药物预防桡动脉痉挛(经桡动脉介入治疗)效果的观察

目的对经桡动脉介入术患者进行硝酸甘油、维拉帕米及地西泮干预,观察各组药物及相应药物联合干预的效果。方法选择经桡动脉介入检查或治疗的患者1200例,随机分为4组(A、B、C、D),A组予硝酸甘油200μg和维拉帕米1 mg;B组予硝酸甘油200μg;C组予维拉帕米1 mg;D组为对照组予生理盐水。每组随机分为2亚组(A1、A2;B1、B2;C1、C2;D1、D2),1组术前30 min给予地西泮0.15 mg/kg(年龄>65岁剂量减半),2组不应用地西泮。分别观察各组内和组间患者桡动脉痉挛发生情况。结果实际入选病例数1167例,平均年龄(65.7±8.3)岁,男621例,女546例;桡动脉痉挛发生率A1(3.4%),A2(4.1%);B1(4.2%),B2(5.4%);C1(12.4%),C2(14.8%);D1(23.6%),D2(33.8%),组内无差异(P>0.05);组间比较,A1与B1无统计学意义(P>0.05),其他各组之间两两比较差异均有统计学意义(P<0.05)。结论硝酸甘油联合维拉帕米与单用硝酸甘油效果最佳,再次为单用维拉帕米,术前应用地西泮可减少桡动脉痉挛发生率不明确。故主张单独应用硝酸甘油,不必要术前常规应用地西泮。

Pharmacal Effect Observation in Radial Spasm Patients with Radial Intervention Treatment

Objective To observe the effect of nitroglycerin,Verapamil and diazepam preventing radial artery spasm which undergoing intervention through radial artery. Methods 1200 patients were selected randomly and divided into 4 groups（ A,B,C and D）. Group A were given nitroglycerin 200μg and Verapamil ling. Group B were given nitroglycerin 200μg. Group C were given Verapamil 1 mg. Group D were given normal sodium as control. Each group was divided into two subgroups（ N1 and N2 , N refers to A, B, C and D）. Group Nl was given diazepam 5rag i. m. half an hour before operation,and Group N2 was not given diazepam. The radial artery spasm was observed in different groups,and in subgroups. The recovery time in treated group and control group was observed when spasm occurred. Results （1）The fact involved patient were 1167, median age 59.5 ± 13.7years, 621 males,546 females. （2）The ratio of radial artery spasm A1 （ 3.4 % ）, A2 （ 4.1% ）, B 1 （4.2 % ）, B2 （ 5.4 % ）, C1 （ 12.4% ） , C2 （ 14.8% ） , D1 （ 23.6% ） , D2 （ 33.8% ） , there were no difference between subgroups （ P 〉 0.05 ）. （2）The ratio of radial artery spasm between subgroups in different groups were A1 〈 B1 〈 C1 〈 D1 ,A1 vs B1 （ P 〉 0.05 ）, and there was no difference, and Al vs C1 （ P 〈 0.05 ） , A1 vs D1 （ P 〈 0.05 ） , B1 vs Cl （ P 〈 0. 05 ）, B1 vs D1 （ P 〈 0.05 ） , C1 vs D1 （ P 〈 0.05 ）. （3）The recovery rate between treatment and control was different （P 〈 0.05 ）. Conclusion The effect with nitroglycerin and verapamil or alone with nitroglycerin to prevent radial spasm is the best methods, and at last with verapamil, It is uncertain that applying diasepam before PCI can reduce ratio of radial spasm. We recommend that nitroglycerin be used alone before PCI because there is no significant difference between nitroglycerin group and combination medicine group. It is recommended that nitroglycerin should be used alone before PCI through radial artery. It is not re