罂粟碱联合利多卡因在先天性心脏病心导管介入手术致肢体急性缺血中的应用研究  

Study on the application of papaverine combined with lidocaine in acute limb ischemia caused by cardiac catheterization intervention in infants with congenital heart disease

作　　者：王葵亮 张旭[1] 罗刚[1] 泮思林[1] Wang Kuiliang;Zhang Xu;Luo Gang;Pan Silin(Heart Center,Women and Children’s Hospital Affiliated to Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,青岛266034

出　　处：《临床小儿外科杂志》2025年第3期255-259,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82271725);泰山学者工程资助(2018)。

摘　　要：目的初步评价局部注射罂粟碱联合利多卡因应用在先天性心脏病(先心病)婴幼儿心导管介入术后血管痉挛致肢体急性缺血中的临床效果。方法回顾性分析2008年6月至2023年6月青岛大学附属妇女儿童医院心脏中心6例接受先心病心导管介入手术后血管痉挛致肢体急性缺血患儿的临床资料。男4例、女2例,动脉导管未闭4例、重度肺动脉瓣狭窄2例。在患肢穿刺处内外两侧采用罂粟碱1.5 mg/kg联合2%利多卡因行局部注射治疗。观察患肢皮肤颜色、温度,足背动脉搏动情况以及患肢经皮血氧饱和度(percutaneous arterial oxygen saturation,SpO_(2));比较罂粟碱注射前和注射后患肢皮肤颜色等级、周径、皮肤温度以及SpO_(2);记录患肢缺血症状缓解时间以及罂粟碱注射前和注射后72 h时肝功能指标(谷丙转氨酶、谷草转氨酶、血清前蛋白)。结果罂粟碱注射前谷丙转氨酶(18.81±7.07)U/L、谷草转氨酶(37.83±9.56)U/L、血清前蛋白(13.44±1.59)mg/L、患肢周径(19.75±2.48)cm、患肢皮肤温度(34.95±0.18)℃、患者SpO_(2)(88.83±1.72)%;注射后谷丙转氨酶(17.13±6.57)U/L、谷草转氨酶(40.71±15.16)U/L、血清前蛋白(13.61±1.66)mg/L、患肢周径(20.08±2.43)cm、患肢皮肤温度(36.33±0.25)℃、患者SpO_(2)(94.17±1.18)%;对比6例患肢罂粟碱注射前和注射后的皮肤温度、患肢SpO_(2),差异均具有统计学意义(P<0.05);罂粟碱注射前、注射后患肢周径、谷丙转氨酶、谷草转氨酶、血清前蛋白比较,差异均无统计学意义(P>0.05);患肢缺血症状恢复时间为罂粟碱局部注射后(1.17±0.53)h。结论罂粟碱联合利多卡因局部注射具有良好的缓解动脉血管痉挛效果,不会导致严重并发症。Objective To evaluate the clinical effect of local injection of papaverine combined with lidocaine in treating acute limb ischemia caused by vascular spasm after cardiac catheterization in infants with congenital heart disease(CHD).Methods A retrospective analysis was conducted on clinical data from infants who developed acute limb ischemia due to vascular spasm after CHD cardiac catheterization at the Heart Center of Women and Children’s Hospital Affiliated to Qingdao University between June 2008 to June 2023.This study included 4 male and 2 female infants,with 4 cases of patent ductus arteriosus and 2 cases of severe pulmonary valve stenosis.A local injection treatment was performed with a solution of papaverine 1.5 mg/kg combined with 2% lidocaine 1 mL,totaling 3 mL,at the puncture site on both the inner and outer sides of the affected limb.Observations were made on the skin color,temperature,dorsalis pedis artery pulsation,and transcutaneous oxygen saturation(SpO_(2))of the affected limb.Comparisons were made between the pre-and post-injection skin color grade,limb circumference,skin temperature,and SpO_(2).The time for ischemic symptoms to alleviate was recorded.Liver function indicators(alanine aminotransferase,aspartate aminotransferase,and serum prealbumin)were measured before and 72 h after the papaverine injection.Results 6 infants received local papaverine injection treatment.The pre-injection levels were:alanine aminotransferase 18.81±7.07 U/L,aspartate aminotransferase 37.83±9.56 U/L,serum prealbumin 13.44±1.59 mg/L,limb circumference 19.75±2.48 cm,skin temperature 34.95±0.18℃,and SpO_(2)88.83±1.72%.Post-injection levels were:alanine aminotransferase 17.13±6.57 U/L,aspartate aminotransferase 40.71±15.16 U/L,serum prealbumin 13.61±1.66 mg/L,limb circumference 20.08±2.43 cm,skin temperature 36.33±0.25℃,and SpO_(2)94.17±1.18%.Significant statistical differences were found in the skin temperature and SpO_(2) of the affected limb before and after papaverine injection(P<0.05).No statistic

关 键 词：罂粟碱 心导管介入 血管痉挛 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]