改變心導管病患術後臥床時間對穿刺部位合併症發生率及病患舒適度之影響

Abstract

背景：現階段臺灣各醫學中心心導管術後臥床時間之照護準則不同，而過長的臥床時間易導致病患身體不適感與疲憊。 目的：探討改變心導管病患術後臥床時間對鼠蹊處合併症發生率以及病患主觀舒適度之差異，了解術後提早下床之可行性。 方法：收集95位符合收案條件之心導管病患，依其意願分派為對照組與實驗組後進行研究。對照組於拔除鼠蹊處導管後臥床12小時，實驗組則臥床4小時，比較兩組下床時穿刺部位發生滲血、出血、血腫、動靜脈廔管合併症之機率、術後接受導尿比率及在不同臥床時間後舒適度差異。 結果：42位提早下床病患中有1人(2.3%)穿刺部位發生滲血，無人發生出血、血腫及動靜脈廔管；53位控制組病患皆未出現穿刺部位合併症，兩組合併症發生率未達統計上顯著差異(p=0.442)。比較兩組在術後接受導尿機率(p=0.223)及下床活動時之不同部位舒適度(p=0.734)皆無差異。 結論：提早下床並不影響病患接受導尿機率及下床活動時主觀舒適度差異，所以將心導管病患術後臥床時間由12小時縮減至4小時是安全且可行的。

The aim of this study was to investigate the feasibility of early ambulation after percutaneous coronary intervention. Patients met the criteria were enrolled into either experimental group or control group by their willingness. Patients in experimental group ambulated after 4 hour bed rest, whereas patients in control group ambulated after 12 hours bed rest. The primary endpoint was the vascular complications: ooze, bleeding, hematoma and arteriovenous fistula. The secondary endpoint was the level of comfort back and urinate difficulty. A total of 95 eligible patients were enrolled into either experimental (n=42) or control group (n=53). The complication rate in experimental group was not significant different to control group (2.3% vs 0%, p=0.442). The level of comfort (p=0.734) and urinate difficulty (p=0.223) were not significant different between two groups. Early ambulation after percutaneous coronary intervention was safe and feasible.