崇云紅
橈動(dòng)脈介入穿刺部位止血器在冠狀動(dòng)脈造影術(shù)后護(hù)理應(yīng)用效果觀察
崇云紅
目的探討橈動(dòng)脈介入穿刺部位止血器在經(jīng)橈動(dòng)脈穿刺冠狀動(dòng)脈造影術(shù)后護(hù)理應(yīng)用效果觀察。方法選取接受冠狀動(dòng)脈造影術(shù)橈動(dòng)脈穿刺的冠心病患者128例,其中70例患者橈動(dòng)脈穿刺處采用橈動(dòng)脈介入穿刺部位止血器應(yīng)用方法為觀察組;另外58例患者采用紗布包扎彈力繃帶包扎方法為對(duì)照組。比較兩組患者術(shù)后1周內(nèi)橈動(dòng)脈穿刺處并發(fā)癥發(fā)生、患者舒適率、護(hù)理干預(yù)時(shí)間及效果和服務(wù)滿(mǎn)意度。結(jié)果觀察組患者并發(fā)癥發(fā)生率低于對(duì)照組;觀察組患者舒適率高于對(duì)照組;觀察組護(hù)理干預(yù)平均總時(shí)間低于對(duì)照組;觀察組護(hù)理滿(mǎn)意度高于對(duì)照組。兩組數(shù)據(jù)差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論橈動(dòng)脈介入穿刺部位止血器應(yīng)用于冠心病冠狀動(dòng)脈造影術(shù)患者,能顯著降低患者術(shù)后并發(fā)癥發(fā)生,減輕患者穿刺處疼痛麻木,增進(jìn)患者舒適,減輕護(hù)理人員工作量,提高了服務(wù)滿(mǎn)意度。
橈動(dòng)脈介入;穿刺部位;止血器;冠狀動(dòng)脈造影術(shù)
冠狀動(dòng)脈造影主要有兩種途徑,既經(jīng)右側(cè)腹股溝股動(dòng)脈和經(jīng)位于手掌上方的前臂動(dòng)脈(多選擇右側(cè)橈動(dòng)脈)穿刺[1]。早些年,國(guó)內(nèi)外基本上以股動(dòng)脈途徑為主。近幾年來(lái),國(guó)內(nèi)多數(shù)醫(yī)院逐漸常規(guī)采用橈動(dòng)脈途徑行冠狀動(dòng)脈造影甚至置入支架。經(jīng)橈動(dòng)脈與經(jīng)股動(dòng)脈途徑有共同和各自的并發(fā)癥。首先,兩種途徑都有可能發(fā)生出血、血腫等并發(fā)癥,但由于橈動(dòng)脈易于壓迫,這類(lèi)并發(fā)癥較少。其次,橈動(dòng)脈途徑除可發(fā)生血管狹窄甚至閉塞外,極個(gè)別化患者可發(fā)生骨筋膜室綜合征、手臂神經(jīng)損傷等嚴(yán)重并發(fā)癥,所以術(shù)后規(guī)范化的止血管理至關(guān)重要[2]。前幾年,我們對(duì)橈動(dòng)脈介入穿刺患者采用穿刺點(diǎn)無(wú)菌紗布卷外加無(wú)膠彈力繃帶加壓包扎法,近年來(lái)采用日本泰爾茂橈動(dòng)脈介入穿刺處部位止血器穿刺處加壓止血法,臨床效果滿(mǎn)意,現(xiàn)總結(jié)如下。
1.1 一般資料
選取2014年3月~2016年9月?lián)P州市中醫(yī)院心內(nèi)科行冠狀動(dòng)脈造影術(shù)的冠心病患者128例,選取其中70例作為觀察組,另58例作為對(duì)照組。兩組患者術(shù)前凝血酶原檢測(cè)結(jié)果正常,臨床資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。見(jiàn)表1。
1.2 方法
1.2.1 對(duì)照組 紗布繃帶壓迫止血法:選定橈動(dòng)脈穿刺處范圍5 cm用稀碘伏消毒,穿刺成功行造影結(jié)束后,將動(dòng)脈鞘管先行退出2 cm,然后以無(wú)菌紗布5 cm×5 cm雙邊三折,共12~16層,成方塊壓緊覆蓋于穿刺點(diǎn),之后覆蓋四層折成長(zhǎng)條狀紗布后,待動(dòng)脈鞘管全部退出后以膠帶固定,外加無(wú)膠彈力繃帶加壓包扎。術(shù)后加強(qiáng)巡視,每2 h解開(kāi)彈力繃帶觀察,共4次總計(jì)8 h,觀察肢體是否有出血、腫脹、張力性水泡等情況,注意詢(xún)問(wèn)患者穿刺肢體是否有疼痛和麻木[3]。
1.2.2 觀察組 橈動(dòng)脈介入穿刺部位止血器止血法:(1)選用TERUMO泰爾茂TB Band橈動(dòng)脈介入穿刺部位止血器,于冠狀動(dòng)脈造影術(shù)后,操作者將導(dǎo)管退出2~3 cm時(shí),將止血器球囊中心對(duì)準(zhǔn)橈動(dòng)脈穿刺點(diǎn),將綁帶環(huán)繞手腕固定,向球囊以專(zhuān)用注射器充氣14~18 ml后拔出動(dòng)脈鞘管,觀察患者表情并詢(xún)問(wèn)患者舒適度,穿刺點(diǎn)觀察數(shù)分鐘,至局部無(wú)出血及橈動(dòng)脈搏動(dòng)良好,局部皮溫顏色正常為宜[4]。(2)造影術(shù)后嚴(yán)密觀察患者生命體征,包括心率、血壓變化和穿刺部位有無(wú)出血、血腫,穿刺側(cè)肢體有無(wú)腫脹,肢體末端皮膚溫度和色澤,穿刺橈動(dòng)脈的搏動(dòng)情況[5]。