桡动脉压迫期间血压波动对经皮冠状动脉介入治疗后患者术侧手掌肿胀的影响

doi:10.3761/j.issn.0254-1769.2022.01.008

摘要/Abstract

摘要：

目的探讨经皮冠状动脉介入治疗 (percutaneous coronary intervention,PCI) 患者在桡动脉压迫期间血压变化与术侧手掌肿胀的关系。方法选取2018年5月—2020年12月入住南昌市某三级甲等综合医院冠心病病区行桡动脉PCI的患者作为研究对象,对其一般资料和压迫器解压相关指标进行回顾性分析,描述患者在桡动脉压迫期间的血压波动情况,采用单因素回归分析术侧手掌肿胀的影响因素,对患者桡动脉压迫期间血压进行节点分组,分层分析不同血压对术侧手掌肿胀的影响,进一步采用趋势回归分析术侧手掌肿胀发生最高风险时对应的血压范围。结果共纳入788例桡动脉PCI患者。对危险因素进行多变量分层分析发现,在有糖尿病史患者中,桡动脉压迫期间收缩压≥130 mmHg (1 mmHg=0.133 kPa) 会增加术侧手掌肿胀发生风险 (OR=1.09,P<0.001),在无论有或无心力衰竭体征和高血压史的患者中,桡动脉压迫期间收缩压>130 mmHg,两组患者术侧手掌肿胀发生风险较一致。趋势回归发现,桡动脉压迫期间平均收缩压为130~149 mmHg时,收缩压每升高10 mmHg,术侧手掌肿胀发生风险增加3.52倍[95%CI (1.37,13.22) ]。结论桡动脉压迫期间,患者平均收缩压为130~149 mmHg,发生术侧手掌肿胀的风险最高,建议临床护理人员在制订术侧手掌肿胀并发症预防方案时,应综合考虑患者收缩压变化的因素。

关键词: 经皮冠状动脉介入治疗, 桡动脉, 血压, 肿胀, 影响因素分析, 护理

Abstract:

Objective To investigate the relationship between the changes of blood pressure and palmar swelling during radial artery compression in patients with radial artery percutaneous coronary intervention (PCI). Methods The patients who underwent radial artery PCI in the coronary heart disease unit of a tertiary general hospital in Nanchang from May 2018 to December 2020 were selected as the study subjects. The general data and the related indexes of decompression were analyzed retrospectively,and the blood pressure fluctuation during radial artery compression was described. Univariate regression analysis was used to analyze the influencing factors of palmar swelling on the operative side,and the blood pressure during radial artery compression was divided into nodes. The effects of different blood pressure on operative side palm swelling were analyzed by stratification,and the corresponding range of blood pressure at the highest risk of operation side palm swelling was further analyzed by trend regression. Results A total of 788 patients with radial artery PCI were included. Based on the analysis of patients’ baseline data,it was found that history of diabetes,history of hypertension,signs of heart failure and high average systolic blood pressure during radial artery compression were the risk factors of operative palmar swelling. However,multivariate stratified analysis of risk factors showed that systolic blood pressure ≥130 mmHg during radial artery compression increased the risk of ipsilateral palm swelling in patients with diabetic history (OR=1.09,P<0.001). In patients with or without heart failure signs and hypertension history,when the systolic blood pressure during radial artery compression was more than 130 mmHg,the 2 groups increased the risk of palmar swelling on the operative side. Furthermore,trend regression analysis showed that the average systolic blood pressure during radial artery compression was between 130 and 149 mmHg. Every 10 mmHg increase in systolic blood pressure had increased the risk of palmar swelling by 3.52 times[95%CI (1.37,13.22) ]. Conclusion During the period of radial artery compression,the average systolic blood pressure of patients is 130-149 mmHg,and the risk of palmar swelling on the operative side is the highest. It is suggested that clinical nurses should comprehensively consider the changes of systolic blood pressure when formulating the prevention plan for complications of palmar swelling on the operative side.

