冠状动脉(guānzhuàng-dòngmài)造影术后处理北京安贞医院心内科吴小凡第一页，共一百零一页。Routinemanagementaftercoronaryangiography成功的冠状动脉造影检查取决于规范的手术过程和准确的术后处理：拔除(báchú)鞘管止血方式术后监测并发症处理BeijingAnzhenHospital第二页，共一百零一页。Routinemanagementaftercoronaryangiography拔除鞘管和压迫止血(zhǐxuè)拔管时机绝大多数术后即刻拔管术中肝素>5000单位，ACT<180s可拔管BeijingAnzhenHospital第三页，共一百零一页。Routinemanagementaftercoronaryangiography拔除鞘管和压迫止血准备(zhǔnbèi)药品：利多卡因、阿托品器材：方盘、注射器、无菌手套、纱布、弹力绷带BeijingAnzhenHospital第四页，共一百零一页。Routinemanagementaftercoronaryangiography拔除鞘管和压迫止血部位：左手食指、中指、无名指并排垂直(chuízhí)放置在穿刺点近心端5~10mm时间：5~15分钟程度：“度”(足背动脉搏动/下肢紫绀)弹力绷带加压包扎6小时BeijingAnzhenHospital第五页，共一百零一页。Routinemanagementaftercoronaryangiography止血人工压迫(yāpò)止血器械压迫止血Femostop血管闭合器PercloseAngiosealVasosealBeijingAnzhenHospital第六页，共一百零一页。RoutinemanagementaftercoronaryangiographyBeijingAnzhenHospital第七页，共一百零一页。Routinemanagementaftercoronaryangiography血管(xuèguǎn)闭合器PercloseAngiosealVasosealBeijingAnzhenHospital第八页，共一百零一页。RoutinemanagementaftercoronaryangiographyMarketshareBeijingAnzhenHospital第九页，共一百零一页。RoutinemanagementaftercoronaryangiographyAccessSiteManagement2003estimatedusePercloseAngiosealVasosealRadialDuettPatchesCompressionBeijingAnzhenHospital第十页，共一百零一页。RoutinemanagementaftercoronaryangiographyArterialPunctureClosingDevicesComparedwithStandardManualCompressionafterCardiacCatheterizationM1.e8ta-analysisof30trialswith4,000patientsand7devicesRR1.61.611.481.41.21.141.191.2110.80.60.40.20HaematomaBleedingPseudoaneurysmSurgeryTransfusionIncreaseriskwithdevicesJAMA,January21,2004,Vol291,No.3BeijingAnzhenHospital第十一页，共一百零一页。RoutinemanagementaftercoronaryangiographyComplicationsDevicesvsCompression1.20%1.00%Perclose(n=5548)1.05%0.80%Angioseal(n=3711)1.00%compression(n=15801)0.89%0.78%0.67%0.60%0.50%0.40%0.30%0.20%0.21%0.20%0.10%Transfusion0.08%0.06%0.00%0.00%0.03%0.00%VascularUltrasoundTotalmajorrepairInfectioncompressioncomplicationTheJournalofCardiovascularManagement,November/December,1998BeijingAnzhenHospital第十二页，共一百零一页。RoutinemanagementaftercoronaryangiographyVascularClosureDevices3027PCI47%GPⅡb/Ⅲa3closuredevices(90%Angioseal,7%Vasoseal,3%Prostar)VascComplicationsLongthofstay3.91Control46.00%5.52%3.55.00%32.774.00%2.53.00%3.03%22.00%1.511.00%0.50.00%Control0ClosureDeviceClosureDeviceTheAmericanJournalofCardiology,Vol.88,September1,2001BeijingAnzhenHospital第十三页，共一百零一页。RoutinemanagementaftercoronaryangiographyBeijingAnzhenHospital第十四页，共一百零一页。RoutinemanagementaftercoronaryangiographyPercloseBeijingAnzhenHospital第十五页，共一百零一页。RoutinemanagementaftercoronaryangiographyPerclose使用条件：位置:股动脉穿刺点距离(jùlí)分叉>2mm病变：穿刺部位无畸形、动脉粥样硬化或钙化BeijingAnzhenHospital第十六页，共一百零一页。RoutinemanagementaftercoronaryangiographyPerclose操作步骤1.准备：把生理盐水注入输送鞘管并看到盐水从标记入口(rùkǒu)流出把打结器泡于盐水中清理及消毒手术部位，放进造影导丝，确保导丝进入血管内足够长BeijingAnzhenHospital第十七页，共一百零一页。Rou...
