探究“八字缝合法”在大口径股动静脉鞘管拔除后对穿刺位点的止血效果
投稿时间:2016-06-21  修订日期:2016-07-12  点此下载全文
引用本文:权大君,单迎光,曹省,黄鹤.探究“八字缝合法”在大口径股动静脉鞘管拔除后对穿刺位点的止血效果[J].医学研究杂志,2017,46(2):32-36
DOI: 10.11969/j.issn.1673-548X.2017.02.010
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作者单位E-mail
权大君 430060 武汉大学人民医院心内科、武汉大学心血管研究所、湖北省心血管重点实验室  
单迎光 430060 武汉大学人民医院心内科、武汉大学心血管研究所、湖北省心血管重点实验室  
曹省 430060 武汉大学人民医院心内科、武汉大学心血管研究所、湖北省心血管重点实验室  
黄鹤 430060 武汉大学人民医院心内科、武汉大学心血管研究所、湖北省心血管重点实验室 huanghe1977@hotmail.com 
基金项目:湖北省科技支撑计划项目(2013BCB013);国家自然科学基金资助项目(面上项目)(81270249);国家自然科学基金资助项目(面上项目)(81570306)
中文摘要:目的 本实验欲比较“八字缝合法”与“指压法”在犬的急性心肌梗死(AMI)模型及Ⅲ度房室传导阻滞(Ⅲ°AVB)模型手术中股动静脉鞘管拔出后对穿刺位点的止血效果。方法 把试验犬分成心肌梗死模型组及Ⅲ度房室传导阻滞模型组,每组再分成“八字缝合法”组与“指压法”组。心肌梗死模型中比较两种方法对股动脉穿刺位点的止血效果,而在Ⅲ度房室传导阻滞模型中比较两者对股静脉穿刺位点的止血效果。手术期间静脉使用肝素以防血栓形成。比较4组的止血时间,并在术后立即、12h后和24h后对两组穿刺位点进行超声多普勒检查,比较术前与术后穿刺位点的血管影像学检查,并观察4组术后的并发症。结果 本实验分别对10只AMI模型犬及9只Ⅲ°AVB模型犬行“八字缝合”止血法,其余行指压止血法。组内比较平均体重与心率差异无统计学意义(P>0.05)。AMI模型与Ⅲ°AVB模型中按压止血所需时间分别为8.45±1.28min与6.61±0.80min。两种模型术后立即行超声多普勒检查发现“八字缝合”处回声增强且没有侧漏,术后12h与24h后增强影消失。模型犬在八字缝合后行静脉造影检查示缝合处明显狭窄。观察一周后AMI模型与Ⅲ°AVB模型犬中分别有两只发生血肿,分别有一只与两只发生感染。结论 “八字缝合”法可以对犬的大口径股动静脉鞘穿刺点进行安全有效的止血,与传统的指压止血法比较并不会增加血肿或再出血等并发症。
中文关键词:"8字缝合"止血法  指压法  股动脉  股静脉  超声多普勒
 
Explore the Hemostatic Effect of ‘Figure-of-Eight’ Suture After Removal of Femoral Arterious and Venous Sheath
Abstract:Objective For this study,we want to compare the hemostatic effect of figure-of-eight' suture and conventional manual compression after removal of femoral arterious and venous sheath in acute myocardial infarction(AMI) caine model and Ⅲ degree atrioventricular block(Ⅲ°AVB) caine model. Methods The experiment was divided into AMI model group and Ⅲ° AVB model group, and each subdivided into FoE suture group and the CMC group. The hemostatic effect of two methods was compared at femoral artery puncture site in AMI model,femoral vein puncture site in Ⅲ° AVB model. Heparin was injected to prevent thrombosis during surgery. Hemostatic time was compared in the four groups,and ultrasound Doppler examination was performed immediately and 12 hours late and 24 hours late after surgery. Phlebography was also performed at preoperative and postoperative vascular puncture site, and vascular access site complications were observed in four groups after surgery. Results In this study, figure-of-eight' suture was performed respectively in 10 AMI model caines and 9 Ⅲ° AVB model, remaining performed manual compression.There were no differences in the mean weight and heart rate between two groups of each models. The hemostatic time of manual compression in AMI model and Ⅲ° AVB models were 8.45±1.28min and 6.61±0.80min. Doppler ultrasound examination was performed immediately after figure-of-eight' suture to reveal strong echogenic and no side leakage at puncture site, and that was disappeared in 12h and 24h after surgery.Phlebography revealed angiostegnosis at suture site.After the observations for a week, there were respectively two caines occured hematoma in the two models,and one occured infection in AMI model and two in Ⅲ° AVB model. Conclusion Usefulness of figure-of-eight' suture can achieve feasible and efficient haemostasis after removal of heavy calibre femoral arterious and venous sheath, and it dosen't increase complications such as bleeding or hematoma in comparison with conventional manual compression.
keywords:‘Figure-of-eight’ suture  Manual compression  Femoral artery  Femoral vein  Ultrasound Doppler
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