(3)患者術(shù)后取平臥位,患者腕部伸直無(wú)遮擋,便于護(hù)士觀察,穿刺側(cè)上肢避免劇烈活動(dòng)及屈腕動(dòng)作。穿刺部位避免感染保持清潔和干燥。術(shù)側(cè)肢體禁止測(cè)血壓以及行靜脈輸液。注意觀察并記錄穿刺側(cè)肢體手指活動(dòng)、末端血運(yùn)、溫度和顏色以及運(yùn)動(dòng)感覺(jué)等情況。(4)護(hù)士在患者術(shù)后詳細(xì)記錄止血情況,記錄壓迫開(kāi)始時(shí)間、初次放氣及拆除時(shí)間,每間隔2 h放氣減壓一次,每次放氣量2~3 ml,共分4次完成,每次放氣保持勻速并觀察3~5 min,觀察局部有無(wú)出血,止血帶末次放氣后繼續(xù)觀察有無(wú)出血30 min,讓余量氣體維持相對(duì)水平壓力,于術(shù)后8 h拆除止血帶[6]。
1.3 效果評(píng)價(jià)
觀察記錄患者穿刺側(cè)肢體有無(wú)腫脹、疼痛;穿刺點(diǎn)有無(wú)出血、滲血、血腫;穿刺肢體末端有無(wú)紫紺、麻木;患者主訴舒適感;護(hù)理干預(yù)時(shí)間;護(hù)理服務(wù)滿(mǎn)意度。
1.4 統(tǒng)計(jì)學(xué)分析
本研究采用SPSS 18.0版軟件分析數(shù)據(jù),計(jì)量資料以(±s)表示,采用t檢驗(yàn);計(jì)數(shù)資料采用有序變量?jī)瑟?dú)立樣本比較的秩和檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
觀察組患者術(shù)后1周內(nèi)發(fā)生血腫1例,訴穿刺側(cè)肢體疼痛麻木6例,對(duì)照組發(fā)生穿刺部位血腫6例,發(fā)生張力性水泡5例,訴穿刺側(cè)肢體疼痛麻木不適12例,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P <0.05)。觀察組患者主訴舒適占總患者比例高于對(duì)照組;觀察組患者護(hù)理干預(yù)總平均時(shí)間低于對(duì)照組;觀察組患者對(duì)護(hù)理服務(wù)滿(mǎn)意度為97.14%(65/70),高于對(duì)照組89.66%(46/58),差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。見(jiàn)表2。
表1 兩組患者臨床資料[n(%)]
表2 兩組患者臨床療效比較[(±s),n(%)]
表2 兩組患者臨床療效比較[(±s),n(%)]
并發(fā)癥發(fā)生率[n(%)]血腫 張力性水泡 疼痛麻木感觀察組 70 1.4(1/70) 0 8.57(6/70) 91.43(64/70) 2.39±0.69 97.14(65/70)對(duì)照組 58 10.34(6/58) 8.62(5/58) 20.60(12/58) 68.97(40/58) 3.49±1.06 89.66(46/58)χ2/t - 15.54 10.506 -7.024 5.054 P - 0.01 0.001 0.001 0.025組別 例數(shù) 舒適率[n(%)]護(hù)理干預(yù)總時(shí)間(h) 滿(mǎn)意度[n(%)]
近年相關(guān)臨床研究結(jié)果顯示,冠狀動(dòng)脈造影術(shù)橈動(dòng)脈途徑的并發(fā)癥發(fā)生率遠(yuǎn)低于股動(dòng)脈途徑,且術(shù)后易于止血、舒適度高,被醫(yī)生和患者及家屬所接受度越來(lái)越高。隨著心內(nèi)科冠狀動(dòng)脈介入治療的廣泛開(kāi)展,穿刺部位的止血方法成為術(shù)后護(hù)理工作觀察的重點(diǎn)[7]。冠狀動(dòng)脈造影術(shù)后管理的規(guī)范化、流程化、標(biāo)準(zhǔn)化,可使術(shù)后并發(fā)癥更有效地減少和發(fā)生[8]。
本研究證明,日本TERUMO泰爾茂TR-Band橈動(dòng)脈介入穿刺部位止血器由特殊材料制成,通過(guò)透明的材質(zhì)可方便直接觀察穿刺點(diǎn)出血情況,一旦發(fā)現(xiàn)穿刺點(diǎn)出血,使用球囊進(jìn)行精準(zhǔn)定位壓迫止血,總氣體量小,壓迫范圍小,患者感覺(jué)舒適,避免既往傳統(tǒng)紗布加無(wú)膠彈力繃帶易引發(fā)張力性水泡及疼痛、麻木不適感及神經(jīng)損傷風(fēng)險(xiǎn)。護(hù)理干預(yù)平均總時(shí)間減少,減輕了護(hù)士勞動(dòng)強(qiáng)度,且提高了護(hù)理服務(wù)滿(mǎn)意度。
[1]何蓮瑛,江小燕,胡凡. 經(jīng)橈動(dòng)脈和股動(dòng)脈途徑行冠狀動(dòng)脈造影的對(duì)比分析[J]. 現(xiàn)代醫(yī)藥衛(wèi)生,2013,29(1):17-18.
