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目的分析早期引发拔管综合症的不同原因,并探寻最佳的处理措施。方法选取我院2001年4月～2011年7月收治的878例行心血管冠脉介入治疗的患者,按照随机分配的方法将其分为A组和B组,每组各439例。A组采用直接拔鞘方法,B组在拔鞘之前进行局部麻醉。所有病例在拔鞘后,均进行6.5h的沙袋加压止血,冠脉介入治疗后采用7.5h的BP、ECG监护。心率减低患者行多巴胺治疗,心包积液行抽液穿刺。针对急性冠脉综合症患者,立即进行搭桥术、冠脉再次介入入治疗。血容量不足者,给予血量补充治疗。结果 878例患者中,拔管综合症有107例,其中心率减低者有89例,心率加快者有68例。B组患者总拔管综合症和慢性心率与A组相比,明显低于A组,具有统计学意义(P<0.01),另外,两组的心率快速反应相似,无统计学意义(P>0.05).结论拔管反应主要分为心率加快和减慢两种,心血管介入治疗后的发生率是13%,心率减低者可以在拔管前进行局部麻醉。心率加快者,多伴有血量不足,心衰、急性冠脉综合症等反应,可通过血量补充来恢复心率,引发严重并发症的病例较少。及时进行积极处理,97.7的患者处理效果良好。
Objective To analyze the different causes of early extubation and explore the best treatment. Methods A total of 878 patients undergoing PCI undergoing PCI in our hospital from April 2001 to July 2011 were randomly divided into group A and group B, with 439 patients in each group. A group using direct pull sheath method, B group before pulling the sheath for local anesthesia. All cases in the sheath, were carried out 6.5h sandbags pressurized hemostasis, 7.5h BP after coronary intervention, ECG monitoring. Patients with reduced heart rate dopamine treatment, pericardial effusion fluid pumping puncture. Acute coronary syndrome patients, immediately bypass surgery, coronary intervention again into the treatment. Patients with insufficient blood volume, give blood supplement treatment. Results Of the 878 patients, 107 had extubation syndromes, 89 with reduced heart rate, and 68 with accelerated heart rate. The total extubation syndrome and chronic heart rate in group B were significantly lower than those in group A (P <0.01). In addition, the fast response of heart rate in both groups was similar, with no statistical significance (P> 0.05) .Conclusion The extubation reaction is mainly divided into two types: heart rate acceleration and slowing down, the incidence of cardiovascular intervention after treatment is 13%, and heart rate reduction can be carried out before extubation of local anesthesia. Heart rate, and more accompanied by insufficient blood, heart failure, acute coronary syndrome and other reactions, can be added by the blood to restore heart rate, less serious cases of complications. Active treatment in a timely manner, 97.7 patients treated well.