心脏导管检查术后使用血管闭合装置减少卧床时间。

Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices.

机构信息

Kristin A. Tuozzo is a senior nurse clinician at New York University (NYU) Langone Health, New York.

Reena Morris is a senior nurse clinician at NYU Langone Health.

出版信息

Am J Crit Care. 2023 Nov 1;32(6):421-428. doi: 10.4037/ajcc2023536.

DOI:10.4037/ajcc2023536

PMID:37907375

Abstract

BACKGROUND

Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay.

OBJECTIVE

To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital.

METHODS

A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly.

RESULTS

The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P < .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005).

CONCLUSION

Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.

摘要

背景

经股动脉左侧心导管术后使用血管闭合装置后卧床休息的时间尚未标准化。尽管有研究支持减少卧床休息，但许多医院仍要求长时间卧床休息。延迟活动与背痛、尿潴留、进食困难和住院时间延长有关。

目的

研究大型城市医院减少卧床休息时间对住院时间、安全性和机会成本节约的影响。

方法

对 12 周内 260 例经股动脉心导管术使用血管闭合装置的患者进行 1 小时卧床休息的单站点研究。将结果与接受类似治疗的历史对照进行比较。

结果

标准卧床休息组包括 295 例患者（207 例男性，88 例女性；平均[SD]年龄 64.4[8.6]岁）。早期活动组包括 260 例患者（188 例男性，72 例女性；平均[SD]年龄 64[9.3]岁）。两组患者的年龄（t634=1.18，P=.21）或性别（χ12=0.2，P=.64）无显著差异。标准卧床休息组 3 例和早期活动组 1 例出现血肿（P=.36）。标准卧床休息组诊断性心导管检查的住院时间较长（平均[SD]，220.7[55.2]分钟），早期活动组（平均[SD]，182.1[78.5]分钟；t196=4.06；P <.001）。标准卧床休息组经皮冠状动脉介入治疗的住院时间较长（平均[SD]，400.2[50.8]分钟），早期活动组（平均[SD]，381.6[54.7]分钟；t262=2.86；P=.005）。