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目的观察硝酸甘油、利多卡因混合液局部麻醉预防桡动脉痉挛(RAS)的效果。方法回顾性分析河南宏力医院2007年2月至2010年11月经桡动脉冠状动脉造影和介入治疗的冠心病患者485例,试验组245例以硝酸甘油、利多卡因混合液(2%利多卡因注射液5 ml+硝酸甘油注射液5 mg入50 ml生理盐水抽取5 ml)局部麻醉,局部浸润麻醉用量1～2 ml;对照组240例,以1%利多卡因注射液1～2 ml局部麻醉;两组穿刺成功后,均经鞘管注入利多卡因30 mg、硝酸甘油300μg、普通肝素钠3000 IU;观察术中RAS发生率、经桡动脉手术成功率。结果试验组桡动脉穿刺成功237例(96.7%),对照组穿刺成功230例(95.8%),两组比较差异无统计学意义(P>0.05);试验组术中发生RAS 7例(3.0%),手术成功223例(94.1%);对照组发生RAS 17例(7.4%),手术成功201例(87.4%);两组比较差异有统计学意义(P<0.05)。结论采用硝酸甘油、利多卡因混合液局部麻醉,能够有效防止桡动脉痉挛,增加手术成功率。
Objective To observe the effect of local anesthesia with nitroglycerin and lidocaine on the prevention of radial artery spasm (RAS). Methods A retrospective analysis of Henan Hongli Hospital from February 2007 to November 2010 by radial artery coronary angiography and interventional treatment of coronary heart disease patients 485 cases, the experimental group of 245 patients with nitroglycerin, lidocaine mixture (2% lidocaine 5 ml injection of 5 ml + nitroglycerin injection 5 ml into 50 ml saline 5 ml) local anesthesia, local infiltration anesthesia dosage of 1 ~ 2 ml; control group of 240 patients with 1% lidocaine injection 1 ~ 2 ml local Anesthesia. After successful puncture of both groups, both lidocaine 30 mg, nitroglycerin 300 μg and unfractionated heparin 3000 IU were injected into the sheath. The incidence of RAS and success rate of transradial artery operation were observed. Results The success rate of radial artery puncture in the experimental group was 237 cases (96.7%), and that in the control group was 230 (95.8%). There was no significant difference between the two groups (P> 0.05) ). Surgical operation was successful in 223 cases (94.1%). There were 17 cases (7.4%) of RAS in control group and 201 cases (87.4%) in operation success. There was significant difference between the two groups (P <0.05). Conclusion Local anesthesia with nitroglycerin and lidocaine mixture can effectively prevent radial artery spasm and increase the success rate of operation.