ภาวะแทรกซ้อนจากการทำหัตถการตรวจสวนหลอดเลือดหัวใจและหัตถการรักษาโรคหลอดเลือด หัวใจผ่านสายสวน: เรื่องสำคัญสำหรับพยาบาลเฉพาะทางโรคหัวใจและหลอดเลือด
บทคัดย่อ
วัตถุประสงค์ : เพื่อรวบรวมอุบัติการณ์การเกิดภาวะแทรกซ้อน และเปรียบเทียบอัตราการเกิดภาวะแทรกซ้อนระหว่าง การตรวจสวนหลอดเลือดหัวใจกับการรักษาโรคหลอดเลือดหัวใจผ่านสายสวน
วิธีการวิจัย : เป็นการศึกษาเชิงพรรณนา โดยกลุ่มตัวอย่างจากโครงการลงทะเบียนผู้ป่วยที่ได้รับการตรวจสวนหัวใจใน มหาวิทยาลัยขอนแก่น ที่เข้ารับบริการครั้งแรก จำนวน 886 ราย
ผลการศึกษา : พบว่ามีอุบัติการณ์การเกิดภาวะแทรกซ้อนระหว่างการตรวจสวนหลอดเลือดหัวใจกับการรักษาโรคหลอด เลือดหัวใจผ่านสายสวนมีความแตกต่างทางสถิติ ได้แก่ hematoma (1.97% VS 6.16%; Risk difference = 4.19; 95%CI: 1.15 to 7.24; P = 0.007) เลือดออกในระบบทางเดินอาหารส่วนต้น (0.66% VS 3.26%; Risk difference = 2.60; 95%CI: 0.41 to 4.79; P = 0.020) ภาวะช็อคจากหัวใจ (1.64% VS 6.16%; Risk difference = 4.52; 95%CI: 1.51 to 7.53; P = 0.003) ไตวายเฉียบพลัน (2.79% VS 9.06%; Risk difference = 6.27; 95%CI: 2.64 to 9.90; P = 0.001) หัวใจเต้น ผิดจังหวะ (3.61% VS 7.97%; Risk difference = 4.36; 95%CI: 0.84 to 7.89; P = 0.015) ส่วนภาวะหัวใจล้มเหลว (8.69% VS 12.68%) Risk difference = 3.99;95% CI: 0.52 to 8.51; P = 0.083 โรคหลอดเลือดสมอง (0.16 %VS 0%) Risk difference = 0.16;95% CI: 1.73 to 1.72; P = 0.156 ภาวะหัวใจบีบรัด (0% VS 0.72%) และอัตราการเสียชีวิต (0.66% VS 2.54%) Risk difference = 1.88;95% CI: -0.08 to 3.84; P = 0.06 ไม่มีความแตกต่างทางสถิติ
สรุปว่า : การตรวจสวนหลอดเลือดหัวใจและการรักษาโรคหลอดเลือดหัวใจผ่านสายสวน มีโอกาสเกิดภาวะแทรกซ้อน ได้ พยาบาลที่ปฏิบัติหน้าทีในการดูแลผู้ป่วยควรเตรียมความพร้อมในการให้การดูแลตลอดระยะเวลาที่ผู้ป่วยเข้ารับการตรวจ รักษา
คำสำคัญ : ภาวะแทรกซ้อน, การตรวจสวนหลอดเลือดหัวใจ, การรักษาหลอดเลือดหัวใจผ่านสายสวน, พยาบาลโรค หัวใจและหลอดเลือด
References
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Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999 May; 33(6):1756–824.
Kern morton jhon. The Cardiac Catheterization Handbook, 5th edition. 5th ed. Philadelphia: Elsevier; 2011. 432 p.
Kiatchoosakun S, Sutra S, Thepsuthammarat K. Coronary artery disease in the Thai population: data from health situation analysis 2010. J Med Assoc Thail Chotmaihet Thangphaet. 2012 Jul;95 Suppl 7:S149-155.
Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. J Nucl Cardiol. 2017 Oct 1;24(5):1759–92.
Acharjee S, Teo KK, Jacobs AK, Hartigan PM, Barn K, Gosselin G, et al. Optimal medical therapy with or without percutaneous coronary inter vention in women with stable coronary disease: A pre-specified subset analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial. Am Heart J. 2016 Mar;173:108–17.
Rani S, Lakshmi R, Pillai A, Nisha S. The risk factors associated with complications of coronary angiogram: A cross-sectional observational study. Int J Adv Med Health Res. 2016;3(1):11–5.
Paganin AC, Beghetto MG, Feijó MK, Matte R, Sauer JM, Rabelo-Silva ER. Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study. Rev Lat Am Enfermagem [Internet]. 2018 Oct 11 [cited 2019 Jul 7];26. Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6190486/
Dukkipati S, O’Neill WW, Harjai KJ, Sanders WP, Deo D, Boura JA, et al. Characteristics of cerebrovascular accidents after percutaneous coronary interventions. J Am Coll Cardiol. 2004 Apr 7;43(7):1161–7.
