Pancholy Samir B, Coppola John, Patel Tejas
Department of Cardiology, Mercy Hospital and Community Medical Center, Scranton, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2006 Sep;68(3):389-91. doi: 10.1002/ccd.20881.
To study the effect of sublingual versus subcutaneous nitroglycerin on radial artery spasm caused by failed access attempts.
Radial artery spasm is the leading reason for failed radial access. We studied the efficacy of systemic versus local nitroglycerin in relieving radial artery spasm caused by needle entry resulting in failed cannulation.
Fifty-two consecutive patients were studied. All patients had failed attempt at radial artery cannulation, resulting in loss of radial pulse. Patients were divided in three groups, group I (n = 11), observed without additional treatment, group II (n = 20), administered 400 mcg of sublingual nitroglycerin, and group III (n = 21), administered 400 mcg of subcutaneous nitroglycerin at the site of the lost radial pulse. All patients were monitored for the return of radial pulse. Demographics, hemodynamics, and time to return of radial pulse as well as ability to successfully cannulate the radial artery were recorded.
Seventy-two percent of group I patients, 90% of group II patients, and 100% of group III patients had re-establishment of radial pulse. The time to return of radial pulse was significantly shorter for group III compared with that for group II (3 +/- 1 min vs. 8 +/- 1 min respectively, P < 0.001). Re-establishment of radial pulse was faster in group II and group III compared with that in group I (18 +/- 5 min, P < 0.001). Systolic blood pressure changes and headaches were less common in group III.
Subcutaneous administration of nitroglycerin is superior in facilitating radial artery cannulation after initial failed attempt.
研究舌下含服与皮下注射硝酸甘油对因穿刺失败导致的桡动脉痉挛的影响。
桡动脉痉挛是桡动脉穿刺失败的主要原因。我们研究了全身应用与局部应用硝酸甘油缓解因进针导致穿刺失败引起的桡动脉痉挛的疗效。
对52例连续患者进行研究。所有患者桡动脉穿刺均失败，导致桡动脉搏动消失。患者分为三组，第一组（n = 11），未接受额外治疗，仅观察；第二组（n = 20），舌下含服400 mcg硝酸甘油；第三组（n = 21），在桡动脉搏动消失部位皮下注射400 mcg硝酸甘油。所有患者均监测桡动脉搏动恢复情况。记录患者的人口统计学资料、血流动力学参数、桡动脉搏动恢复时间以及成功穿刺桡动脉的能力。
第一组72%的患者、第二组90%的患者以及第三组100%的患者桡动脉搏动恢复。与第二组相比，第三组桡动脉搏动恢复时间显著缩短（分别为3±1分钟和8±1分钟，P < 0.001）。与第一组相比，第二组和第三组桡动脉搏动恢复更快（18±5分钟，P < 0.001）。第三组收缩压变化和头痛较少见。
在初次穿刺失败后，皮下注射硝酸甘油在促进桡动脉穿刺方面更具优势。
