橈骨動脈穿刺法による心臓カテーテル検査後の新しい止血システム

New Haemostatic Device to be used in Coronary Angiography with Radial Puncture

要旨

　目的：橈骨動脈用の新しい止血システムMTI社製BSRを使用し，良好な止血効果が得られた．しかし，エアー注入口の三方活栓が回り出血を認めた例を経験したため，一方弁に変更した改良型BSREを作成し，その止血効果および安全性について検討した．

　対象・方法：対象患者は橈骨動脈より4Frシースを挿入して診断カテーテル検査を施行した75症例である．改良型BSREを装着後，まず25例には，エアー15ccで加圧しシース抜去後1時間毎に5ccずつ抜く方法(プロトコール1)を用いた．また残り50例には，シース抜去後2～3ccを抜き12～13ccとする方法(プロトコール2)を用いた．また，全て患者にアンケート調査を実施した．

　結果：プロトコール1，2ともに各々3時間で患者の88%，90%が止血可能であった．4時間以内に全例で止血ができた. また，改良型BSREを使用中に誤ってエアーが抜けて出血するような例は認められなかった．軽度の皮下血腫を4%で認めた．アンケート調査から，プロトコール1では痛み28%，しびれ12%，むくみは24%という結果であったが，プロトコール2では痛み10%，しびれ10%，むくみ12%と改善傾向を認めた．

　結語：橈骨動脈穿刺法に対する新しい止血システムの一部を改良した．全例で十分な止血効果が得られ，三方活栓から一方弁に変更することで安全に圧迫解除を行うことが可能であった．また，プロトコール2を用いれば，臨床上患者の訴えが軽減されることが確認された．

Summary

　Purpose: A new haemostatic device(BSR) for radial artery puncture was delivered and appreciated as a device suitable for conventional use. However,we encountered bleeding events from the puncture site due to leakage of air through the three-way stopcock of this device. To overcome this defect,we developed a new haemostatic device(BSRE) in which the three-way stopcock was replaced by a one-way valve. Using this device,the haemostatic effect and its safety were tested.

　Subjects and methods: Coronary angiography by radial artery puncture was undergone by 75 patients. (Protocol 1): The arterial sheath was removed from the radial artery after injecting 15cc of air into the BSRE. Then 5cc of air was released once every hour.(Protocol 2): The arterial sheath was removed from the radial artery after injecting 15cc of air into the BSRE and immediately 2-3cc of air was released. After that,5cc of air was released once every hour. 25 patients applied to be treated by protocol 1,but complaints of pain increased. Because of this,the remaining 50 patients applied to be trected by protocol 2.

　Results: Complete haemostasis was achieved after three hours in 88%,90% of the patients using protocol 1 and 2 respectively,and 100% of the patients after four hours in both protocols. Mild subcutaneous hematoma occurred in 4% of the patients using the BSRE. The results of a questionnaire survey showed complaints of pain in 28% of the patients using protocol 1; numbness in 12% and venous edema in 24%. Using protocol 2,there were less complaints of pain (10%),of numbness (10%) and of venous edema(12%).

　Conclusion: Optimal haemostatic effect and safety after the sheath removal was achieved using BSRE,which is easy to use even for beginners.