Wong SC, Minutello R, Hong MK. Neurological Complications Following Percutaneous Coronary Interventions (A Report from the 2000–2001 New York State Angioplasty Registry). Am J Cardiol. 2005 Nov 1;96(9) :1248–50.
Singh M, Rihal CS, Lennon RJ, Garratt KN, Holmes DR. Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions. J Am Coll Cardiol. 2004 Jul 21;44(2):357–61.
Kiatchoosakun S, Keelapang P, Kaewsuwana P, Chotinaiwattarakul C, Piumsomboon C. Percutaneous coronary intervention in the elderly: results from the Thai National Percutaneous Coronary Intervention Registry (TPCIR). EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 2010 Nov;6(5):611–5.
Wu AH, Parsons L, Every NR, Bates ER. Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: A report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol. 2002 Oct 16;40(8):1389–94.
Mamas MA, Anderson SG, O’Kane PD, Keavney B, Nolan J, Oldroyd KG, et al. Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Eur Heart J. 2014 Nov 14;35(43):3004–12.
Andersen K, Bregendahl M, Kaestel H, Skriver M, Ravkilde J. Haematoma after Coronary Angiography and Percutaneous Coronary Intervention via the Femoral Artery Frequency and Risk Factors. Eur J Cardiovasc Nurs. 2005 Jun 1;4(2):123–7.
Kelly DJ, Gershlick T, Witzenbichler B, Guagliumi G, Fahy M, Dangas G, et al. Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: The HORIZONS-AMI trial. Am Heart J. 2011 Oct 1;162(4):663–70.
Lee J-M, Park S-Y, Choi J-H, Kim U-J, Rew S-J, Cho JY, et al. Clinical Risk Factors for Upper Gastrointestinal Bleeding after Percutaneous Coronary Intervention: A Single-Center Study. Gut Liver. 2016 Jan;10(1):58–62.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-77.
French JK, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, Hellkamp AS, et al. Cardiogenic shock and heart failure post– percutaneous coronary intervention in ST-elevation myocardial infarction: Observations from “ Assessment of Pexelizumab in Acute Myocardial Infarction”. Am Heart J. 2011 Jul 1;162(1):89–97.
Harjola V-P, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015; 17(5):501–9.
Albanese M, Alpaslan K, Ouarrak T, Merguet P, Schneider S, Schöls W. In-hospital major arrhythmias , arrhythmic death and resuscitation after successful primary percutaneous intervention for acute transmural infarction: a retrospective single-centre cohort study. BMC Cardiovasc Disord [Internet]. 2018 Jun 14 [cited 2019 Jul 21];18. Available from: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC6001058/
Mehta RH, Yu J, Piccini JP, Tcheng JE, Farkouh ME, Reiffel J, et al. Prognostic Significance of Postprocedural Sustained Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial). Am J Cardiol. 2012 Mar 15;109(6):805–12.
Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutane ous Coronary Interventions. JACC Cardiovasc Interv. 2014 Jan;7(1):1–9.
Kooiman Judith, Seth Milan, Dixon Simon, Wohns David, LaLonde Thomas, Rao Sunil V., et al. Risk of Acute Kidney Injury After Percutaneous Coronary Interventions Using Radial Versus Femoral Vascular Access. Circ Cardiovasc Interv. 2014 Apr 1;7(2):190–8.
Song F, Sun G, Liu J, Chen J, He Y, Liu L, et al. Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial. Trials [Internet]. 2019 May 27 [cited 2019 Jul 20];20. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6537180/
Acharya T, Salisbury AC, Spertus JA, Kennedy KF, Bhullar A, Reddy HKK, et al. In-Hospital Outcomes of Percutaneous Coronary Intervention in America’s Safety Net: Insights From the NCDR Cath-PCI Registry. JACC Cardiovasc Interv. 2017 Aug 14;10(15):1475–85.
Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999 May; 33(6):1756–824.
Kern morton jhon. The Cardiac Catheterization Handbook, 5th edition. 5th ed. Philadelphia: Elsevier; 2011. 432 p.
Kiatchoosakun S, Sutra S, Thepsuthammarat K. Coronary artery disease in the Thai population: data from health situation analysis 2010. J Med Assoc Thail Chotmaihet Thangphaet. 2012 Jul;95 Suppl 7:S149-155.
Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease. J Nucl Cardiol. 2017 Oct 1;24(5):1759–92.
Acharjee S, Teo KK, Jacobs AK, Hartigan PM, Barn K, Gosselin G, et al. Optimal medical therapy with or without percutaneous coronary inter vention in women with stable coronary disease: A pre-specified subset analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial. Am Heart J. 2016 Mar;173:108–17.
