硝酸甘油联合利多卡因混合液缓解桡动脉痉挛的临床观察

Clinical observation on nitroglycerin combined with lidocaine in the alleviation of radial artery spasm

目的分析硝酸甘油和利多卡因混合液皮下注射治疗冠状动脉造影及介入治疗前桡动脉穿刺痉挛的临床疗效。方法回顾性分析南阳市中心医院及陆军总医院于2005年7月~2015年7月行冠状动脉造影及介入治疗时桡动脉穿刺时出现桡动脉痉挛的冠心病患者1476例,按照入院的先后顺序分为3组,试验1组626例,予以硝酸甘油2.5 mg+利多卡因混合液1ml皮下注射;试验2组367例,予以硝酸甘油5 mg+利多卡因混合液1 ml皮下注射;试验3组483例,仅予以利多卡因注射液1 ml皮下注射。观察并记录三组患者桡动脉搏动恢复、穿刺成功的几率以及术中低血压的发生率。结果试验1组桡动脉穿刺成功558例,穿刺成功率92.3%;试验2组桡动脉穿刺成功332例,穿刺成功率90.5%;试验3组桡动脉穿刺成功157例,穿刺成功率32.5%;术中试验1组低血压24例,发生率3.8%,试验2组低血压46例,发生率12.5%,试验3组低血压3例,发生率0.6%,三组比较差异有统计学意义(P<0.05)。结论冠状动脉造影及介入治疗时桡动脉穿刺时一旦出现痉挛,给予硝酸甘油2.5 mg及利多卡因混合液皮下注射,可以大大缓解桡动脉痉挛,增加桡动脉穿刺成功率,且术中低血压发生率明显减少,安全性高。

Objective To investigate the clinical effect of nitroglycerin combined with lidocaine in the alleviation of radial artery spasm during puncture before coronary angiography. Methods We retrospectively analyzed 1476 patients with coronary heart disease（CHD） from July 2005 to July 2015. All the radial artery spasm occurred after radial artery puncture before coronary angiography and interventional therapy. Patients were divided into 3 groups. Group 1 included 626 patients, received nitroglycerin 2.5 mg ＋ lignocaine 1 ml; group 2 included 367 patients, received nitroglycerin 5 mg ＋ lignocaine 1 ml; group 3 included 483 patients, received lidocaine 1 ml only. The rate of radial pulse recovery, the chance of success and the incidence of intraoperative hypotension were recorded. Results The rate of radial pulse recovery and the chance of success in group 1 was greater than those of group 2 and group 3. The rate of the incidence of intraoperative hypotension in group 1 and group 3 were significantly less than that of group 2. The differences between three groups are statistically significant（P 0.05）. Conclusion When radial artery spasm occurred after radial artery puncture before coronary angiography and interventional therapy, nitroglycerin 2.5 mg and lidocaine can greatly alleviate the radial artery spasm, increase the radial artery puncture success rate and significantly reduce the incidence of intraoperative hypotension.