Ezhumalai Babu, Satheesh Santhosh, Jayaraman Balachander
Department of Cardiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India.
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Indian Heart J. 2014 Nov-Dec;66(6):593-7. doi: 10.1016/j.ihj.2014.05.023. Epub 2014 Jun 7.
The success of transradial catheterization depends on meticulous access of radial artery which in turn depends on palpating a good radial pulse.
Our objectives were to analyze the effects of subcutaneously infiltrated nitroglycerin on diameter of radial artery, palpability of radial pulse, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography.
Patients undergoing transradial coronary angiography were randomized to Group NL or Group SL. In Group NL, 3 ml of solution containing nitroglycerin and lignocaine was infiltrated subcutaneously at the site intended for puncture of radial artery. Similarly, saline and lignocaine were infiltrated in Group SL. Diameter of radial artery was objectively assessed by ultrasonography. Measurements were performed at baseline and repeated at 1 min after injecting the solutions. The ease-of-puncture was evaluated by the number of punctures and the time needed for successful access of radial artery.
Both groups had 100 patients each. Baseline diameter of radial artery was similar between two groups. The post-injection diameter of radial artery increased by 26.3% in Group NL and 11.4% in Group SL. Nitroglycerin significantly improved the palpability of radial pulse, reduced the number of punctures and shortened the time needed for successful access of radial artery. Pre-cannulation spasm of radial artery occurred in 1% of Group NL and 8% of Group SL.
Subcutaneously infiltrated nitroglycerin leads to significant vasodilation of radial artery. This avoids pre-cannulation spasm of radial artery, enhances palpability of the radial pulse and thus makes the puncture of radial artery easier.
经桡动脉导管插入术的成功取决于对桡动脉的精细穿刺，而这又依赖于能摸到良好的桡动脉搏动。
我们的目的是分析皮下注射硝酸甘油对经桡动脉冠状动脉造影术中桡动脉直径、桡动脉搏动的可触及性、穿刺的难易程度以及桡动脉插管前痉挛的影响。
接受经桡动脉冠状动脉造影术的患者被随机分为NL组或SL组。在NL组中，将3毫升含硝酸甘油和利多卡因的溶液皮下注射到预定穿刺桡动脉的部位。同样，在SL组中注射生理盐水和利多卡因。通过超声客观评估桡动脉直径。在基线时进行测量，并在注射溶液后1分钟重复测量。通过穿刺次数和成功穿刺桡动脉所需时间评估穿刺的难易程度。
两组各有100例患者。两组桡动脉的基线直径相似。NL组注射后桡动脉直径增加了26.3%，SL组增加了11.4%。硝酸甘油显著改善了桡动脉搏动的可触及性，减少了穿刺次数，缩短了成功穿刺桡动脉所需的时间。NL组1%的患者和SL组8%的患者发生了桡动脉插管前痉挛。
皮下注射硝酸甘油可导致桡动脉显著血管扩张。这可避免桡动脉插管前痉挛，增强桡动脉搏动的可触及性，从而使桡动脉穿刺更容易。
