利多卡因外擦导管预防桡动脉痉挛的临床分析

目的 研究在经桡动脉冠状动脉介入诊疗中应用利多卡因外擦动脉鞘管和造影(导引)导管对预防桡动脉痉挛(RAS)的有效性。 方法 选取2013年11月至2014年8月经桡动脉途径行冠状动脉造影(CAG)和CAG+经皮冠状动脉介入治疗(PCI)的患者429例,采用随机对照单盲实验,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(215例,观察组)或 0.9%氯化钠溶液 (214例,对照组)外擦其表面。记录并比较两组桡动脉痉挛的发生率。 结果 实际入选病例为观察组213例,对照组213例。手术用时观察组明显低于对照组(P<0.05);行单纯CAG,观察组的RAS发生率低于对照组(5.3% vs 12.8%,P<0.05);行CAG+PCI,观察组的RAS发生率低于对照组(4.8% vs 19.2%,P<0.05);总RAS发生率,观察组的RAS发生率低于对照组(5.2% vs 14.6%,P<0.05),差异均有统计学意义。 结论 经桡动脉途径行冠脉介入诊疗过程中,利多卡因溶液外擦介入导管表面可以有效防止桡动脉痉挛的发生。

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

Objective To investigate the effect of the prevention of radial artery spasm(RAS) with a lidocaine gauze swab during transradial coronary angiography/intervention. Methods A total of 429 patients treated with simple coronary angiography (CAG) or CAG and percutaneous coronary intervention (PCI) from November 2013 to August 2014 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=215;experiment group) or normal saline(n=214;control group).The incidence of RAS was compared between the two groups. Results The patients were actually enrolled into experiment group with 213 cases and 213 cases into control group.The time of operation was significantly lower in experiment group than that in control group(P<0.05). With simple CAG, the incidence of RAS was lower in experiment group than that in control group(5.3% vs 12.8%, P<0.05). With CAG+PCI, the incidence of RAS was lower in experiment group than that in control group(4.8% vs 19.2%, P<0.05).With total incidence of RAS, it was also lower in experiment group than that in control group(5.2% vs 14.6%,P<0.05). Conclusion Direct wiping of the arterial sheath and angiographic catheters with a lidocaine gauze swab before insertion can reduce the occurrence of RAS during routine transradial CAG/PCI.