装置（VHD）在经股动脉途径行冠状动脉造影（CA）或经皮冠状动脉介入治疗（PCI）患者中的疗效和安全性。
引言
在冠状动脉手术中使用股动脉途径可能导致与穿刺部位相关的并发症、患者长时间制动及不适。与VHD相比，MC导致止血时间（TTH）和下床活动时间（TTA）更长，但在接受冠状动脉手术的患者中，其在与穿刺部位相关并发症方面的作用仍不明确。
方法
我们检索了MEDLINE、EMBASE、Cochrane CENTRAL及相关参考文献，纳入自数据库建立至2016年9月30日发表的英文随机对照试验（RCT）。我们采用随机效应模型进行荟萃分析。观察指标为止血时间、下床活动时间、大出血、直径>5cm的大血肿、假性动脉瘤及其他不良事件。
结果
电子数据库检索共得到44项RCT，总计18802例患者纳入分析。与VHD相比，MC导致更长的TTH[平均差（MD）：11.21分钟；95%置信区间（CI）8.13 - 14.29；P<0.00001]和TTA[标准化平均差：1.2（0.79 - 1.62）；P<0.00001]，同时直径>5cm血肿形成风险增加[风险比（RR）：1.38（1.15 - 1.67）；P = 0.0008]。MC导致的大出血风险[1.01（0.64 - 1.60）；P = 0.95]、假性动脉瘤风险[0.99（0.75 - 1.29）；P = 0.92]、感染风险[0.52（0.25 - 1.10）；P = 0.09]以及手术需求[0.60（0.29 - 1.22）；P = 0.16]、动静脉瘘风险[0.93（0.68 - 1.27）；P = 0.63]和同侧下肢缺血风险[0.95（0.57 - 1.60）；P = 0.86]与VHD相似。
结论
与血管止血装置相比，手动压迫增加了止血时间、下床活动时间及血肿形成风险。
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