耳穴贴压对降低冠脉介入诊疗中桡动脉穿刺后血管痉挛和迷走反射的临床研究
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摘要
目的:评估耳穴贴压降低介入诊疗中桡动脉穿刺后血管痉挛[包括桡动脉痉挛(radial artery spasm,RAS)和冠状动脉痉挛(coronary artery spasm,CAS)]和迷走反射的作用及临床应用价值。方法:480例经桡动脉穿刺行冠脉介入诊疗的患者,随机分为观察组(224例)和对照组(256例)。对照组行冠脉介入术治疗,围术期给予常规护理;观察组行冠脉介入术前12 h开始耳穴贴压治疗,穴取交感、神门、皮质下、内分泌、心、肾、肾上腺,术前至术后12 h内每隔2 h按压1次,每次每穴按压1 min。比较两组患者在穿刺过程中血管痉挛和迷走反射的发生率,并记录硝酸甘油注射液、多巴胺注射液、阿托品注射液等血管活性药物的使用率。结果:观察组血管痉挛的发生率为4.9%(11/224),低于对照组的13.3%(34/256,P<0.01);观察组迷走反射的发生率为7.1%(16/224),低于对照组的19.5%(50/256,P<0.01)。观察组患者硝酸甘油注射液使用率为3.6%(8/224),低于对照组的14.8%(38/256,P<0.01);观察组患者阿托品注射液使用率为7.1%(16/224),低于对照组的15.6%(40/256,P<0.01);观察组患者多巴胺注射液使用率为6.3%(14/224),低于对照组的15.2%(39/256,P<0.01)。结论:耳穴贴压对降低经桡动脉穿刺行冠脉介入诊疗时的血管痉挛和迷走反射发生率具有确切疗效。
Objective To evaluate the effect and clinical value of auricular point sticking for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture, including radial artery spasm(RAS) and coronary artery spasm(CAS). Methods A total of 480 patients were randomized into an observation group(224 cases) and a control group(256 cases). Percutaneous coronary intervention and usual care in perioperative period were used in the control group. Auricular point sticking was began to apply 12 h before percutaneous coronary intervention in the observation group at Jiaogan(AH6 a), Shenmen(TF4), Pizhixia(AT4), Neifenmi(CO18), Xin(CO15), Shen(CO10), Shenshangxian(TG2 p), 1 min a time every point, once every 2 h, 12 h before and after operation. The incidences of vasospasm and vagus reflex during piercing process were compared, and the usage ratios of vasoactive agent were recorded, including glyceryl trinitrate, dopamine and atropine injections. Results The incidence of angiospasm was 4.9%(11/224) in the observation group, which was lower than 13.3%(34/256) in the control group(P<0.01). The incidence of vagal reflex of the observation group was 7.1%(16/224), which was lower than 19.5%(50/256) of the control group(P<0.01). The usage ratios of glyceryl trinitrate, atropine and dopamine injections were 3.6%(8/224), 7.1%(16/224), 6.3%(14/224) respectively in the observation group, which were lower than 14.8%(38/256), 15.6%(40/256), 15.2%(39/256) in the control group(all P<0.01). Conclusion Auricular point sticking achieves effect for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture.
Objective To evaluate the effect and clinical value of auricular point sticking for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture, including radial artery spasm(RAS) and coronary artery spasm(CAS). Methods A total of 480 patients were randomized into an observation group(224 cases) and a control group(256 cases). Percutaneous coronary intervention and usual care in perioperative period were used in the control group. Auricular point sticking was began to apply 12 h before percutaneous coronary intervention in the observation group at Jiaogan(AH6 a), Shenmen(TF4), Pizhixia(AT4), Neifenmi(CO18), Xin(CO15), Shen(CO10), Shenshangxian(TG2 p), 1 min a time every point, once every 2 h, 12 h before and after operation. The incidences of vasospasm and vagus reflex during piercing process were compared, and the usage ratios of vasoactive agent were recorded, including glyceryl trinitrate, dopamine and atropine injections. Results The incidence of angiospasm was 4.9%(11/224) in the observation group, which was lower than 13.3%(34/256) in the control group(P<0.01). The incidence of vagal reflex of the observation group was 7.1%(16/224), which was lower than 19.5%(50/256) of the control group(P<0.01). The usage ratios of glyceryl trinitrate, atropine and dopamine injections were 3.6%(8/224), 7.1%(16/224), 6.3%(14/224) respectively in the observation group, which were lower than 14.8%(38/256), 15.6%(40/256), 15.2%(39/256) in the control group(all P<0.01). Conclusion Auricular point sticking achieves effect for the diagnosis and treatment of vasospasm and vagus reflex during radial artery puncture.
