复合应用硝酸甘油和利多卡因桡动脉周围浸润预防穿刺动脉痉挛的效果

Efficiency of periarterial infiltration with lidocaine-nitroglycerin mixture in preventing vasospasm after radial artery cannulation

目的比较桡动脉周围利多卡因浸润或硝酸甘油+利多卡因浸润对桡动脉穿刺痉挛的影响。方法桡动脉穿刺置管患者60例随机均分为三组,在超声引导下分别行动脉周围浸润:L组用1%利多卡因0.6ml,LN组用2%利多卡因0.3ml+硝酸甘油0.3ml(500μg),S组用生理盐水0.6ml。记录穿刺前后桡动脉直径,比较桡动脉痉挛的发生率和穿刺后的并发症。结果 LN组穿刺前后桡动脉直径变化值小于L组和S组[(0.2±2.6)mm vs.(3.8±1.9)mm和(5.5±2.0)mm](P<0.01)。LN组桡动脉痉挛的发生率低于L组和S组(15.0%vs.68.4%和89.5%)(P<0.01)。结论复合采用利多卡因和硝酸甘油行动脉周围浸润能有效预防桡动脉穿刺后痉挛。

Objective To investigate the efficiency of periarterial infiltration with lidocaine- nitroglycerin mixture in preventing vasospasm after radial artery cannulation. Methods Guided by ultrasound, radial artery puncture was performed in 60 patients undergoing surgery, who were equally randomized into three groups. The subcutaneous infiltration in the area around the radial artery was performed with a mixture of 2% lidocaine 0. 3 ml and nitroglycerin 0.3 ml（500 μg） in group LN,with 2% lidocaine 0. 6 ml in group L and with normal saline 0. 6 ml in group S. The diameter of the radial artery was measured by ultrasound before and after arterial cannulation. The incidence of vasospasm after radial artery cannulation was calculated and arterial puncture-related complications were recorded. Results The changes in arterial diameter were less in group LN than those in groups of L and S[（0. 2±2.6） mm vs. （3.8±1.9） mm and （5.5±2. 0） mini （P〈0. 01）. The incidence rate of vasospasm was less in group LN than those in groups of L and S（15.0% vs. 68. 40% and 89. 5%） （P〈0. 01）. Conclusion The subcutaneous infiltration with a mixture of 2% lidocaine 0.3 ml and nitroglycerin 0. 3 ml（500μg） in the area around the radial artery can effectively reduce the incidence of vasospasm after radial artery puncture and cannulation without adverse effect on the hemodynamics.