mikailiMirak Sevda, Talasaz Azita H, Jenab Yaser, Vatanara Alireza, Amini Mohsen, Jalali Arash, Gheymati Azin
Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Int J Cardiol Heart Vasc. 2020 Dec 25;32:100689. doi: 10.1016/j.ijcha.2020.100689. eCollection 2021 Feb.
Radial approach for coronary angioplasty is accepted by many specialists in medical centers around the world. The use of radial access is associated with fewer vascular complications and the same success rate in comparison with traditional femoral access. Radial artery spasm is one of the main concerns in this method. The small size of the radial artery and high density of alpha-1 adrenergic receptors in this artery can accelerate the spasm. The objects of this study were to evaluate whether the combined topical gel of lidocaine-verapamil-nitroglycerin could dilate the radial artery and reduce patient pain and sympathetic response during radial puncture.
Patients undergoing elective trans-radial angioplasty were randomized to either placebo or therapeutic gel group in single-center, double-blind study. Placebo or therapeutic gel applied 1 cm proximal to the radial styloid process. Radial artery size was measured by ultrasound. Radial pain was reported by the visual analog scale (VAS) and the sympathetic response was assessed by changes in systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR). The incidence of spasm was defined by the radial artery spasm score.
60 patients (30 patients in each group) participated in this study. A significant increase in the size of the radial artery was observed in the group receiving therapeutic gel compared to the placebo group (mean diameter, mm: 2.95 ± 0.48 vs. 2.54 ± 0.43, p = 0.001; area, cm: 0.07 vs. 0.05, p = 0.001). During radial puncture, the radial pain intensity was significantly decreased in patients receiving therapeutic gel (4 (1-5) vs. 2 (1-2), p = 0.003). Radial artery spasm didn't happen in any group.
Based on our results, Pre-procedural administration of combined topical gel of verapamil-nitroglycerin-lidocaine significantly increases the size of the radial artery and effectively reduces the radial pain during radial puncture in patients undergoing trans-radial angioplasty.
冠状动脉血管成形术的桡动脉入路已被全球许多医疗中心的专家所接受。与传统的股动脉入路相比，使用桡动脉入路的血管并发症更少，成功率相同。桡动脉痉挛是该方法的主要问题之一。桡动脉管径小且该动脉中α-1肾上腺素能受体密度高，会加速痉挛。本研究的目的是评估利多卡因-维拉帕米-硝酸甘油复合局部用凝胶是否能扩张桡动脉，并减轻患者在桡动脉穿刺过程中的疼痛和交感神经反应。
在单中心双盲研究中，将接受择期经桡动脉血管成形术的患者随机分为安慰剂组或治疗凝胶组。在桡骨茎突近端1厘米处涂抹安慰剂或治疗凝胶。通过超声测量桡动脉管径。采用视觉模拟量表（VAS）报告桡动脉疼痛情况，并通过收缩压（SBP）、舒张压（DBP）和心率（HR）的变化评估交感神经反应。痉挛发生率由桡动脉痉挛评分定义。
60例患者（每组30例）参与了本研究。与安慰剂组相比，接受治疗凝胶组的桡动脉管径显著增加（平均直径，mm：2.95±0.48对2.54±0.43，p = 0.001；面积，cm：0.07对0.05，p = 0.001）。在桡动脉穿刺过程中，接受治疗凝胶的患者桡动脉疼痛强度显著降低（4（1 - 5）对2（1 - 2），p = 0.003）。两组均未发生桡动脉痉挛。
基于我们的研究结果，术前给予维拉帕米-硝酸甘油-利多卡因复合局部用凝胶可显著增加桡动脉管径，并有效减轻经桡动脉血管成形术患者桡动脉穿刺时的疼痛。