引文
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[6]张璇,王硕仁,李瑞杰.冠心病经皮冠状动脉介入术后心脏康复的中医药治疗研究进展[J].中西医结合心脑血管病杂志,2017,15(4):428-432.
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[9]梁铁彪,周玉杰,刘同库,等.药物预防桡动脉痉挛(经桡动脉介入治疗)效果的观察[J].医学综述,2009(9):1414-1417.
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[11]同辉.心血管介入术后血管迷走反射的原因和护理[J].河南外科学杂志,2017,23(2):166-167.
[12]于红.冠状动脉痉挛的基础与临床研究进展[J].中国实用神经病学杂志,2010,13(5):95-96.
[13]孙培华.针刺配合耳压治疗偏头痛临床观察[J].上海针灸杂志,2006,25(8):12-13.
[14]孙立虹,梁玉磊,李新华,等.针刺结合耳穴贴压对经行头痛患者血清前列腺素F2α及血浆血管加压素含量的影响[J].中国针灸,2015,35(2):137-140.
[15]邱伟芬.耳穴压丸对心脏术后排便和血管活性肠肽的影响[D].广州:广州中医药大学,2012.
[16]童培建,汪海东,马镇川,等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9):931-934.
[17]王金红.采用耳穴埋籽治疗心悸患者的效果观察[J].中国医疗前沿,2013,8(12):103-104.
[2]Saito S,Ikei H,Hosokana G,et a1.Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention[J].Catheter Cardiovasc Interv,1999,62(4):173-178.
[3]Ruiz-Salmeron RJ,Mora R,Masotti M,et al.Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures:a randomized study comparing phentolamine vs.verapamil[J].Catheter Cardiovasc Interv,2005,66(2):192-198.
[4]Kim SH,Kim EJ,Cheon WS,et al.Comparative study of nicorandil and a spsamolytic cocktail in preventing radial artery spasm during transradial coronary angiography[J].Int J Cardiol,2007,120(3):325-330.
[5]向定成.吸烟和高脂血症是冠状动脉痉挛的重要危险因子[J].中华心血管病杂志,2002,30(4):243.
[6]张璇,王硕仁,李瑞杰.冠心病经皮冠状动脉介入术后心脏康复的中医药治疗研究进展[J].中西医结合心脑血管病杂志,2017,15(4):428-432.
[7]冷闰杰,肖林.经股动脉和桡动脉途径行冠脉介入诊疗术比较[J].中国医药科学,2013,3(18):8.
[8]方钊华.经桡动脉途径冠状动脉介入诊疗围术期的护理体会[J].中国全科医学,2013,16(6):991-992.
[9]梁铁彪,周玉杰,刘同库,等.药物预防桡动脉痉挛(经桡动脉介入治疗)效果的观察[J].医学综述,2009(9):1414-1417.
[10]陈艺,周玉杰.经桡动脉冠状动脉介入术中桡动脉痉挛的研究现状[J].中国介入心脏病学杂志,2009,17(5):289-291.
[11]同辉.心血管介入术后血管迷走反射的原因和护理[J].河南外科学杂志,2017,23(2):166-167.
[12]于红.冠状动脉痉挛的基础与临床研究进展[J].中国实用神经病学杂志,2010,13(5):95-96.
[13]孙培华.针刺配合耳压治疗偏头痛临床观察[J].上海针灸杂志,2006,25(8):12-13.
[14]孙立虹,梁玉磊,李新华,等.针刺结合耳穴贴压对经行头痛患者血清前列腺素F2α及血浆血管加压素含量的影响[J].中国针灸,2015,35(2):137-140.
[15]邱伟芬.耳穴压丸对心脏术后排便和血管活性肠肽的影响[D].广州:广州中医药大学,2012.
[16]童培建,汪海东,马镇川,等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9):931-934.
[17]王金红.采用耳穴埋籽治疗心悸患者的效果观察[J].中国医疗前沿,2013,8(12):103-104.