摘要目的 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.

abstractsObjective 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.