[2]莫秀鳳,楊海玉. 經(jīng)橈動(dòng)脈與經(jīng)股動(dòng)脈途徑冠狀動(dòng)脈介入術(shù)的護(hù)理比較分析[J]. 醫(yī)學(xué)理論與實(shí)踐,2011,24(19):2303-2304.
[3]劉美麗,于文華,孔玉紅. 經(jīng)橈動(dòng)脈行冠狀動(dòng)脈介入治療冠心病的護(hù)理體會(huì)[J]. 中國(guó)冶金工業(yè)醫(yī)學(xué)雜志,2013,30(2):184-185.
[4]楊秀琴,朱曉萍,陸蕓嵐. 兩種橈動(dòng)脈壓迫器在冠狀動(dòng)脈造影術(shù)后止血中的應(yīng)用[J]. 中華現(xiàn)代護(hù)理雜志,2012,18(15):1771-1773.
[5]李軍,張軍. 冠狀動(dòng)脈內(nèi)支架術(shù)后穿刺口出血的觀察與護(hù)理[J].健康必讀,2012,11(3):17-18.
[6]費(fèi)紅,朱翠清,葛文賢,等. 快速減壓法對(duì)橈動(dòng)脈徑路行冠狀動(dòng)脈介入治療患者的影響[J]. 中國(guó)實(shí)用護(hù)理雜志,2016,32(28):2175-2178.
[7]王鵬飛,金衛(wèi)東,劉艷賓. 經(jīng)橈動(dòng)脈和股動(dòng)脈途徑行冠狀動(dòng)脈介入術(shù)的對(duì)比研究[J]. 中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志,2011,14(7):967-968.
[8]舒進(jìn)田,趙芳,李煜,等. 冠狀動(dòng)脈造影及PCI術(shù)中常見(jiàn)并發(fā)癥及防治措施分析[J]. 甘肅醫(yī)藥,2013,32(12):924-926.
Observation on the Nursing Effect of the Application of Radial Artery Puncture Site Hemostasis Device After Coronary Angiography
CHONG Yunhong Cardiology Department, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou Jiangsu 225002, China
ObjectiveTo explore the radial artery interventional puncture tourniquet in the radial artery puncture nursing application effect after coronary angiography.MethodsTo accept coronary angiography of the radial artery puncture, 128 cases of patients with coronary heart disease were selected, among them, 70 cases of patients with radial artery puncture place by radial artery interventional puncture tourniquet application methods for observation group. The other 58 patients with gauze elastic bandage method for the control group. To compare two groups of patients with postoperative week radial artery puncture rate of complications, patients with comfortable, nursing intervention in time and effect and service satisfaction.ResultsThe complication rate of observation group of patients was significantly lower than the control group. The comfortable rate in observation group of patients was significantly higher than the control group. Nursing intervention the average total time in observation group was obviously lower than the control group. The nursing satisfaction in observation group was signifcantly higher than the control group. The difference between the two groups was statistically significant (P<0.05).ConclusionRadial artery interventional puncture hemostat used in coronary heart disease (CHD) in patients with coronary artery angiography, can significantly reduce the postoperative complications patients, relieve excruciating pain and numbness to the patients, improve patient comfort, reduce workload of nursing staf, improve the service satisfaction.
Radial artery intervention, Puncture, Hemostat, Coronary angiography
R473
A
1674-9308(2016)36-0201-03
10.3969/j.issn.1674-9308.2016.36.113
揚(yáng)州市中醫(yī)院心內(nèi)科,江蘇 揚(yáng)州 225002