目的 寻找桡动脉加压器(TR Band止血器)在经桡动脉行冠状动脉介入治疗(TRI)术后首次减压时间的最佳实证,为临床护理实践提供证据支持及指导建议,为进一步制订相应的临床实践指南提供证据支持. 方法 计算机检索Cochrane Library、OVID、PubMed、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库中的文献,并筛选已获文献的参考文献,纳入TRI术后应用TR Band止血器压迫止血的随机对照试验(RCT)、临床对照试验(CCT)及历史性队列研究(HCT).由2名评价员根据Cochrane Handbook 5.0推荐的"偏倚风险评估"工具对纳入研究独立进行方法学质量评价,采用RevMan 5.1.5软件进行Meta分析. 结果 共纳入2项RCT、3项CCT,合计1 881例患者. Meta分析结果显示,术后首次减压时间30 min与1 h比较,患者术侧肢体肿胀、疼痛发生率差异有统计学意义[(OR=2.22,95%CI 1.25~3.93,P<0.01)比(OR=1.63,95%CI 1.02~2.59,P<0.05) ],穿刺部位出血、术侧肢体麻木、青紫发生率差异无统计学意义[(OR=0.77,95%CI 0.35~1.71,P>0.05)比(OR=2.14,95%CI 0.75~6.12,P>0.05)比(OR=11.73,95%CI 0.64~215.74,P>0.05) ];1 h与2 h比较,患者术侧肢体出血、疼痛的发生率差异有统计学意义[(OR=0.09,95%CI-0.13~-0.05,P<0.01)比(OR=2.07,95%CI 1.24~3.46,P<0.01) ];90 min与2 h比较,患者术侧肢体疼痛、肿胀发生率差异有统计学意义[(OR=2.77,95%CI 1.82~4.23,P<0.01)比(OR=2.73,95%CI 1.41~5.28,P<0.01) ],穿刺部位出血、血肿、淤斑的发生率及术侧肢体麻木程度差异均无统计学意义[(OR=0.97,95%CI 0.61~1.54,P>0.05)比(OR=0.95,95%CI 0.52~1.75,P>0.05)比(OR=0.96,95%CI 0.54~1.73,P>0.05) ]. 结论 TRI术后30 min开始减压可减低术侧肢体肿胀、疼痛的发生率,对穿刺部位出血、术侧肢体麻木的发生率无明显影响.
目的 尋找橈動脈加壓器(TR Band止血器)在經橈動脈行冠狀動脈介入治療(TRI)術後首次減壓時間的最佳實證,為臨床護理實踐提供證據支持及指導建議,為進一步製訂相應的臨床實踐指南提供證據支持. 方法 計算機檢索Cochrane Library、OVID、PubMed、中國生物醫學文獻服務繫統(CBM)、中國期刊全文數據庫(CNKI)、維普數據庫(VIP)、萬方數據庫中的文獻,併篩選已穫文獻的參攷文獻,納入TRI術後應用TR Band止血器壓迫止血的隨機對照試驗(RCT)、臨床對照試驗(CCT)及歷史性隊列研究(HCT).由2名評價員根據Cochrane Handbook 5.0推薦的"偏倚風險評估"工具對納入研究獨立進行方法學質量評價,採用RevMan 5.1.5軟件進行Meta分析. 結果 共納入2項RCT、3項CCT,閤計1 881例患者. Meta分析結果顯示,術後首次減壓時間30 min與1 h比較,患者術側肢體腫脹、疼痛髮生率差異有統計學意義[(OR=2.22,95%CI 1.25~3.93,P<0.01)比(OR=1.63,95%CI 1.02~2.59,P<0.05) ],穿刺部位齣血、術側肢體痳木、青紫髮生率差異無統計學意義[(OR=0.77,95%CI 0.35~1.71,P>0.05)比(OR=2.14,95%CI 0.75~6.12,P>0.05)比(OR=11.73,95%CI 0.64~215.74,P>0.05) ];1 h與2 h比較,患者術側肢體齣血、疼痛的髮生率差異有統計學意義[(OR=0.09,95%CI-0.13~-0.05,P<0.01)比(OR=2.07,95%CI 1.24~3.46,P<0.01) ];90 min與2 h比較,患者術側肢體疼痛、腫脹髮生率差異有統計學意義[(OR=2.77,95%CI 1.82~4.23,P<0.01)比(OR=2.73,95%CI 1.41~5.28,P<0.01) ],穿刺部位齣血、血腫、淤斑的髮生率及術側肢體痳木程度差異均無統計學意義[(OR=0.97,95%CI 0.61~1.54,P>0.05)比(OR=0.95,95%CI 0.52~1.75,P>0.05)比(OR=0.96,95%CI 0.54~1.73,P>0.05) ]. 結論 TRI術後30 min開始減壓可減低術側肢體腫脹、疼痛的髮生率,對穿刺部位齣血、術側肢體痳木的髮生率無明顯影響.
