地尔硫与硝酸甘油联用预防桡动脉痉挛的临床研究

Clinical study on the effect of diltiazem combined with nitroglycerin for prevention of radial artery spasm

目的:探讨地尔硫与硝酸甘油联用在预防经桡动脉介入诊疗中桡动脉痉挛的临床效果。方法:选取选2005年10月-2011年12月宜昌市中心人民医院医院心内科住院接受经桡动脉冠状动脉介入检查及治疗的患者803例,按数字表法随机将患者分为A组(地尔硫卓芯5 mg、264例)、B组(硝酸甘油200μg、271例)和C组(地尔硫芯卓5 mg+硝酸甘油200μg、268例)。A组常规动脉鞘内注入地尔硫卓芯5 mg、B组常规动脉鞘内注入硝酸甘油200μg和C组常规动脉鞘内注入地尔硫5mg+硝酸甘油200μg,然后行冠状动脉造影术(CAG)和经皮冠状动脉介入治疗(PCI)。记录各组患者注入药物前后患者血压、心率及桡动脉痉挛和不良反应。结果:A组和B组桡动脉痉挛发生率没有明显差异(5.5%∶4.9%,P>0.05),C组明显低于A组(2.8%∶3.5%,P<0.05)和B组(2.9%∶3.5%,P<0.05)。不良反应B组(4.1%)和C组(5.3%)相似(P>0.05),均较少。A组不良反应发生率高于B组(8.4%∶4.80%,P<0.05)和C组8.4%∶5.3%,P<0.05)。结论:在经桡动脉介入诊疗中,联合使用地尔硫5 mg和硝酸甘油200μg可以更好地预防桡动脉痉挛,且不良反应相对较少,安全有效,比单一应用地尔硫或硝酸甘油具有明显优越性,值得临床推荐使用。

OBJECTIVE To study the clinical effect of diltiazem combined with nitroglycerin for the prevention of the radial artery spasm in interventional therapy via radial artery. METttOI）S 803 patients who accepted the interventional examination and interventional treatment of coronary vessels via the radial artery were selected. Patients were randomly divided into group A （diltiazem 5 mg, 264 cases）, B（nitroglycerin 200 μg,271 cases） and C （diltiazem 5 mg ＋ nitroglycerin 200 μg,268 cases） group： group A of intrathecal injection of routine artery 5 mg diltiazem,group B of intrathecal injection of routine artery 200μg nitroglycerin, and group C of intrathecal injection of routine artery 5 rng diltiazem and 200μg nitroglycerin; then carried out the coronary angiography （CAG） and PCI. The blood pressure, heart rate and radial artery spasm and adverse reactions in each group were recorded before and after injection of drugs. RESULTS The incidence of radial artery spasm between Group A and Group B was not difference significantly （5.5% vs 4. 9% ,P〉0. 05） the incidence of radial artery spasm of Group C was lower than that in group A （2. 8 % vs 3.5 %, P〈0. 05） and group B （2. 9% vs 3.5 %, P〈0. 05）, and the difference was significant. Adverse reactions were similar in group B（4. 1%） and C（5.3%） ,not much（P〉0. 05）. There were much more adverse reac- tions in group A than the other two groups （8. 4% vs 4. 80% or 8. 4% vs 5.3%,P〈0. 05）. CONCLUSION In transradial in- tervention for the diagnosis and treatment, the joint use of diltiazem 5 mg and nitroglycerin 200μg can better prevent from ra- dial artery spasr With relatively few adverse reactions, it is safe and effective, and has obviously more advantages than a sin- gle application of diltiazem or nitroglycerin, is worthy for recommendation.