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目的探讨阿托品对冠状动脉介入手术(PCI)术后拔除动脉鞘管所致心血管迷走反射(CWRS)的防治作用。方法选取经股动脉、桡动脉途径PCI治疗的患者683例,按照拔鞘前不同药物处理方式进行分组,对照组(拔鞘前予0.9%氯化钠注射液水化)经桡动脉途径拔鞘119例、经股动脉途径拔鞘105例:预防1组(拔鞘前给2%利多卡因鞘管周围浸润麻醉)经桡动脉途径拔鞘115例、经股动脉途径拔鞘118例;预防2组(拔鞘前给阿托品0.5mg皮下注射)经桡动脉途径拔鞘112例、经股动脉途径拔鞘114例。观察患者在拔除动脉鞘管时CVVRS的发生情况。结果经桡动脉途径与经股动脉途径CVVRS的发生率差异有统计学意义(χ~2=4.633,P<0.05),经股动脉PCI更容易出现血管迷走反射。经桡动脉途径的不同预处理方式CVVRS的发生率差异无统计学意义(χ~2=3.998,P>0.05)。经股动脉途径者中预防1组与对照组CVVRS的发生率差异无统计学意义(χ~2=2.717,P>0.05);预防2组与对照组间差异有统计学意义(χ~2=5.765,P<0.05),CVVRS的发生率低于对照组。结论经桡动脉途径CVVRS发生率明显低于经股动脉途径。PCI术后应用阿托品提高心率能有效预防股动脉途径拔鞘所致的CWRS。
Objective To investigate the prevention and treatment of atropine on cardiovascular vagal reflex (CWRS) caused by removal of arterial sheath after percutaneous coronary intervention (PCI). Methods Sixty-three (683) patients undergoing PCI via the femoral artery and radial artery were divided into groups according to the different drug treatment before pulling the sheath. In the control group (0.9% sodium chloride injection hydration before draining the sheath) One hundred and ninety-nine patients were enrolled in this study. One hundred and eleven patients were enrolled through the femoral artery: one patient in prevention group (115 patients with 2% lidocaine sheath infiltration before percutaneous catheterization) was catheterized by radial artery and 118 patients by femoral artery catheterization. 2 groups (0.5mg subcutaneous injection of atropine before pulling the sheath) by radial artery pull sheath 112 cases, 114 cases by the femoral artery pull sheath. The incidence of CVVRS was observed in patients with arterial sheath removal. Results There was significant difference in the incidence of CVVRS between transradial approach and femoral artery approach (χ ~ 2 = 4.633, P <0.05). Vasovagal reflex was more likely to occur through the femoral artery PCI. There was no significant difference in the incidence of CVVRS between different preconditioning methods (χ ~ 2 = 3.998, P> 0.05). There was no significant difference in the incidence of CVVRS between the prevention group 1 and the control group (χ ~ 2 = 2.717, P> 0.05). There was a significant difference between the two groups in prevention and the control group (χ ~ 2 = 5.765, P <0.05). The incidence of CVVRS was lower than that of the control group. Conclusions The incidence of CVVRS through the radial artery is significantly lower than that of the femoral artery. The use of atropine to raise heart rate after PCI can effectively prevent CWRS caused by pulling the sheath through the femoral artery.