冠狀動脈加護單位股動脈止血加壓創新流程成效之探討

Outcome Investigation of a New Femeral Artery Compression Procedure in Coronary Care Unit

本研究主在探討某醫院冠狀動脈加護中心止血加壓創新流程施行於冠狀動脈擴張術後，股動脈鞘管拔除患者之成功止血率、腹股溝合併症發生率及合併症發生之預測因子。採相關描述性研究，以立意取樣收集民國年月至月間，行冠狀動脈成形術後住進該加護中心之個病患為收案對象。依觀察記錄表收集資料，以、、及進行統計分析。結果顯示成功止血率為、合併症發生率為，合併症患者中發生出血有、血腫佔；另發生出血合併血腫有。合併症的預測因子為：手壓起始疼痛程度、平躺起始疼痛程度及拔管前後末梢肢體溫度變化。推論可能與醫師在手壓之初因個案主訴疼痛，而減輕手加壓力量及在股動脈止血加壓器移除後平躺初，個案因疼痛或躺久不舒服而挪動身體有關。研究建議在病患拔管前先考慮局部給予麻醉劑減少患者疼痛，並小心衡量加壓力量；而於股動脈止血加壓器移除後，應協助翻身並密切觀察有無合併症發生；另拔管前後末梢肢體溫度未回暖者，需密切觀察有無合併症發生。

The purpose of this study was to search the hemostasis success rate, groincomplication rate and complication predictors associated with a new femeral arterycompression procedure after Percutaneous Coronary Angioplasty(PTCA) in acoronary care unit(C.C.U.). While descriptive correlational study design was used.The purposive sample consisted of 120 patients after PTCA admittance to C.C.U.of a medical center from June to August in 2004. Variables included patients'variables during and after PTCA procedural variables, and pain scale of patientsduring compression. Chi-squre test, t-test and logistic regression were used toanalyze the data. The results indicated the hemostasis success rate was 77.5% andgroin complication rate was 22.5%. The complication predictors were pain scale ofpatients at initial manual compression and lying flat, and variation of low limbperfusion before and after intrasheath removal. The suggestions are as follows: (1)Doctors can administer local anesthesia to the patient before intrasheath removaland carefully decrease manual compression pressure when patients complain ofpain. (2)Nurses must help change position after femostop is removed especiallywhen patients complain of discomfort. (3)Nurses must pay attention to thesepatients' low limb perfusion without variation, and observe the complications'.