利多卡因-硝酸甘油混合溶液在桡动脉穿刺中的临床应用观察

Clinical Observation on the application of mixed Solution with Lidocaine and Nitroglycerin in Radial Artery Puncture

目的:探讨利多卡因-硝酸甘油混合溶液局部皮下注射,改善桡动脉痉挛、提高穿刺成功率的有效性和安全性。方法:选取2013年5月至2015年5月北京军区总医院心血管内科住院行经桡冠状动脉介入诊疗术、并在穿刺过程中发生桡动脉痉挛的患者214例,随机将患者分为实验组和对照组,实验组给予1%利多卡因1.5mL+硝酸甘油注射液0.5mL(2.5mg)混合溶液、对照组给予1%利多卡因注射液2mL,于穿刺部位皮下沿桡动脉走形局部浸润注射,记录两组患者注射药物前后桡动脉搏动、血压以及心率等变化。结果:两组患者性别、年龄、高血压、心肌梗死、糖尿病、吸烟、LVEF、肌酐和C反应蛋白等一般资料的比较,差异无统计学意义(P>0.05)。穿刺时间:实验组5.21±1.119min,对照组8.32±1.506min,实验组的穿刺时间低于对照组,差异有统计学意义(P=0.000)。穿刺次数:实验组4.33±1.014次,对照组6.29±1.324次,实验组的穿刺次数明显低于对照组,差异有统计学意义(P=0.000)。桡动脉复跳时间:实验组1.79±0.399min,对照组3.36±0.629min,实验组的桡动脉复跳时间明显短于对照组,差别有统计学意义(P=0.000)。穿刺成功率:实验组94.44%,对照组81.13%,实验组穿刺成功率明显高于对照组,差异有统计学意义(P=0.003)。局部给药后,两组患者均无低血压、头晕、头痛、新发心律失常等不良反应发生。结论:局部皮下注射1%利多卡因1.5mL+硝酸甘油0.5mL(2.5mg)混合溶液可较好地改善桡动脉痉挛、显著提高穿刺成功率、减少穿刺次数、缩短穿刺时间,且无明显不良反应发生,安全有效,值得临床推荐使用。

Objective：To explore the efficacy and safety of subcutaneous injection of lidocaine-nitro- glycerin mixed solution to relieve radial artery spasm and improve the success rate of puncture. Method ： A to- tal of 214 patients with radial artery spasm during the course of puncture, from May 2013 to May 2015 in the cardiology of Beijing Military General Hospital, were randomly divided into experimental group and control group. The patients in the experimental group were given 1% lidocaine 1.5ml ＋ nitroglycerin injection 0.5ml （2.5mg） mixed solution subcutaneous injection, and the patients in the control group were given 1% lidocaine injection 2ml subcutaneous injection. Record the changes of radial artery pulsation,blood pressure and heart rate before and after treatment. Results： There was no significant difference in age, sex, hypertension, myo- cardial infarction,diabetes mellitus, smoking, LVEF, serum creatinine and high sensitivity C-reactive protein between the two groups （P〈0.05}. The time of puncture was 5.21 ±1.119 min in the experimental group and 8.32± 1.506 rain in the control group. The puncture time of the experimental group was significantly lower than that of the control group （P = 0.000}. The number of puncture was 4.33±1.014 in the experimental group and 6.29±1.324 in the control group. The difference was statistically significant （P = 0.000）. The time of recovery pulsation of radial artery was 1.79±0.399 min in the experimental group and 3.36±0.629 min in the control group. The time of recovery pulsation of radial artery in the experimental group was significantly shorterthan that in the control group. The difference was statistically significant （P= 0.000）. （5） The success rate of puncture was 94.44% in the experimental group and 81.13% in the control group. The difference was statistically significant （P = 0.003）. Before and after treatment, there were no Significant change in blood pres- sure, headache, new arrhythmia and other adverse reactions of the two groups. Conclusion： The subcutaneous injeCtion of 1% lidocaine 1.5ml＋ 0.5ml nitroglycerin （2.5mg） mixed solution can effectively improve the ra- dial artery spasm, improve the success rate of puncture, reduce the number of puncture, and shorten the time of puncture, with no obvious adverse reaction. Which is safe and effective, worthy of recommendation to use.