【正文】 百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital Perclose 第十五頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital The American Journal of Cardiology,September1,2024 %%%%%%%%%Closure Device Control01234Closure Device ControlVascular Closure Devices PCI GP Ⅱ b/ Ⅲ a closure devices( Angioseal Vasoseal, Prostar) Vasc Complications Longth of stay 第十三頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital JAMA, January 21, 2024, Vol 291, 01Haematoma Bleeding Pseudoaneurysm Surgery TransfusionArterial Puncture Closing Devices Compared with Standard Manual Compression after Cardiac Catheterization Increase risk with devices RR Metaanalysis of 30 trials with 4,000 patients and 7 devices 第十一頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital Market share 第九頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 第七頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 拔除鞘管和壓迫止血 部位：左手食指、中指、無名指并排 垂直放置在穿刺點近心端5~10mm 時間： 5~15分鐘 程度：“度〞 (足背動脈搏動 /下肢紫紺 ) 彈力繃帶加壓包扎 6小時 第五頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 拔除鞘管和壓迫止血 ? 拔管時機 絕大多數(shù)術(shù)后即刻拔管 術(shù)中肝素 5000單位， ACT180s可拔管 第三頁，共一百零一頁。冠狀動脈造影術(shù)后處理 北京安貞醫(yī)院心內(nèi)科 吳小凡 第一頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 成功的冠狀動脈造影檢查取決于標準的手術(shù)過程和準確的術(shù)后處理： 拔除鞘管 止血方式 術(shù)后監(jiān)測 并發(fā)癥處理 第二頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 拔除鞘管和壓迫止血 ? 準備 藥品：利多卡因、阿托品 器材：方盤、注射器、無菌手套、紗布、 彈力繃帶 第四頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 止血 ? 人工壓迫止血 ? 器械壓迫止血 ? Femostop ? 血管閉合器 ? Perclose ? Angioseal ? Vasoseal 第六頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 血管閉合器 ? Perclose ? Angioseal ? Vasoseal 第八頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital A c c e s s S i te M an age m e n t 2024e s ti m ate d u s eP at c h e sD u e t tV as os e alR ad i alP e r c l os eA n gi os e alC om p r e s s i on第十頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital Complications Devices vs Compression %%%%%%%%%%% %%%%%%%%%%%VascularrepairTransfusion Infection UltrasoundpressionTotal majorplicationPerclose(n=5548)Angioseal(n=3711)pression(n=15801)The Journal of Cardiovascular Management, November/December,1998 第十二頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 第十四頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital Perclose 使用條件 ： ? 位置 : 股動脈穿刺點距離分叉 2mm ? 病變： 穿刺部位無畸形、動脈粥樣硬化或鈣化 第十六頁，共一百零一頁。 Routine management after coronary angiography Beijing Anzhen Hospital 2 置入縫合器 放“腳〞： 推針：