皮下注射硝酸甘油应用于经鼻烟壶区桡动脉置管的随机对照研究

doi:10.20047/j.issn1673-7210.2023.31.04

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摘要目的探究皮下注射硝酸甘油在经鼻烟壶区桡动脉穿刺置管操作中的临床价值。方法选取2021年7月至2023年2月广东省中医院珠海医院拟行经皮冠脉造影术的患者205例，采用数字奇偶法随机将其分为对照组（102例）和研究组（103例）。对照组穿刺处皮下注射利多卡因与盐水混合液，研究组穿刺处皮下注射利多卡因与硝酸甘油混合液，比较两组动脉管腔长、短径，首针穿刺成功比例、穿刺针数、置管成功时间、置管成功率、血管痉挛发生率、鞘管型号比例、血肿发生率、术后24 h桡动脉闭塞发生率。结果两组给药后平均动脉压差、心率差比较，差异无统计学意义（P＞0.05）；研究组血管痉挛发生率低于对照组，置管成功率高于对照组，差异有统计学意义（P＜0.05）；局麻后，研究组鼻烟壶区桡动脉管腔长、短径长于局麻前血管痉挛发生率低于对照组，差异有统计学意义（P＜0.05），对照组局麻前后比较，差异无统计学意义（P＞0.05）；局麻后，研究组鼻烟壶区桡动脉管腔长、短径长于对照组，差异有统计学意义（P＜0.05）；研究组鞘管型号比例、首针穿刺成功比例、穿刺针数、置管成功时间、术中肝素用量及压迫止血时间比较，差异无统计学意义（P＞0.05）；两组术后血管痉挛发生率、术口血肿、前臂血肿、近桡闭塞、远桡闭塞、夹层、超声管腔直径比较，差异无统计学意义（P＞0.05）。结论经鼻烟壶区桡动脉穿刺置管术前皮下注射硝酸甘油能扩张动脉，减少置管前桡动脉痉挛发生，提高置管成功率，具有良好的安全性，值得临床推广使用。

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	刘培中1　　梁宇鹏1▲　　李文金1　　魏超1　　李创鹏1　　杨平1　　彭瑟1　　郭艺膨2

关键词 ：鼻烟壶区, 远端桡动脉, 硝酸甘油, 冠脉造影术, 冠脉介入治疗

Abstract：Objective To investigate the clinical value of subcutaneous Nitroglycerin injection in radial artery catheterization through the snuff box area. Methods A total of 200 patients with percutaneous coronary angiography in Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine Zhuhai Hospital from July 2021 to February 2023 were selected, they were randomly divided into control group (102 cases) and study group (103 cases) by digital parity method. The control group was injected a mixture of subcutaneously with Lidocaine and saline solution at the puncture site, while the study group was injected a mixture of Lidocaine and Nitroglycerin subcutaneously at the puncture site. The length and short diameter of the artery lumen, the successful proportion of first needle puncture, the number of puncture needles, the successful time of catheterization, the success rate of catheterization, the incidence of vasospasm, the proportion of sheath tube types, the incidence of hematoma, and the incidence of radial artery occlusion 24 h after surgery. Results There were no significant differences in mean arterial pressure difference, heart rate difference between two groups after administration (P＞0.05). The incidence of vasospasm in the study group was lower than that in the control group, the success rate of catheterization in the study group was higher than that in the control group, the difference was statistically significant (P＜0.05). After local anesthesia, the length and short diameter of the radial artery lumen in the snuff bottle area of the study group were significantly longer than those before local anesthesia, the differences were statistically significant (P＜0.05), while the difference was not statistically significant in the control group (P＞0.05). After local anesthesia, the length of the radial artery lumen in the snuff bottle area of the study group was longer than that of the control group, the difference was statistically significant (P＜0.05). There were no significant differences in the proportion of sheath type, successful proportion of first needle puncture, number of puncture needles, successful catheterization time, intraoperative heparin dosage, and pressure hemostasis time among groups (P＞0.05). There was no significant difference in the incidence of postoperative vasospasm, operative hematoma, forearm hematoma, near radial occlusion, far radial occlusion, dissection, and ultrasonic lumen diameter between the two groups (P＞0.05). Conclusion Subcutaneous injection of Nitroglycerin before radial artery catheterization through the snuff pot area can dilate the artery, reduce the occurrence of radial artery spasm before catheterization, improve the success rate of catheterization, and have good safety, which is worthy of clinical popularization.

Key words： Snuff box area Distal radial artery Nitroglycerin Coronary angiography Coronary intervention therapy

基金资助:广东省医学科学技术研究基金资助项目（A2020514、B2021044）。

通讯作者: ▲通讯作者

引用本文:

刘培中1　　梁宇鹏1▲　　李文金1　　魏超1　　李创鹏1　　杨平1　　彭瑟1　　郭艺膨2. 皮下注射硝酸甘油应用于经鼻烟壶区桡动脉置管的随机对照研究[J]. 中国医药导报, 2023, 20(31): 25-29,91.
LIU Peizhong1 LIANG Yupeng1▲ LI Wenjin1 WEI Chao1 LI Chuangpeng1 YANG Ping1 PENG Se1 GUO Yipeng2. A randomized controlled study of subcutaneous Nitroglycerin injection for radial artery catheterization in the snuff box area. 中国医药导报, 2023, 20(31): 25-29,91.

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