经桡动脉介入诊疗联合地尔硫和硝酸甘油防治桡动脉痉挛有效性和安全性临床观察

目的对比研究经桡动脉路径行冠状动脉介入诊疗,经桡动脉应用硝酸甘油、地尔硫及联合地尔硫和硝酸甘油防治桡动脉痉挛的有效性及安全性。方法 220例经绕动脉路径行冠状动脉诊疗患者,成功置入动脉鞘管后在鞘管内注入硝酸甘油200μg,地尔硫5mg,联合硝酸甘油200μg和地尔硫2.5mg,用心电血压监护仪记录注入药物前、注入后患者最高（或最低）心率、最低血压、心电及观察桡动脉痉挛、局部和全身症状发生情况。结果①联合药物组桡动脉痉挛发生率、局部和全身症状发生率均低于硝酸甘油组和地尔硫组,组间差异均有统计学意义;②联合药物组对心率和心电的影响低于硝酸甘油组和地尔硫组,但3组间对血压的影响无统计学意义。结论经桡动脉介入治疗时,局部联合应用硝酸甘油和地尔硫可以更有效防治桡动脉痉挛的发生,并且对心率、血压和心电无明显影响,且患者耐受能力好,并发症少,比单一应用硝酸甘油或地尔硫具有明显的优越性,易为患者所接受。

Efficacy and safety of diltiazem and nitroglycerin during trans-radial approach coronary intervention

Objective To investigate the efficacy and safety of diltiazem and nitroglycerin when injected into the radial artery in order to avoid radial artery spasm during the trans-radial approach for coronary intervention.Methods 220 patients who had arranged to coronary intervention by the trans-radial approach in our hospital were randomly divided into 3 groups：diltiazem 5mg,nitroglycerin 200μg and diltiazem 2.5mg plus nitroglycerin 200μg was injected into the radial artery after radial artery vaso-sheath was planted successfully.The heart rate,the blood pressure,and electrocardiogram were recorded.Furthermore,radial artery spasm and general condition was observed.Results ①Radial artery spasm and bad general conduction in the diltiazem plus nitroglycerin group were significantly less than diltiazem group and nitroglycerin group.②The variance of the blood pressure did not show statistical notability among the 3 the groups.However,the influences of the electrocardiogram and heart rate in the combination group were lower than diltiazem group and nitroglycerin group.Conclusion During the trans-radial approach for coronary intervention,diltiazem 2.5mg plus nitroglycerin 200μg was injected into the radial artery can avoid radial artery spasm effectively and has no effect on patient′s heart rate,the blood pressure and electrocardiogram,and it had been easier accepted by patients than diltiazem or nitroglycerin because of the less complication and bad general condition.