Waksman R, Scott N A, Ghazzal Z M, Mays R, Frerichs F A, Petersen J Y, King S B
Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA 30022, USA.
Am Heart J. 1996 Jun;131(6):1076-8. doi: 10.1016/s0002-8703(96)90079-4.
Patients who undergo percutaneous transluminal coronary angioplasty (PTCA) by the femoral approach are usually required to lie flat in bed for 6 to 24 hours, which may result in significant discomfort. This study was performed to evaluate the safety and benefit of a flexible sheath that enables patients to sit at a 60-degree angle while the sheath is in place in the femoral artery. Sixty patients were randomly assigned to receive either flexible or nonflexible sheaths before PTCA. Patients with flexible sheaths were allowed to sit at an angle of 60 degrees after the procedure. Heparin management was the same in both groups. Frequency of calls to nurses for back pain was recorded for both groups. For analgesia, nalbuphine was administered in 2-mg increments. All sheaths were removed the day after the procedure. Femoral ultrasound was used to detect groin complications (hematoma, pseudoaneurysm, or arteriovenous fistula) and was performed in all patients. Baseline characteristics were similar in both groups. There were no differences in ease of sheath insertion or guide catheter movement through the sheaths. The arterial pressure waveform was not dampened in any of the flexible sheath patients while in the sitting position. Patients with flexible sheaths had fewer calls for back pain and required less nalbuphine than patients with nonflexible sheaths. Groin complications were similar in both groups. In conclusion, by allowing patients to sit up to an angle of 60 degrees, flexible sheaths have a beneficial effect in reducing back pain and the need for analgesics after PTCA.
采用股动脉途径进行经皮腔内冠状动脉成形术（PTCA）的患者通常需要卧床平躺6至24小时，这可能会导致明显不适。本研究旨在评估一种柔性鞘管的安全性和益处，该鞘管可使患者在鞘管置于股动脉时以60度角坐姿。60例患者在PTCA前被随机分配接受柔性或非柔性鞘管。接受柔性鞘管的患者在术后被允许以60度角坐姿。两组的肝素管理相同。记录两组患者因背痛呼叫护士的频率。镇痛时，纳布啡以2毫克递增剂量给药。术后第二天取出所有鞘管。所有患者均接受股动脉超声检查以检测腹股沟并发症（血肿、假性动脉瘤或动静脉瘘）。两组的基线特征相似。鞘管插入的难易程度或引导导管通过鞘管的移动情况在两组之间没有差异。任何柔性鞘管患者在坐姿时动脉压波形均未衰减。与接受非柔性鞘管的患者相比，接受柔性鞘管的患者因背痛呼叫护士的次数更少，所需纳布啡也更少。两组的腹股沟并发症相似。总之，通过允许患者坐至60度角，柔性鞘管在减轻PTCA术后背痛和镇痛需求方面具有有益作用。
