桡动脉痉挛分析及药物干预试验

目的通过桡动脉造影法观察桡动脉痉挛(RAS)的相关因素,比较不同配方血管解痉剂对于RAS的效果。方法接受经桡动脉途径介入治疗(TRI)的患者180例,其中男性97例,女性83例。随机分入硝酸甘油组(硝酸甘油200μg),尼卡地平组(尼卡地平200μg),鸡尾酒组(硝酸甘油100μg+尼卡地平100μg),每组60例。在常规桡动脉造影后分别经鞘给予协定药物。给药后1、2 min分别行桡动脉造影。以方差分析法比较3组患者给药前、给药后1、2 min RAS发生率的变化。桡动脉痉挛程度通过计算机定量分析法(QCA)测得,桡动脉狭窄>70%定义为桡动脉痉挛,出现导管因痉挛发生推送、旋转困难以及拔管时阻力大、疼痛等临床表现定义为临床桡动脉痉挛。用Logistic回归分析桡动脉痉挛相关因素。结果 180例患者桡动脉正常参考段内径在基线水平为1.08～3.76 mm,平均为(2.24±0.52)mm。用药前RAS总发生率为10.6%,临床RAS发生率为6.2%。桡动脉直径、桡动脉鞘直径及既往TRI术≥2次是RAS的独立相关因素。硝酸甘油组、尼卡地平组和鸡尾酒组在桡动脉穿刺后RAS的发生率分别为15.0%、8.3%和8.3%,给药后1 min分别降至3.3%、5.0%和1.7%,给药后2 min分别降至1.7%、3.3%和0%。硝甘-尼卡组、尼卡-鸡尾酒组RAS发生率差异有统计学意义,但硝甘-鸡尾酒组桡动脉RAS发生率差异无统计学意义。结论 RAS总发生率为10.6%,其独立相关因素包括桡动脉直径、桡动脉鞘外径及既往TRI术≥2次。硝酸甘油及尼卡地平均具有明显扩张桡动脉的作用,但硝酸甘油及两者联合应用比单用尼卡地平有更大优势。

Radial artery spasm and vasodilator intervention

Objective To study the risk factors of radial artery spasm(RAS) and the effects of different vasodilators on RAS. Methods One hundred and eighty patients(97 males and 83 females) underwent transradial coronary angiography or intervention(TRI) were enrolled and randomly divided into three groups:nitroglycerin group(n=60),nicardipine group(n=60) and cocktail group(n=60).Radial arteriography was performed through the sheath at baseline.Then nitroglycerin 200 μg(nitroglycerin group),or nicardipine 200 μg(nicardipine group) or nitroglycerin 100 μg plus nicardipine 100 μg(cocktail group) were injected into right radial arteries through the sheath.Radial arteriography was repeated 1 min and 2 min after injection of vasodilators.RAS incidence was compared at baseline,1 min and 2 min after injection of vasodilators by one-way ANOVA among three groups.Stenosis of radial artery in diameter was measured by quantitative computed analysis(QCA) method on radial arteriography.RAS was defined as stenosis >70% in diameter and clinical RAS defined as patients′ feeling of pain or marked resistance when advancing or withdrawing catheters.Logistic regression analysis was used to assess the risk factors of RAS. Results The incidence of RAS and clinical RAS in all patients at baseline was 10.6% and 6.2%,respectively.Diameter of radial artery,sheath profile and previous TRI were independent risk factors of RAS.The incidence of RAS at baseline(15.0%,8.3% and 8.3%,all P>0.05) and 1 min after injection of vasodilators(3.3%,5.0% and 1.7%,P>0.05) was similar among the three groups.The incidence of RAS in nitroglycerin group(1.7%) and cocktail group(0%) was significantly lower than in nicardipine group(3.3%)(both P<0.05) at 2 min after injection. Conclusions Diameter of radial artery,sheath profile and previous TRI were independent risk factors of RAS.Injection of nitroglycerin or nitroglycerin plus nicardipine is more effective than nicardipine alone in releasing RAS.