应用利多卡因外擦导管减少桡动脉痉挛的临床观察

目的:桡动脉痉挛是经桡动脉路径冠状动脉造影(CAG)和(或)介入治疗(PCI)的常见并发症之一。本研究旨在观察应用利多卡因外擦动脉鞘和造影导管,减少桡动脉痉挛的临床疗效。方法:将连续237例接受经桡动脉路径CAG/PCI的患者随机分为两组,分别于动脉鞘和造影/导引导管插入前应用2%利多卡因溶液(118例,利多卡因组)或0.9%氯化钠溶液(119例,对照组)外擦其表面。主要观察终点:严重桡动脉痉挛(导管推进或操作困难并伴前臂疼痛、桡动脉造影示管腔内径狭窄>70%)发生率。次要终点:前臂出血或血肿、患者不适程度以及操作成功率。结果:利多卡因组5例(4.2%)和对照组16例(13.4%)发生严重桡动脉痉挛(P=0.013);利多卡因组中无一例发生前臂出血或血肿,但对照组中3例前臂轻度出血(表现为造影剂外渗)和1例局部血肿形成,均经局部加压包扎后好转;利多卡因组因疼痛引起的重度不适减少;两组CAG/PCI均成功。结论:CAG/PCI时,应用2%利多卡因溶液外擦动脉鞘和造影/导引导管可能是一种减少严重桡动脉痉挛及其相关并发症的简易方法。

Prevention of radial artery spasm with a lidocaine gauze swab during transradial coronary angiography/intervention

Objective:Radial artery spasm is one of the most common complications during transradial coronary angiography and/or percutaneous coronary intervention(CAG/PCI).This study investigated whether direct wiping of arterial sheath and angiographic catheters with a lidocaine gauze swab before insertion could reduce the occurrence of severe radial artery spasm. Method:Two hundred and thirty-seven consecutive patients undergoing transradial CAG/PCI were randomly divided into 2 groups.Before inserting into radial artery,the arterial sheath and angiographic catheters were wiped with a gauze swab of lidocaine(n=118;lidocaine group) or normal saline(n=119;control group).The primary endpoint was the rate of severe radial artery spasm defined as difficulties in pushing and manipulating the catheter with severe arm pain and angiographic radial artery diameter narrowing of >70%.The second endpoints included brachial hemorrhage(exudation of contrast media) or hematoma,degree of discomfort,and procedural success rate. Result:Despite similar baseline characteristics and types of catheterization/intervention,the rate of severe radial artery spasm was significantly lower in the lidocaine group(5 cases,4.2%) than in controls(16 cases,13.4%)(P=0.013).None in the lidocaine group but 4 patients in the control group(exudation of contrast media in 3 and hematoma in 1) had brachial bleeding,which was recovered successfully by local compression.The rate of severe discomfort was lower in the lidocaine group.All patients underwent successful CAG/PCI. Conclusion:Direct wiping of the arterial sheath and angiographic catheters with a lidocaine gauze swab before insertion reduces the occurrence of radial artery spasm.This simple method should prove practically useful during routine transradial CAG/PCI.