Key words: Percutaneous Coronary Intervention, Radial Artery, Blood Pressure, Palm Swelling, Analysis of Influencing Factors, Nursing Care

肖丹, 郭婷, 涂惠, 李欣, 刘佳文, 陈华, 魏雯婷, 易凤仪, 熊晓云. 桡动脉压迫期间血压波动对经皮冠状动脉介入治疗后患者术侧手掌肿胀的影响[J]. 中华护理杂志, 2022, 57(1): 56-60.

XIAO Dan, GUO Ting, TU Hui, LI Xin, LIU Jiawen, CHEN Hua, WEI Wenting, YI Fengyi, XIONG Xiaoyun. Influence of blood pressure fluctuation on operative side palm swelling in patients with radial artery compression after percutaneous coronary intervention[J]. Chinese Journal of Nursing, 2022, 57(1): 56-60.

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参考文献 18

[1]	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization[J]. Eur Heart J, 2019, 40(2):87-165. DOI URL
[2]	Aminian A, Saito S, Takahashi A, et al. Impact of sheath size and hemostasis time on radial artery patency after transradial coronary angiography and intervention in Japanese and non-Japanese patients:a substudy from RAP and BEAT (Radial Artery Patency and Bleeding,Efficacy,Adverse evenT) randomized multicenter trial[J]. Catheter Cardiovasc Interv, 2018, 92(5):844-851. DOI URL
[3]	胡凌云, 田杰, 胡建川, 等. 老年患者经桡动脉径路与股动脉径路行选择性冠状动脉和脑动脉联合造影的对比研究[J]. 中华老年心脑血管病杂志, 2021, 23(2):200-202.
	Hu LY, Tian J, Hu JC, et al. A comparative study of selective combined coronary angiography and cerebral artery angiography via radial artery approach and femoral artery approach in elderly patients[J]. Chin J Geriatr Heart Brain Vessel Dis, 2021, 23(2):200-202.
[4]	郭金鹏, 邓颖, 吴立萍. 改良手指操在经桡动脉行冠状动脉介入治疗术后患者中的应用[J]. 中华护理杂志, 2017, 52(12):1456-1458.
	Guo JP, Deng Y, Wu LP. Effects of modified finger exercise on limb pain and numbness after transradial percutaneous coronary intervention[J]. Chin J Nurs, 2017, 52(12):1456-1458.
[5]	梁菲, 何妍臻. 六步手指操改善经桡动脉介入术后患者肢体症状的效果评价[J]. 护理学杂志, 2018, 33(23):33-35.
	Liang F, He YZ. Evaluation of the effect of six-step finger exercises on improving limb symptoms of patients after transradial artery intervention[J]. J Nurs Sci, 2018, 33(23):33-35.
[6]	瞿奥林, 任艳琴, 郭任维, 等. 经桡动脉入径冠状动脉介入治疗术后桡动脉闭塞的研究[J]. 中国介入心脏病学杂志, 2020, 28(6):347-350.
	Qu AL, Ren YQ, Guo RW, et al. Study on radial artery occlusion after percutaneous coronary intervention[J]. Chin J Interv Cardiol, 2020, 28(6):347-350.
[7]	张淑, 王建宁, 周松, 等. 螺旋式与气囊式桡动脉压迫止血器应用效果的系统评价[J]. 护理研究, 2019, 33(13):2252-2258.
	Zhang S, Wang JN, Zhou S, et al. Systematic evaluation on application effect of spiral and balloon radial artery compression hemostat[J]. Nurs Res, 2019, 33(13):2252-2258.
[8]	游华, 任新生. 不同止血方式在经桡动脉冠状动脉介入术后应用效果对比[J]. 中国卫生标准管理, 2020, 11(23):51-53.
	You H, Ren XS. Comparison of the application effect of different hemostatic methods after transradial coronary intervention[J]. China Heal Stand Manag, 2020, 11(23):51-53.
