Outpatient cardiac catheterisation.
Outpatient cardiac catheterisation.
复制标题
门诊心导管检查。
DOI：
10.1016/0167-5273(96)02554-5
复制
发表时间：
1996
影响因子：
3.5
通讯作者：
P. Adams
中科院分区：
文献类型：
--
作者：
J. Skinner;P. Adams
心脏导管插入术越来越多地在门诊进行。大多数门诊心脏导管插入术系列都是在可以立即进行心血管手术的实验室进行的。然而，一些单位可能会被放置得更远，尽管通常仍然靠近医院。与住院手术相比，门诊心脏导管插入术增加了床位可用性，并有相当大的经济回报，建议节省11-54%的住院费用。大多数患者对门诊手术感到满意，尽管有四分之一的患者在手术后可能有未回答的问题，但这一水平可能与住院患者的情况没有什么不同。没有足够大的研究来检测在任何情况下都不常见的主要并发症发生率的差异，并且在门诊手术后的轻微并发症发生率方面，研究之间存在相当大的差异。在唯一一项将所有合格患者随机分配至住院（189例患者）或门诊（192例患者）手术的研究中，7例门诊患者（3.6%）在活动期结束时发生经皮股动脉穿刺部位出血或血肿，1例患者晕厥。这些事件被认为是在门诊环境中进行手术的直接结果。在不同的系列中，认为符合门诊心脏导管插入术条件的患者比例从20%到80%以上变化很大。尽管其中一些差异可能是由于对患有潜在严重疾病的患者实施了不同的排除标准，但差异如此之大，以至于很可能研究了不同的人群。计划外入院率从不到1%到近19%不等。根据目前可用的数据，无法得出排除所有有并发症风险的患者的绝对指南，但美国心脏病学会/美国心脏协会（ACC/AHA）工作组最近发布了指南，确定了适合门诊手术的低风险患者。这些指南已被用于在美国的两个移动的单位选择患者进行研究，只有0.9%的患者因临床不稳定需要紧急转移，0.6%的患者发生严重并发症。然而，大多数患者不需要转诊到三级中心进行额外手术，与美国相比，在英国ACC/AHA指南中选择患者的范围可能较小。
Cardiac catheterisation is increasingly performed in an outpatient setting. The majority of series of outpatient cardiac catheterisation are in laboratories with immediate access to cardiovascular surgery. However, some units may be sited more distantly, although still generally close to a hospital. Compared to an inpatient procedure, outpatient cardiac catheterisation increases bed availability and there are considerable financial rewards with suggested savings of 11–54% of inpatient costs. Most patients are satisfied with an outpatient procedure and, although a quarter may have unanswered questions afterwards, this level may not differ from that found with inpatients. No study has been large enough to detect differences in the major complication rate which occur infrequently in whichever setting, and there is considerable variation between studies in the incidence of minor complications after outpatient procedures. In the only study which randomised all eligible patients to an inpatient (189 patients) or outpatient (192 patients) procedure, seven outpatients (3.6%) suffered bleeding or developed haematomas at the site of percutaneous femoral artery puncture towards the end of the mobilisation period and one patient was syncopal. These events were thought to be a direct result of the procedure being carried out in the outpatient setting. The proportion of patients considered eligible for outpatient cardiac catheterisation varies widely between different series from 20% to more than 80%. Whereas some of this variation may result from the implementation of different exclusion criteria for patients with potentially severe disease, the differences are so large that it is likely that different populations were studied. Unplanned admission rates varied from less than 1% to nearly 19%. With the currently available data no absolute guidelines can be derived to exclude all patients at risk of complications, but the American College of Cardiology/ American Heart Association (ACC/AHA) task force recently published guidelines which identified low risk patients suitable for outpatient procedures. These guidelines have been used to select patients for investigation in two mobile units in the USA, and only 0.9% required urgent transfer for clinical instability, and 0.6% developed major complications. However, most patients did not need referral to a tertiary centre for additional procedures and there may be less scope for selecting patients within the ACC/AHA guidelines in the UK compared with the USA.