经桡动脉行冠状动脉介入过程中小剂量芬太尼联合咪唑安定预防桡动脉痉挛的临床效果

Effect of small dose of fentanyl combined with midazolam on prevention of radial artery spasm during transradial coronary intervention

目的探讨剂量芬太尼联合咪唑安定预防桡动脉痉挛的效果。方法将1 806例经桡动脉行冠状动脉介入手术患者随机分为药物组及对照组。药物组常规给予静脉注射芬太尼及咪唑安定,对照组不给任何药物。记录并比较2组桡动脉痉挛发生率、血管并发症、30 d内患者死亡率、再住院率等指标。结果药物组桡动脉痉挛发生率为2.5%,显著低于对照组的8.8%(P<0.001)。2组患者舒适度有显著差异(P<0.001)。2组患者30 d内死亡率或再住院率无显著差异(P>0.05)。多因素分析结果显示,影响桡动脉痉挛因素主要与性别、身高、肥胖、吸烟、导管使用数量、手术方式及手术复杂程度相关。结论小剂量芬太尼联合咪唑安定能够明显降低桡动脉痉挛的发生率、血管并发症,30 d内死亡率及再住院率并无增加。

Objective To explore the effect of small dose of fentanyl combined with midazo-lam on prevention of radial artery spasm.Methods 1086 patients with elective transradial percuta-neous coronary intervention were randomly divided into medicine group and control group.The medicine group was treated with conventional intravenous injection of fentanyl and midazolam.Inci-dence rate of radial spasm,vascular complications and mortality rate or re-hospitalization rate with-in 30 days were recorded and compared between two groups.Results Incidence rate of radial spasm in medicine group was 2.5%,which was significantly lower than 8.8% in the control group （P 〈0.001）.There were no significant differences in aspects of VAS score,mortality rate and re-hos-pitalization rate between two groups.Multivariate analysis showed that there were obvious correla-tion between incidence of radial spasm and gender,height,obesity,smoking,numbers of tubes, surgical way and difficulty of operation.Conclusion Small dose of fentanyl combined with midazo-lam during transradial interventional procedures can significantly reduce the incidence of radial spasm and vascular complications,and it won’t cause increasing of mortality rate and re-hospitalization rate.