冠狀動脈加護單位股動脈止血加壓創新流程成效之探討

Outcome Investigation of New Femeral Artery Compression Procedure in the Coronary Care Unit

張秀敏(Hsiu-Min Chang) ； 廖秋月(Cheu-Ye Liau) ； 古玉貞(Yuh-Chen Ku)

《榮總護理》 22卷3期 (2005/09) Pp. 229-238

https://doi.org/10.6142/VGHN.22.3.229

摘要

本研究主在探討某醫院冠狀動脈加護中心止血加壓創新流程施行於冠狀動脈擴張術後，股動脈鞘管拔除患者之成功止血率、腹股溝合併症發生率及合併症發生之預測因子。採相關描述性研究，以立意取樣收集民國93年6月至8月間，行冠狀動脈成形術後住進該加護中心之120個病患爲收案對象。依觀察記錄表收集資料，以t-test、Chi-square test、Fisher's exact test及Logistic regression進行統計分析。結果顯示成功止血率爲77.50%、合併症發生率爲22.50%，合併症患者中發生出血有10.83%、血腫佔8.33%；另發生出血合併血腫有3.34%。合併症的預測因子爲：手壓起始疼痛程度、平躺起始疼痛程度及拔管前後末梢肢體溫度變化。推論可能與醫師在手壓之初因個案主訴疼痛，而減輕手加壓力量及在股動脈止血加壓器移除後平躺初，個案因疼痛或躺久不舒服而挪動身體有關。研究建議在病患拔管前先考慮局部給予麻醉劑減少患者疼痛，並小心衡量加壓力量；而於股動脈止血加壓器移除後，應協助翻身並密切觀察有無合併症發生；另拔管前後末梢肢體溫度未回暖者，需密切觀察有無合併症發生。

關鍵字

股動脈止血加壓創新流程 ； 加壓止血效果 ； 成功止血率 ； 合併症

並列摘要

The purpose of this study was to search the hemostasis success rate, groin complication rate and complication predictors associated with a new femeral artery compression procedure after Percutaneous Coronary Angioplasty (PTCA) in a coronary care unit (C.C.U.). While descriptive correlational study design was used. The purposive sample consisted of 120 patients after PTCA admittance to C.C.U. of a medical center from June to August in 2004. Variables included patients' variables during and after PTCA procedural variables, and pain scale of patients during compression. Chi-squre test, t-test and logistic regression were used to analyze the data. The results indicated the hemostasis success rate was 77.5% and groin complication rate was 22.5%. The complication predictors were pain scale of patients at initial manual compression and lying flat, and variation of low limb perfusion before and after intrasheath removal. The suggestions are as follows: (1) Doctors can administer local anesthesia to the patient before intrasheath removal and carefully decrease manual compression pressure when patients complain of pain. (2)Nurses must help change position after femostop is removed especially when patients complain of discomfort. (3)Nurses must pay attention to these patients' low limb perfusion without variation, and observe the complications'.

並列關鍵字

new femeral artery compression procedure ； compression effect ； hemostasis success rate ； groin complication rate