阿托品对冠状动脉介入术后拔除动脉鞘管所致心血管迷走反射的防治作用

Preventive effect of atropine on cardiovascular vagal reflex during arterial sheath removal after percutaneous coronary intervention

目的 探讨阿托品对冠状动脉介入手术（PCI）术后拔除动脉鞘管所致心血管迷走反射（CVVRS）的防治作用.方法 选取经股动脉、桡动脉途径PCI治疗的患者683例,按照拔鞘前不同药物处理方式进行分组,对照组（拔鞘前予0.9％氯化钠注射液水化）经桡动脉途径拔鞘119例、经股动脉途径拔鞘105例;预防1组（拔鞘前给2％利多卡因鞘管周围浸润麻醉）经桡动脉途径拔鞘115例、经股动脉途径拔鞘118例;预防2组（拔鞘前给阿托品0.5mg皮下注射）经桡动脉途径拔鞘112例、经股动脉途径拔鞘114例.观察患者在拔除动脉鞘管时CVVRS的发生情况.结果 经桡动脉途径与经股动脉途径CVVRS的发生率差异有统计学意义（x2=4.633,P＜0.05）,经股动脉PCI更容易出现血管迷走反射.经桡动脉途径的不同预处理方式CVVRS的发生率差异无统计学意义（x2=3.998,P＞0.05）.经股动脉途径者中预防1组与对照组CVVRS的发生率差异无统计学意义（x2=2717,P＞0.05）;预防2组与对照组间差异有统计学意义（x2=5.765, P＜0.05）,CVVRS的发生率低于对照组.结论 经桡动脉途径CVVRS发生率明显低于经股动脉途径.PCI术后应用阿托品提高心率能有效预防股动脉途径拔鞘所致的CVVRS.

Objective To investigate the preventive of atropine on cardiovascular vagal reflex during removing arterial sheath after percutaneous coronary intervention. Methods Total 683 patients undergoing percutaneous coronary intervention through radial or femoral arteries were enrolled in the study. They were divided into prevention group 1（through radial artery in 115 cases and through femoral artery in 118 cases）, prevention group 2 （through radial artery in 112 cases and through femoral artery in 114 cases） and control group （through radial artery in 119 cases and through femoral artery in 105 cases）. Before removing the arterial sheath, 2% lidocaine was applied for infiltration anesthesia in prevention group 1, 0.5 mg atropine was injected subcuta- neously in prevention group 2, and normal saline was given in control group, Results The incidence of cardiovascular vagal re- flex in patients via radial artery was significantly less than that in patients via femoral artery（P〈0.05）. There was no significant dif- ference in incidence of vasovagal reflex among 3 groups in patients via radial artery （P 〉0.05）. In patients via femoral artery there was significant difference in incidence of vasovegal reflex between prevention group 2 and control group （P〈0.05）, while there was no significant difference between prevention group 1 and control group （P 〉0.05）. Conclusion Radial artery approach is superior to femoral approach in prevention of cardiovascular vagal reflex; and subcutaneous injection of 0.5 mg atropine before the removing arterial sheath may prevent vagal reflex in percutaneous coronary intervention.