基于动态血压联合末梢灌注指数调整桡动脉压迫器强度对 TRA-PCI术后患者止血效果的影响 [中文引用][英文引用]

目的  探讨经桡动脉冠状动脉介入治疗（transradial access percutaneous coronary intervention，TRA-PCI）术后依据动态血压联合末梢灌注指数（tip perfusion index，TPI）调整桡动脉压迫器强度的止血效果，为临床提供一种有效的止血方法。方法  选取 2024 年 1 月至 12 月在本市某三级甲等综合医院心血管内科住院的 201 例 TRA-PCI 患者为研究对象，采用随机数字表法将其随机分为试验组（101 例）与对照组（100 例）。对照组采用传统经验法设定压迫强度（初始旋转 3~4 圈，术后 2h、4h、6h分阶段解压），试验组以术毕有创动脉血压收缩压 +30mmHg设定初始压迫强度，并于术后 1h开始，参考动态舒张压及 TPI（阈值≥ 95% 或术前基线）于术后 1h、2h、4h、6h 分阶段解压。比较两组患者术后 1h、2h、4h、6h、24h 皮下出血、疼痛、麻木、肿胀发生率及术后 1 个月桡动脉闭塞（radial artery occlusion，RAO）发生率。结果  试验组患者术后 1h 皮下出血发生率，术后各时间点手部肿胀发生率，术后 1h、4h 手部麻木发生率及疼痛程度，以及术后 1 个月 RAO 发生率均低于对照组，两组比较，差异具有统计学意义（均 P<0.05）。结论  基于动态血压联合 TPI 监测调整桡动脉压迫强度，能将首次安全解压时间提前至术后 1h，可降低患者术后皮下出血、疼痛、麻木、肿胀及 RAO 的发生，提高患者舒适度，并具有安全性。

Objective To evaluate the haemostatic efficacy of the pressure adjustment of radial artery compressor guided by dynamic blood pressure and tip perfusion index（TPI）in haemostasis after transradial access percutaneous coronary intervention（TRAPCI）,and to establish an effective strategy for management of haemostasis in clinical practice. Methods A total of 201 patients who underwent TRA-PCI in the department of cardiology of a Tier-IIIA hospital in Zunyi between January and December 2024 were randomly assigned to an trial group（n=101）or a control group（n=100）using a random number table. Pressure of radial artery compressor was adjusted using the traditional empirical method in control group（by initially turned the pressure knob 3 to 4 turns followed by staged decompression at 2,4 and 6 hours after surgery）. While in the trial group,the initial compression pressure was set at a 30 mmHg above the intraoperative systolic blood pressure（SBP）immediately after the surgery,and followed by staged decompression guided by dynamic diastolic blood pressure and TPI（threshold：≥ 95% of baseline pressure or the baseline pressure before surgery）,started at 1,2,4 and 6 hours after surgery. Postoperative incidences of subcutaneous bleeding,pain,numbness and swelling at 1,2,4,6 and 24 hours as well as radial artery occlusion（RAO）at 1 month were compared between the groups. Results The trial group showed significantly lower incidences of subcutaneous bleeding at 1 hour,hand swelling at all postoperative time points,pain,hand numbness at 1 and 4 hours after surgery and postoperative RAO at 1 month（all P<0.05）,in comparison with those in the control group. All differences between the two groups were statistically significant（all P<0.05）. Conclusion Adjustment of the pressure of radial artery compressor guided by dynamic blood pressure combined with TPI monitoring advances the first safety decompression at 1 hour after TRA-PCI. This strategy effectively reduces the incidences of postoperative subcutaneous bleeding,pain,numbness,swelling and RAO. It improves patient comfort and is safe for clinical application.