探討血管閉合裝置對股動脈經皮冠狀動脈介入術止血及預防血管合併症之成效－系統性文獻回顧

The Effects on Hemostasis and Vascular Complications Prevention of Using a Vascular Closure Device after Transfemoral Percutaneous Coronary Interventions: A Systematic Review

廖盈謹(Ying‐Chin Liao) ； 蘇淑芬(Shu‐Fen Su)

《護理暨健康照護研究》 11卷4期 (2015/12) Pp. 330-340

https://doi.org/10.6225/JNHR.11.4.330

摘要

背景：股動脈經皮冠狀動脈介入術可治冠心病，為緊急置入的首選，術後需臥床2-24小時避免出血，而血管閉合裝置被用來止血和縮短臥床，但相關文獻結論不一。目的：本系統性文獻回顧主要目的欲探討血管閉合裝置對股動脈經皮冠狀動脈介入術止血及預防血管合併症之成效。方法：搜尋近十年中、英文文獻，華藝線上圖書館、台灣碩博士論文、PubMed、MEDLINE、Cochrane Library和Science Direct資料庫，以PICO建立中、英文關鍵字，P：經皮冠狀動脈介入術患者（percutaneous coronary intervention patients），I：血管閉合裝置（vascular closure device），C：徒手加壓（manual compression），O：止血成效（hemostatic effectiveness）、血管合併症（vascular complications）。選取與主題相關之實驗、類實驗及世代研究，以CASP（Critical Appraisal Skills Programme）為文章品質評析工具。結果：從納入的11篇研究共120,742位病人的結果指出，與徒手加壓相比，股動脈經皮冠狀動脈介入術後使用血管閉合裝置可縮短止血時間及早點下床；不會增加出血、血腫、假性動脈瘤、動靜脈瘻管等血管合併症，但有輕微增加後腹膜出血的風險。結論：所有納入的研究均來自歐美國家，大多為非隨機控制試驗，研究設計及收案對象不同，結果難以推論。建議進行大型隨機長期的研究，以確立止血策略，改善照護品質。

關鍵字

血管閉合裝置 ； 徒手加壓 ； 股動脈經皮冠狀動脈介入術 ； 止血成效 ； 血管合併症

並列摘要

Background: Transfemoral percutaneous coronary intervention (PCI) is the most common puncture procedure used to treat coronary artery diseases. After receiving PCI, patients are prescribed 2-24 hours bedrest in order to avoid bleeding. A vascular closure device (VCD) is often used to stop bleeding and shorten the duration of bedrest time. However, the findings of prior studies regarding the efficacy of the VCD intervention have been inconsistent. Purpose: This systematic review aimed to explore the effect of using VCDs on hemostasis and on preventing vascular complications following transfemoral PCIs. Methods: Electronic databases including CEPS (Chinese Electronic Periodical Services), National Digital Library of Theses and Dissertations in Taiwan, PubMed, MEDLINE, Cochrane Library, and Science Direct were searched. The languages of publication were restricted to Chinese and English. Only studies published in the past decade were included. Keywords used referenced the PICO format, i.e., P: percutaneous coronary intervention, I: vascular closure device, C: manual compression, and O: hemostatic effectiveness and vascular complications. Experimental, quasi‐experimental, and cohort studies were included in this review. The Critical Appraisal Skills Programme (CASP) was used to appraise the quality of the studies that were reviewed. Results: Eleven studies with a total of 120,742 patients were included in this systematic review. Results showed that the use of VCD resulted in times to hemostasis and times to ambulation that were shorter than the equivalent times achieved using manual compression in post‐transfemoral PCI patients. Furthermore, VCD did not increase vascular complications such as bleeding, hematoma, pseudoaneurysm, and arteriovenous fistula. However, the use of this intervention slightly increased the risk of retroperitoneal bleeding. Conclusion: All of the studies that were reviewed in the present study originated in European and North American countries. Further, a majority were not randomized, controlled trials. Thus, the findings of this review are limited in terms of generalizability. It is suggested that larger studies that are randomized and longitudinal are necessary in order to identify the most effective strategy for optimizing hemostasis and for improving the quality of clinical care.

並列關鍵字

vascular closure devices ； manual compression ； transfemoral percutaneous coronary intervention ； hemostatic effectiveness ； vascular complications

參考文獻

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