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目的:探讨硝酸甘油注射液联合盐酸地尔硫注射剂对桡动脉入路(TRA)冠状动脉(冠脉)造影辐射量的影响.方法:采用随机数字表法,将符合条件的300例患者依CAG术前经桡动脉予不同的血管扩张剂随机分成3组:A组(100例)硝酸甘油200 μg,B组(99例)盐酸地尔硫5 mg,C组(101例)硝酸甘油200 μg+-盐酸地尔硫5 mg.观察并比较3组患者术中桡动脉痉挛的发生率(冠脉造影第1阶段、第2阶段、第3阶段及全程的桡动脉痉挛发生率);桡动脉直径(给药前、给药后2 min、冠脉造影结束后的桡动脉直径);辐射量指标(曝光时间、球管辐射总剂量、剂量-面积乘积),记录生命体征(给药前及给药2 min后的有创平均动脉压、心率)及观察药物所致的不良事件.结果:①3组患者在合并疾病(高血压、糖尿病、高胆固醇、高三酰甘油)、吸烟、年龄、体重、穿刺次数等方面差异无统计学意义(P＞0.05);3组患者手术时间有差异,联合用药组短于硝酸甘油组和地尔硫组,差异有统计学意义(P＜0.05),但硝酸甘油组和地尔硫组差异无统计学意义(P＞0.05).②术中桡动脉痉挛发生率:用药后在冠脉造影第1阶段桡动脉痉挛发生率B组高于A组和C组,冠脉造影第3阶段桡动脉痉挛发生率A组高于B组和C组,冠脉造影全程桡动脉痉挛发生率C组低于A组和B组,差异有统计学意义(P＜0.05);③桡动脉直径:3组患者用药前桡动脉直径参考值的差异无统计学意义(P＞0.05);给药2 min后及冠脉造影结束后的桡动脉直径均有扩张,但给药2 min后桡动脉直径C组＞A组＞B组,冠脉造影结束后桡动脉直径C组＞B组＞A组,差异有统计学意义(P＜0.05);④辐射量指标比较:用药后C组曝光时间、球管辐射总剂量、剂量-面积乘积等均少于A组和B组,差异有统计学意义(P＜0.05),但A组和B组差异无统计学意义(P＞0.05).结论:TRA冠脉造影中,与单用硝酸甘油或地尔硫比,硝酸甘油和盐酸地尔硫联合应用,可充分扩张桡动脉直径,减少桡动脉痉挛,缩短X线曝光时间,减少造影辐射剂量,二者合并用药安全.“,”Objective:To explore the effect of Nitroglycerin Injection combined with diltiazem hydrochloride on the radiation level of transradial coronary angiography.Method:According to the random number table method,300 patients according to preoperative CAG via radial artery to different vasodilators were randomly divided into three groups:group A (n=100) nitroglycerin 200μg,group B (n =99) diltiazem hydrochloride 5 mg,C group (n =101) nitroglycerin 200 μg+ diltiazem hydrochloride 5 mg.The following indexes of the three groups were observed and compared:the rate of radial artery spasm in Phase 1,2 and 3,respectively,as well as the rate in the whole process;the radial artery diameter (before treatment,2 min after treatment and after the end of coronary angiography,respectively);radiation level(length of exposure,the total radiation dose of tubes,dose area product).Result:①No significant difference among three groups in the accompanying disease(hypertension,diabetes,high cholesterol,high triglycerides),smoking,age,weight,number of puncture and other aspects (P＞0.05);there were statistically significant differences in the length of operation of the three groups(in which the data of C Group was shorter than A Group and B Group)(P＜0.05),but the difference between A Group and B Group was not statistically significant(P＞0.05).②The rate of radial artery spasm:In Phase 1 of coronary angiography,the rate of radial artery spasm in B Group after treatment was higher than those of A Group and C Group;in Phase 3,the rate in A Group was higher than B Group and C Group;in the whole process,the rate of C Group was lower than the remaining two groups and the differences were statistically significant(P＜0.05).③Radial artery diameter.The reference radial artery diameter of the three groups before treatment had no significant difference(P＞ 0.05);2 min after treatment and after the end of coronary angiography,the diameter increased;the radial artery diameter results 2 min after treatment(C Group＞AGroup＞ B Group)and after the end of coronary angiography(C Group＞ B Group＞ A Group)had statistically significant differences(P＜0.05).④Comparison of radiation level.After treatment,the length of exposure,the total radiation dose of tubes and DAP of C Group were smaller than those of A Group and B Group,with statistically significant differences(P＜0.05),but there was no significant difference between A Group and B Group(P＞0.05).Conclusion:In TRA coronary angiography,the combination of nitroglycerin and diltiazem could fully expand the radial artery diameter,reduce the radial artery spasm,shorten the length of X-ray exposure and reduce radiation level.The combination was also safe.