血管閉合裝置對由股動脈行經皮冠狀動脈介入術後止血效益之統合分析

Effectiveness of Vascular Closure Devices for Transfemoral Percutaneous Coronary Interventions: A Meta-Analysis

臨床上，冠心症患者接受股動脈行經皮冠狀動脈介入術後，需要臥床2-24小時以避免出血，然而使用傳統徒手加壓或血管閉合裝置何者較具止血效益，目前仍有不同論點。本文經由系統性文獻回顧，搜尋PubMed、Medline、Cochranelibrary、Science direct、台灣碩博士論文和CEPS 等資料庫，檢索2008 年至2014年間之相關研究，搜尋385 篇文章，經篩選後共獲得11 篇文獻，以ReviewManager 5 軟體進行統合分析，結果顯示經皮冠狀動脈介入術後，使用血管閉合裝置所造成的血管合併症，如假性動脈瘤、動靜脈瘻管、手術修復、需要輸血等4 項指標之風險，顯著比徒手加壓方法低，並可提早5.99 小時下床。但是血管閉合裝置仍潛藏後腹膜出血之風險，故建議醫護人員應了解不同止血方式之成效證據及優缺點，提供適切護理措施，降低血管合併症發生，並促進病人舒適。

Transfemoral percutaneous coronary intervention (PCI), used for treating patients with coronary artery disease requires patents to be bedridden for 2-24 hours to avoid bleeding. Whether the hemostasis effectiveness of the traditional manual compression (MC) or vascular closure device (VCD) is higher remains a controversial question. Through a systematic review of evidence-based research literature, we explored the hemostasis effectiveness of VCD and MC for transfemoral PCI. Moreover, we followed the evidence-based steps to search related references published between 2008 and 2014 by using keywords in the electronic databases of PubMed, MEDLINE, Cochrane library, Science Direct, National Digital Library of Theses and Dissertations (Taiwan) and Centre for European Policy Studied and shortlisted 385 studies. These studies were carefully assessed and 11 studies complementing the research topic were selected for this meta-analysis conducted through RevMan 5. The meta-analysis revealed that following PCI, compared with MC, VCD has fewer complications, such as pseudoaneurysm, arteriovenous fi stula, repair, and blood transfusion, and has a signifi cantly early ambulation (5.99 hours). However, the risk of retroperitoneal hemorrhage after VCD was not revealed in the meta-analysis. We suggest that nurses understand the advantages and disadvantages of the different hemostasis methods for standardizing nursing cares, thus reducing vascular complications and promoting patient comfort.