经桡动脉行冠状动脉介入治疗患者术肢管理改进策略的研究

doi:10.3761/j.issn.0254-1769.2024.13.005

摘要/Abstract

摘要：

目的改进经桡动脉行冠状动脉介入治疗患者术肢管理策略并探讨其应用效果，为术肢并发症的预防提供依据。方法选择2023年3月—2024年2月温州市某三级甲等医院心血管内科经桡动脉行冠状动脉介入治疗的患者，采用随机数字表法，分为试验组241例和对照组236例，术后均采用旋压式止血器压迫止血，试验组在术后返回病房时实施术肢管理改进策略，具体为开展逆向Barbeau试验，实现非闭塞性压迫，之后每小时减压；对照组实施常规术肢管理，压迫强度以触及远端桡动脉搏动为指导，术后1 h首次减压，之后每2 h减压1次。比较两组术肢并发症发生率、中文简化版Kolcaba舒适状况量表评分、压迫时长、减压次数的差异。结果试验组术肢并发症发生率为14.11%，对照组为44.49%，两组比较，差异具有统计学意义（χ²=53.308，P<0.001）；试验组中文简化版Kolcaba舒适状况量表评分为（77.71±5.43）分，对照组为（74.66±5.83）分，两组比较，差异具有统计学意义（t=-3.354，P=0.001）；试验组压迫时长（172±52） min、减压次数2（2，3）次，均低于对照组的（289±60） min、4（3，4）次，差异均具有统计学意义（P<0.001）。结论实施基于逆向Barbeau试验的桡动脉非闭塞性压迫法可降低经桡动脉行冠状动脉介入治疗患者的术肢并发症，缩短止血器压迫时长，减少减压次数，提高患者舒适度，为护士评估止血器压迫强度和减压时机提供客观依据。

关键词: 经皮冠状动脉介入治疗, 桡动脉途径, Barbeau试验, 并发症, 舒适状况, 改善护理服务

Abstract:

Objective Improving the limb management strategy for patients undergoing coronary intervention through radial artery puncture and observe the application effect，and to provide scientific basis for the prevention of limb complications. Methods From March 2023 to February 2024，patients who underwent coronary intervention in the Cardiovascular Department of a Tertiary A hospital in Wenzhou City were selected. They were randomly divided into an experimental group of 241 cases and a control group of 236 cases using a random number table method. After surgery，they were all treated with a rotary hemostatic device for compression hemostasis. The experimental group implement improvement strategies for surgical limb management, specifically underwent a reverse Barbeau test upon returning to the ward after surgery to achieve non-occlusive compression，followed by decompression every hour. The compression intensity of the control group was guided by palpating the distal radial artery pulsation，and the first decompression was performed 1 hour after surgery，followed by decompression at intervals of every 2 hours. The main evaluation indicators are the incidence of surgical limb complications and simplified Chinese version of General Comfort Questionnaire（GCQ） scores in 2 groups of patients，while the secondary evaluation indicators are the duration of compression and the number of decompression times in both groups. Results The incidence of postoperative complications in the experimental group was 14.11%，which was statistically significant compared to 44.49% in the control group（χ²=53.308，P<0.001）. The GCQ score of the experimental group was（77.71±5.43） points，which was higher than （74.66±5.83） points in the control group，and the difference was statistically significant （t=-3.354，P=0.001）. The compression duration of （172±52） minutes and decompression frequency of 2（2，3） in the experimental group were lower than（289±60） minutes and 4（3，4） in the control group，and the differences were statistically significant（P<0.001）. Conclusion The non-occlusive compression method of the radial artery based on the reverse Barbeau test can significantly reduce limb complications in patients undergoing coronary intervention，shorten the duration of hemostatic compression，reduce the number of depressions，and improve patient comfort. It provides objective basis for nursing staff to evaluate the intensity of hemostatic compression and the timing of decompression.

Key words: Percutaneous Coronary Intervention, Radial Approach, Barbeau Test, Complications, Comfort, Improving Nursing Services

冯小芳, 滕艳文, 朱雪梦, 李文玉, 李明明, 赖叔意, 陈冬雪, 陈晓燕, 孙彩霞. 经桡动脉行冠状动脉介入治疗患者术肢管理改进策略的研究[J]. 中华护理杂志, 2024, 59(13): 1568-1574.

FENG Xiaofang, TENG Yanwen, ZHU Xuemeng, LI Wenyu, LI Mingming, LAI Shuyi, CHEN Dongxue, CHEN Xiaoyan, SUN Caixia. A study of strategies to improve the management of the operative limb in patients undergoing coronary intervention through radial artery puncture[J]. Chinese Journal of Nursing, 2024, 59(13): 1568-1574.

图/表 4

表1 两组一般资料的比较

Table 1 General information of patients in 2 groups

表2 两组术肢并发症的比较[例（百分率，%）]

Table 2 Comparison of surgical limb complications of patients in 2 groups[cases（percentage，%）]

表3 两组糖尿病与非糖尿病患者术肢并发症的比较[例（百分率，%）]

Table 3 Comparison of the complications of limb surgery of patients in 2 groups with diabetes and without diabetes[cases（percentage，%）]

表4 两组中文简化版Kolcaba舒适状况量表评分比较（分，$\bar{x} \pm s$）

Table 4 Comparison of GCQ of patients in 2 groups（scores，$\bar{x} \pm s$）

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