Rani S, Lakshmi R, Pillai A, Nisha S. The risk factors associated with complications of coronary angiogram: A cross-sectional observational study. Int J Adv Med Health Res. 2016;3(1):11–5.
Paganin AC, Beghetto MG, Feijó MK, Matte R, Sauer JM, Rabelo-Silva ER. Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study. Rev Lat Am Enfermagem [Internet]. 2018 Oct 11 [cited 2019 Jul 7];26. Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6190486/
Dukkipati S, O’Neill WW, Harjai KJ, Sanders WP, Deo D, Boura JA, et al. Characteristics of cerebrovascular accidents after percutaneous coronary interventions. J Am Coll Cardiol. 2004 Apr 7;43(7):1161–7.
Wong SC, Minutello R, Hong MK. Neurological Complications Following Percutaneous Coronary Interventions (A Report from the 2000–2001 New York State Angioplasty Registry). Am J Cardiol. 2005 Nov 1;96(9) :1248–50.
Singh M, Rihal CS, Lennon RJ, Garratt KN, Holmes DR. Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions. J Am Coll Cardiol. 2004 Jul 21;44(2):357–61.
Kiatchoosakun S, Keelapang P, Kaewsuwana P, Chotinaiwattarakul C, Piumsomboon C. Percutaneous coronary intervention in the elderly: results from the Thai National Percutaneous Coronary Intervention Registry (TPCIR). EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 2010 Nov;6(5):611–5.
Wu AH, Parsons L, Every NR, Bates ER. Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: A report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol. 2002 Oct 16;40(8):1389–94.
Mamas MA, Anderson SG, O’Kane PD, Keavney B, Nolan J, Oldroyd KG, et al. Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. Eur Heart J. 2014 Nov 14;35(43):3004–12.
Andersen K, Bregendahl M, Kaestel H, Skriver M, Ravkilde J. Haematoma after Coronary Angiography and Percutaneous Coronary Intervention via the Femoral Artery Frequency and Risk Factors. Eur J Cardiovasc Nurs. 2005 Jun 1;4(2):123–7.
Kelly DJ, Gershlick T, Witzenbichler B, Guagliumi G, Fahy M, Dangas G, et al. Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: The HORIZONS-AMI trial. Am Heart J. 2011 Oct 1;162(4):663–70.
Lee J-M, Park S-Y, Choi J-H, Kim U-J, Rew S-J, Cho JY, et al. Clinical Risk Factors for Upper Gastrointestinal Bleeding after Percutaneous Coronary Intervention: A Single-Center Study. Gut Liver. 2016 Jan;10(1):58–62.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-77.
French JK, Armstrong PW, Cohen E, Kleiman NS, O’Connor CM, Hellkamp AS, et al. Cardiogenic shock and heart failure post– percutaneous coronary intervention in ST-elevation myocardial infarction: Observations from “ Assessment of Pexelizumab in Acute Myocardial Infarction”. Am Heart J. 2011 Jul 1;162(1):89–97.
Harjola V-P, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015; 17(5):501–9.
Albanese M, Alpaslan K, Ouarrak T, Merguet P, Schneider S, Schöls W. In-hospital major arrhythmias , arrhythmic death and resuscitation after successful primary percutaneous intervention for acute transmural infarction: a retrospective single-centre cohort study. BMC Cardiovasc Disord [Internet]. 2018 Jun 14 [cited 2019 Jul 21];18. Available from: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC6001058/
Mehta RH, Yu J, Piccini JP, Tcheng JE, Farkouh ME, Reiffel J, et al. Prognostic Significance of Postprocedural Sustained Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial). Am J Cardiol. 2012 Mar 15;109(6):805–12.
Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutane ous Coronary Interventions. JACC Cardiovasc Interv. 2014 Jan;7(1):1–9.
Kooiman Judith, Seth Milan, Dixon Simon, Wohns David, LaLonde Thomas, Rao Sunil V., et al. Risk of Acute Kidney Injury After Percutaneous Coronary Interventions Using Radial Versus Femoral Vascular Access. Circ Cardiovasc Interv. 2014 Apr 1;7(2):190–8.
Song F, Sun G, Liu J, Chen J, He Y, Liu L, et al. Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial. Trials [Internet]. 2019 May 27 [cited 2019 Jul 20];20. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6537180/
Acharya T, Salisbury AC, Spertus JA, Kennedy KF, Bhullar A, Reddy HKK, et al. In-Hospital Outcomes of Percutaneous Coronary Intervention in America’s Safety Net: Insights From the NCDR Cath-PCI Registry. JACC Cardiovasc Interv. 2017 Aug 14;10(15):1475–85.
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2019-10-04
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