[9]	郭晶, 张丽萍, 邱果, 等. 缩短压迫器止血时间对桡动脉介入术患者止血效果及舒适度的影响[J]. 中西医结合心血管病电子杂志, 2016, 4(4):12-13.
	Guo J, Zhang LP, Qiu G, et al. Effect of shortening hemostatic time of compression device on hemostatic effect and comfort of patients undergoing radial artery intervention[J]. Cardiovasc Dis J Integr Tradit Chin West Med, 2016, 4(4):12-13.
[10]	中国高血压防治指南2018年修订版[J]. 心脑血管病防治, 2019, 19(1):1-44.
	Chinese guidelines for prevention and treatment of hypertension revised in 2018[J]. Prev Treat Cardiac Cereb Vasc Dis, 2019, 19(1):1-44.
[11]	乔积民, 佘莉萍, 常芸. 不同压力对减轻老年冠心病介入治疗患者前臂血肿的效果[J]. 中华护理杂志, 2020, 55(1):74-78.
	Qiao JM, She LP, Chang Y. Effects of different cuff pressures on compression of forearm hematoma in geriatric patients with coronary heart disease[J]. Chin J Nurs, 2020, 55(1):74-78.
[12]	祝玲娟, 李颐, 钟雯, 等. 依据有创压力指导桡动脉压迫强度对冠状动脉介入诊疗术患者的影响研究[J]. 护理实践与研究, 2018, 15(15):134-135.
	Zhu LJ, Li Y, Zhong W, et al. Study on the effect of radial artery compression intensity guided by invasive pressure on patients undergoing percutaneous coronary intervention[J]. Nurs Pract Res, 2018, 15(15):134-135.
[13]	李金娥. 经桡动脉行冠状动脉介入治疗术后桡动脉气囊压迫器不同压迫时间止血效果比较[J]. 中国全科医学, 2019, 22(S1):111-113.
	Li JE. Hemostatic effects of different compression time of radial artery balloon compressor after transradial intervention[J]. Chin Gen Pract, 2019, 22(S1):111-113.
[14]	黄雪嘉, 刘华玲, 赵惠芬, 等. 经桡动脉冠脉介入术后患者肢体肿胀的护理干预[J]. 中外医学研究, 2019, 17(14):102-104.
	Huang XJ, Liu HL, Zhao HF, et al. Nursing intervention of limb swelling in patients after transradial percutaneous coronary intervention[J]. Chin Foreign Med Res, 2019, 17(14):102-104.
[15]	华珊珊, 李闺臣, 彩虹, 等. 运动疗法对糖尿病周围神经病变影响的研究进展[J]. 中华护理杂志, 2017, 52(10):1252-1256.
	Hua SS, Li GC, Cai H, et al. The effects of exercise on diabetic peripheral neuropathy:a literature review[J]. Chin J Nurs, 2017, 52(10):1252-1256.
[16]	许艳玲, 史冬梅, 顾婕, 等. 经桡动脉冠状动脉介入术后优化气囊压迫器首次减压时间的有效性与安全性分析[J]. 护理研究, 2018, 32(24):3943-3945.
	Xu YL, Shi DM, Gu J, et al. Analysis of effectiveness and safety of optimizing first decompression time of air bag compressor after percutaneous coronary intervention[J]. Nurs Res, 2018, 32(24):3943-3945.
[17]	陈韦, 史冬梅, 许艳玲, 等. 血压计袖带充气压迫经桡动脉冠状动脉介入术后前臂血肿的效果观察[J]. 护理学报, 2016, 23(17):69-71.
	Chen W, Shi DM, Xu YL, et al. Observation on the effect of pneumatic compression of sphygmomanometer cuff on forearm hematoma after transradial coronary intervention[J]. J Nurs China, 2016, 23(17):69-71.
[18]	于小香, 徐明星, 韩冬凤, 等. 局部加压对老年经皮冠状动脉介入治疗术后桡动脉穿刺处血肿护理的效果[J]. 实用老年医学, 2018, 32(12):1194-1196.
	Yu XX, Xu MX, Han DF, et al. Effect of local pressure on nursing of hematoma at radial artery puncture site in elderly patients after percutaneous coronary intervention[J]. Pract J Geriatr, 2018, 32(12):1194-1196.