목적 심조뇨동맥가압기(TR Band지혈기)재경뇨동맥행관상동맥개입치료(TRI)술후수차감압시간적최가실증,위림상호리실천제공증거지지급지도건의,위진일보제정상응적림상실천지남제공증거지지. 방법 계산궤검색Cochrane Library、OVID、PubMed、중국생물의학문헌복무계통(CBM)、중국기간전문수거고(CNKI)、유보수거고(VIP)、만방수거고중적문헌,병사선이획문헌적삼고문헌,납입TRI술후응용TR Band지혈기압박지혈적수궤대조시험(RCT)、림상대조시험(CCT)급역사성대렬연구(HCT).유2명평개원근거Cochrane Handbook 5.0추천적"편의풍험평고"공구대납입연구독립진행방법학질량평개,채용RevMan 5.1.5연건진행Meta분석. 결과 공납입2항RCT、3항CCT,합계1 881례환자. Meta분석결과현시,술후수차감압시간30 min여1 h비교,환자술측지체종창、동통발생솔차이유통계학의의[(OR=2.22,95%CI 1.25~3.93,P<0.01)비(OR=1.63,95%CI 1.02~2.59,P<0.05) ],천자부위출혈、술측지체마목、청자발생솔차이무통계학의의[(OR=0.77,95%CI 0.35~1.71,P>0.05)비(OR=2.14,95%CI 0.75~6.12,P>0.05)비(OR=11.73,95%CI 0.64~215.74,P>0.05) ];1 h여2 h비교,환자술측지체출혈、동통적발생솔차이유통계학의의[(OR=0.09,95%CI-0.13~-0.05,P<0.01)비(OR=2.07,95%CI 1.24~3.46,P<0.01) ];90 min여2 h비교,환자술측지체동통、종창발생솔차이유통계학의의[(OR=2.77,95%CI 1.82~4.23,P<0.01)비(OR=2.73,95%CI 1.41~5.28,P<0.01) ],천자부위출혈、혈종、어반적발생솔급술측지체마목정도차이균무통계학의의[(OR=0.97,95%CI 0.61~1.54,P>0.05)비(OR=0.95,95%CI 0.52~1.75,P>0.05)비(OR=0.96,95%CI 0.54~1.73,P>0.05) ]. 결론 TRI술후30 min개시감압가감저술측지체종창、동통적발생솔,대천자부위출혈、술측지체마목적발생솔무명현영향.
Objective To investigate the first decompression time of TR Band hemostasis after transradial percutaneous coronary intervention (TRI), provide evidence to support and guidance for clinical nursing practice. Methods By searching Cochrane Library, OVID, PubMed, Chinese biomedical literature service system(CBM),China National Knowledge Infrastructure(CNKI), VIP database(VIP), Wanfang database, the randomized controlled trials (RCTs),controlled clinical trials (CCT) and historical cohort study(HCT) of TR Band hemostasis after coronary artery intervention were collected and analyzed. Two reviewers used bias risk assessment tool according to Cochrane recommendation Handbook 5.0 to evaluate, Meta-analysis was carried out using RevMan 5.1.5 software. Results A total of 1 881 patients in 2 RCTs and 3 CCTs were included.Compared with the first decompression time 30 min, patients in 1 h group with limb swelling and pain incidence were statistically significant difference [ (OR=2.22, 95%CI 1.25-3.93, P<0.01) vs. (OR=1.63,95%CI 1.02-2.59, P < 0.05)], bleeding at the puncture sites or the operative limbnumbness or ecchymosis there was no significant difference [(OR=0.77,95%CI 0.35-1.71, P>0.05) vs.(OR=2.14, 95%CI 0.75-6.12, P>0.05)vs.(OR=11.73, 95%CI 0.64-215.74, P>0.05)];1h compared with 2 h patients with limbs, pain, hemorrhage rate had significant difference [(OR=0.09, 95%CI-0.13--0.05, P<0.01) vs. (OR=2.07, 95%CI 1.24-3.46, P<0.01)]; a comparison between 90 min and 2h, the limb pain and swelling incidence were statistically significant difference [(OR=2.77, 95%CI 1.82-4.23, P<0.01)vs.(OR=2.73,95%CI 1.41-5.28, P<0.01)], the puncture site bleeding, hematoma, ecchymosis rate and the operative limb numbness extent differences were no statistical significance [(OR=0.97,95%CI 0.61-1.54, P>0.05) vs. (OR=0.95, 95%CI 0.52-1.75, P>0.05)vs. (OR=0.96,95%CI 0.54-1.73, P>0.05)]. Conclusions 30 min decompression after TRI can reduce operative limb swelling and pain incidence rate. There is no obvious influence between puncture site bleeding and operative limb numbness.
