摘要
目的 比较地尔硫（蕈）、罂粟碱及硝酸甘油缓解老年冠状动脉粥样硬化性心脏病（冠心病）患者桡动脉痉挛的能力.方法 2009年7月至2010年3月,应用自体桡动脉对60例70岁以上老年冠心病患者行冠状动脉旁路移植术（CABG）,收集术中剩余桡动脉,采用血管环灌流技术,分别比较3种抗痉挛药物对离体痉挛桡动脉的缓解作用.所有患者随机分为3组,自桡动脉远端分别向桡动脉管腔内注入地尔硫（蕈）、罂粟碱及硝酸甘油,测量注射前后30 s血流量及血流动力学指标（心率、平均动脉压、中心静脉压）.结果 三种抗痉挛药物可不同程度缓解桡动脉痉挛,最终缓解率均超过80%.硝酸甘油可完全舒张桡动脉,舒张能力高于地尔硫（蕈）及罂粟碱.注射前后患者血流动力学指标差异无统计学意义,硝酸甘油[（42±10）ml/30 s比（28±7）ml/30 s,P〈0.05]可增加桡动脉血流量,地尔硫（蕈） [（23±10）ml/30 s比（25±8）ml/30 s,P〉0.05]与罂粟碱[（25±10）ml/30 s比（24±9）,P〉0.05]对桡动脉血流无明显影响.结论 硝酸甘油可有效缓解桡动脉痉挛,改善血流;相比于地尔硫（蕈）及罂粟碱,硝酸甘油是较为适宜的老年冠心病患者桡动脉抗痉挛药物.
Objective To compare the relief effect of diltiazem, papaverine and nitroglycerin on radial artery spasm in elderly patients with coronary atherosclerotic heart disease. Methods Sixty patients aged beyond 70 years underwent coronary artery bypass grafting （CABG）with autologous radial artery from July 2009 to March 2010. Redundant radial artery was collected and the relief function of different drugs was evaluated through ＂organ bath＂ technique in vitro. All the patients were randomly divided into 3 groups based on different antispasmodic drugs： diltiazem, papaverine and nitroglycerin. Thirty seconds free blood flow of radial artery and hemodynamic parameters （heart rate, mean arterial pressure and central venous pressure）were assessed before and after intraradial administration of diltiazem, papaverine and nitroglycerin in vivo. Results All three drugs could relieve radial artery spasm in different levels and the eventual relief rate was over 80%. Only nitroglycerin could relax radial artery completely, the relief capacity of nitroglycerin, diltiazem and papaverine decreased in order. There was no significant difference in the hemodynamic parameters before and after the injection. Blood flow of radial artery increased in nitroglycerin group [（42 ±10）ml/30 s vs. （28 ±7）ml/30 s, P〈0.05] while there was no significant difference in diltiazem [（23 ± 10）ml/30 s vs. （25 ±8）ml/30 s, P 〉0. 05] and papaverine group [（25 ± 10）ml/30 s vs. （24 ± 9）, P 〉 0. 05]. Conclusions Nitroglycerin could relieve vasospasm of radial artery effectively and increased blood flow. Nitroglycerin is the suitable antispasmoic drug for radial artery in the elderly patients with coronary atherosclerotic heart disease compare with diltiazem and papaverine.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2010年第19期1488-1491,共4页
Chinese Journal of Surgery
基金
江苏省“333工程”资助项目（2009）
