摘要
目的 探讨不同血管缝合、闭合和封堵装置在神经介入术后股动脉穿刺止血中的疗效和并发症发生情况.方法 回顾性分析2018年2月至2022年1月郑州大学第一附属医院放射介入科(郑东院区)神经介入术后采用Starclose血管闭合器、Angio-Seal和Exoseal血管封堵器及Perclose ProGlide血管缝合器进行股动脉穿刺部位止血的1 123例患者的临床资料,按照装置止血方式不同将其分为闭合组(Starclose,n=271)、封堵组(Angio-Seal,n=327 和 Exoseal,n=352)和缝合组(ProGlide,n=173).分析比较3类不同止血装置止血效果和并发症发生情况,对可能影响并发症发生的相关因素进行logistic回归分析.结果 3类不同血管止血装置施行后均能够迅速止血,止血成功率分别为闭合组(Starclose,92.6％)、封堵组(Angio-Seal 93.0％和 Exoseal 93.8％,合计93.4％)和缝合组(ProGlide,89.6％),组间比较差异无统计学意义(x2=3.026,P=0.388).102例(9.1％)患者术后观察到单个或多个并发症发生,包括操作完成即刻局部渗血(闭合组16例、封堵组39例和缝合组13例)、术后局部血肿形成(闭合组14例、封堵组31例和缝合组11例)、假性动脉瘤形成(闭合组13例、封堵组35例和缝合组10例)和术后局部感染(闭合组2例、封堵组3例和缝合组1例),各组间比较差异均无统计学意义(P＞0.05).术后3组患者均未观察到股动脉闭塞、栓子脱落、永久性神经损伤等严重并发症发生.单因素和多因素logistic回归分析显示患者超重(OR=1.562,95％CI 1.023～2.385,P=0.039)、股动脉合并钙化斑块(OR=1.934,95％CI 1.172～3.189,P=0.010)、联合使用多种抗血小板药物(OR=1.769,95％CI 1.103～2.839,P=0.018)、使用 8 F鞘管(OR=2.824,95％CI1.406～5.671,P=0.004)和术者止血操作熟练度(OR=0.508,95％CI 0.328～0.788,P=0.002)是影响并发症发生的独立因素,其中前4项是并发症发生的危险促进因素,操作者经验丰富、止血器械操作熟练度高是并发症的保护因素.结论 3类不同止血装置在神经介入术后股动脉穿刺止血中均有较为满意的止血效果且并发症发生情况相当;患者超重、股动脉存在钙化斑块、联合使用多种抗血小板药物、使用8 F鞘管和操作者熟练度是并发症发生的独立影响因素.
Abstract
Ojective To investigate the efficacy and complications associated with vascular suture,closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention.Methods From February 2018 to January 2022,the clinical data of 1123 patients who underwent Starclose vascular closure device,Angio-Seal and Exoseal vascular occlusion devices and Perclose ProGlide vascular suture device at femoral artery puncture hemostasis after neuro-intervention,in the Department of Interventional Radiology(Eastern District),The First Affiliated Hospital of Zhengzhou University,were retrospectively analyzed.The patients were divided into three groups based on the intervention method:the closure group(Starclose,n=271),the occlusion group(Angio-Seal,n=327 and Exoseal,n=352)and the suture group(ProGlide,n=173).Next,the hemostatic efficacy and complications associated with the three devices were analyzed and compared.Additionally,regression analysis was conducted to identify any relevant factors that may contribute to complications.Results Three vascular hemostatic devices demonstrated effective hemostasis and the success rate were 92.6％in the closure group(Starclose),93.4％in the occlusion group(Angio-Seal 93.0％and Exoseal 93.8％)and 89.6％in the suture group(ProGlide).There was no statistically significant difference(x2=3.026,P=0.388).Single or multiple complications were observed in 102 patients(9.1％),including local oozing(16 cases in the closure group,39 cases in the occlusion group,13 cases in the suture group),local hematoma(14 cases in the closure group,31 cases in the occlusion group,11 cases in the suture group),pseudoaneurysm(13 cases in the closure group,35 cases in the occlusion group,10 cases in the suture group),local infection(2 cases in the closure group,3 cases in the occlusion group,1 case in the suture group).There were no statistically significant differences(P＞0.05).Moreover,serious complications such as femoral artery occlusion,embolus shedding and permanent nerve injury weren't observed in the three groups.Multivariate logistic regression analysis revealed that overweight(OR=1.562,95％CI 1.023-2.385,P=0.039),femoral artery with calcified plaque(OR=1.934,95％CI 1.172-3.189,P=0.010),combined use of multiple antiplatelet drugs(OR=1.769,95％CI 1.103-2.839,P=0.018),use of an 8F sheath(OR=2.824,95％CI 1.406-5.671,P=0.004)and the operator's proficiency(OR=0.508,95％CI 0.328-0.788,P=0.002)were the independent factors influencing complications,of which the first four were identified as risk-promoting factors for complications while the operator's rich experience and high proficiency were the protective factors.Conclusions Three hemostatic devices demonstrate effective hemostasis and comparable rates of complications at femoral artery puncture hemostasis after neuro-intervention.Overweight,femoral artery with calcified plaque,combined use of multiple antiplatelet drugs,use of an 8 F sheath and the operator's proficiency were independent factors influencing complications.
基金项目
国家自然科学基金(81801806)
河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029)
河南省医学科技攻关计划省部共建青年项目(KYDZ2020120441)
维普
万方数据