Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
000
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fa
jalali
1390
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gregorian
2011
10
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69
7
online
1
fulltext
fa
بررسی عوامل مرتبط با بروز عوارض عروقی پس از مداخلات کرونر در مرکز قلب و عروق شهید رجایی تهران
The factors relevant to the onset of vascular complications after coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran
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<p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و
هدف:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">عوارض عروقی بهعنوان شایعترین عارضه آنژیوگرافی تشخیصی و
آنژیوپلاستی عروق کرونر، بهعنوان یک عامل مهم در موربیدیتی بیماران مطرح میباشد
و لذا مطالعه روی شیوع این عارضه و عوامل مرتبط با آن در بیماران ضروری بهنظر میرسد.</span><span style="font-size: 9pt"> </span><strong><span style="font-size: 10pt"><br></span></strong></p><p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">روش بررسی: </span></strong><span style="font-size: 10pt">این مطالعه، یک مطالعه توصیفی
بوده، 2097 مورد آنژیوپلاستی عروق کرونر در مدت یکسال از دیماه 87 تا دیماه 88
در بیمارستان قلب شهید رجایی تهران انجام گرفت و این بیماران از نظر پیدایش عوارض
عروقی در طول مدت بستری و نیز عوامل مرتبط به آن مورد مطالعه قرار گرفتند.<strong> </strong></span><strong><span style="font-size: 10pt"><br></span></strong></p><p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">از کل 2097 بیمار، 1544 بیمار مذکر
(6/73%) و 553 بیمار مونث (4/26%) با میانگین سنی 10</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">57 بودند.
میزان بروز عوارض عروقی از زمان آنژیوپلاستی تا زمان ترخیص بیمار از بیمارستان، در
19 مورد (9/0%) مشاهده شد که از این تعداد 10 مورد هماتوم (6/52% عوارض)، آنوریسم کاذب
در پنج مورد (3/26% عوارض)، خونریزی خلف صفاقی و فیستول شریانی وریدی هر کدام دو
مورد (5/10% عوارض در هر مورد) را تشکیل دادند. عوارض در جنس مونث (003/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)، در بیماران با سابقه </span><span style="font-size: 7pt">HTN</span><span style="font-size: 10pt"> <span lang="FA">(02/0</span></span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)،
در بیماران با قد کوتاهتر (004/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)، در بیمارانی که
از مهارکننده </span><span style="font-size: 8pt">gp</span><span style="font-size: 9pt"> </span><span style="font-size: 7pt">III</span><span style="font-size: 8pt">a/</span><span style="font-size: 7pt">II</span><span style="font-size: 8pt">b</span><span style="font-size: 10pt"> استفاده کرده بودند (003/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)، بهطور قابلتوجهی شایعتر بود.</span><strong><em><span style="font-size: 10pt"> <br></span></em></strong></p><p dir="rtl" style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">میزان بروز
عوارض عروقی در بیماران بعد از آنژیوپلاستی کرونر پایین است و یک روش مناسب درمانی
برای بیماران با تنگی کرونر محسوب میشود و در صورتیکه بعد از برداشتن شیت
شریانی، در مدت زمان مناسب، فشار روی محل دستیابی </span><span style="font-size: 8pt">(Access)</span><span style="font-size: 10pt"> عروقی داده شود، بهخصوص در مورد بیماران زن، سابقه </span><span style="font-size: 7pt">HTN</span><span style="font-size: 10pt">،
سطح آنتیکوآگولانت بالاتر، احتمال پیدایش عوارض عروق پایین میباشد.</span></p>
<p style="text-align: justify"><strong>Background: </strong>Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures thus, this study was done to evaluate the prevalence of these complications and their related factors.<br><strong></strong></p>
<p style="text-align: justify"><strong>Methods:</strong> This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.<br><strong></strong></p>
<p style="text-align: justify"><strong>Results: </strong>Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 57±10 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each. The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).<br><strong></strong></p>
<p style="text-align: justify"><strong>Conclusion:</strong> The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations.</p>
عوارض عروقی،هماتوم،فیستول شریانی وریدی،خونریزی خلف صفاقی
Arteriovenous fistula,hematoma,hemorrhage,retroperitoneal,vascular complication
445
450
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-216&slc_lang=fa&sid=1
Yousefi
AA
احمدعلی
یوسفی