孙莲莲　 单培仁 胡伟珍　张敏月

[摘要] 目的 觀察夹心式包扎法联合动脉止血器在经皮行冠状动脉介入术后的应用效果。 方法 采取便利抽样法，选取2019年5—12月我院收治的确诊为冠心病且拟行经皮行冠状动脉造影术的患者210例，随机分为对照组和实验组，每组各105例。对照组在旋压式止血器压迫垫下方置入纱布（中心点包扎法），实验组采取在旋压式止血器压迫垫及锁扣的下方置入纱布（夹心形包扎法），减压时间统一为术后1 h开始减压，之后为每0.5小时放松止血器，4～6 h完全放松止血器。观察两组术后并发症（渗血、Ⅰ期压疮、Ⅱ期压疮、肿胀、疼痛≥4分）发生情况、术后舒适度及对护理工作满意度。并分析患者并发症与舒适度、舒适度与对护理工作满意之间的关系。 结果 两组术后渗血、Ⅱ期压疮发生率比较，差异无统计学意义（P>0.05），其他术后并发症（Ⅰ期压疮、肿胀、疼痛≥4分）发生率比较，差异有统计学意义（P<0.05）。实验组舒适率显著高于对照组，差异有统计学意义（P<0.05）。将患者根据舒适程度进行分析，不舒适组患者并发症（Ⅰ期压疮、肿胀、疼痛≥4分）发生率显著高于舒适组，差异有统计学意义（P<0.05）。经Spearman相关性分析，患者术后舒适度[（2.3±0.9）分]与对护理工作满意度[（3.0±0.8）分]呈正相关（r=0.639，P<0.001）。 结论 夹心包扎法将纱布垫入锁扣可作为一个缓冲力量，可减轻锁扣对皮肤的直接压迫损伤，有效降低与止血器相关的术后并发症，可提升患者舒适度及对护理工作的满意度。

[关键词] 包扎;桡动脉;止血器;经皮行冠状动脉介入术

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2021）06-0163-04

The application efficacy of sandwich bandaging method combined with radial artery hemostat after percutaneous coronary intervention

SUN Lianlian   SHAN Peiren   HU Weizhen   ZHANG Minyue

Department of Cardiovascular Internal Medicine， the First Affiliated Hospital of Wenzhou Medical University， Wenzhou  325000， China

[Abstract] Objective To observe the application efficacy of sandwich bandaging method combined with radial artery hemostat after percutaneous coronary intervention. Methods By convenience sampling method， a total of 210 patients diagnosed with coronary heart disease and scheduled for percutaneous coronary angiography in our hospital from May to December 2019 were selected and randomly divided into control group and experimental group， 105 cases in each group. In the control group， gauze was placed under the compression pad of the spinning hemostat（central point bandaging method）， while in the experimental group， gauze was placed under the compression pad and lock of spinning hemostat（sandwich bandaging method）. The decompression time was unified after operation， and the hemostat was relaxed every 0.5 hours， then completely after 4-6 hours. The incidence of postoperative complications （bleeding， stage Ⅰ pressure ulcer， stage Ⅱ pressure ulcer， swelling， pain ≥4 points）， postoperative comfort and satisfaction with nursing work were observed. And the relationship between complications and comfort， comfort and nursing satisfaction were analyzed. Results There was no significant difference in the incidence of postoperative bleeding and stage Ⅱ pressure ulcer between the two groups（P>0.05）， but there was significant difference in the incidence of other postoperative complications（stage Ⅰ pressure ulcer， swelling， pain ≥4 points）（P<0.05）. The comfort rate of the experimental group was significantly higher than that of the control group（P<0.05）. The incidence of complications（stage Ⅰ pressure ulcer， swelling， pain ≥4 points） in the uncomfortable group was significantly higher than that in the comfortable group（P<0.05）. Spearman correlation analysis showed that postoperative comfort（[2.3±0.9] points） was positively correlated with nursing satisfaction（[3.0±0.8] points）（r=0.639， P<0.001）. Conclusion Sandwich bandaging method can be used as a buffering force by putting gauze into the lock buckle， which can reduce the direct compression damage of the lock buckle to the skin， effectively reduce the postoperative complications related to hemostat， improve the patient′s comfort and the satisfaction with nursing work.

[Key words] Bandaging; Radial artery; Hemostat; Percutaneous coronary intervention

經皮行冠状动脉介入术是诊断冠心病的金标准，是急性冠状动脉综合征（Acute coronary syndrome，ACS）尤其是急性非ST段抬高性心肌梗死（Non-STsegment elevated myocardial infarction，NSTEMI）、不稳定型心绞痛（Unstableangina，UA）首选治疗方法[1]。而经桡动脉穿刺是该项手术最常用的血管入路方式[2]，具有创伤小、患者可接受度高、局部包扎简便等优势[3]，但在临床治疗中仍会出现紫绀、肿胀、疼痛、出血、麻木等并发症，给患者带来担忧与痛苦[4]。冯伟等[5]的旋压式桡动脉止血器改良加压包扎是目前临床普遍使用的方法，包扎范围以桡动脉穿刺点为中心，可有效解决桡动脉处渗血与肿胀等并发症，但在临床中也可出现由止血器锁扣及压迫板导致患者皮肤损伤、皮肤水泡等并发症，且患者舒适度低。为降……