Wang Kuiliang,Zhang Xu,Luo Gang,et al.Study on the application of papaverine combined with lidocaine in acute limb ischemia caused by cardiac catheterization intervention in infants with congenital heart disease[J].Journal of Clinical Pediatric Surgery,2025,(03):255-259.[doi:10.3760/cma.j.cn101785-202304038-010]
Study on the application of papaverine combined with lidocaine in acute limb ischemia caused by cardiac catheterization intervention in infants with congenital heart disease
- Keywords:
- Papaverine; Cardiac Catheterization; Vasospasm; Surgical Procedures; Operative; Child
- Abstract:
- 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 (SpO2) of the affected limb.Comparisons were made between the pre-and post-injection skin color grade,limb circumference,skin temperature,and SpO2.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 SpO2 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 SpO2 94.17±1.18%.Significant statistical differences were found in the skin temperature and SpO2 of the affected limb before and after papaverine injection (P<0.05).No statistically significant differences were found in limb circumference,alanine aminotransferase,aspartate aminotransferase,and serum prealbumin levels before and after injection (P>0.05).The average recovery time for ischemic symptoms was 0.5 to 2.0 hours,with a mean of 1.17±0.53 hours.Conclusions Local injection of papaverine combined with lidocaine effectively alleviates arterial vasospasm without causing serious complications.
References:
[1] Rizzi M,Kroiss S,Kretschmar O,et al.Long-term outcome of catheter-related arterial thrombosis in infants with congenital heart disease[J].J Pediatr,2016,170:181-187.e1.DOI:10.1016/j.jpeds.2015.11.024.
[2] Deindl P,Waldh?r T,Unterasinger L,et al.Arterial catheterisation in neonates can result in severe ischaemic complications but does not impair long-term extremity function[J].Acta Paediatr,2018,107(2):240-248.DOI:10.1111/apa.14100.
[3] Rizzi M,Goldenberg N,Bonduel M,et al.Catheter-related arterial thrombosis in neonates and children:a systematic review[J].Thromb Haemost,2018,118(6):1058-1066.DOI:10.1055/s-0038-1642635.
[4] Lackovic M,Nikolic D,Filimonovic D,et al.Reliability,consistency and temporal stability of Alberta infant motor scale in Serbian infants[J].Children (Basel),2020,7(3):16.DOI:10.3390/children7030016.
[5] Ding L,Pockett C,Moore J,et al.Long sheath use in femoral artery catheterizations in infants <15 kg is associated with a higher thrombosis rate:proposed protocol for detection and management[J].Catheter Cardiovasc Interv,2016,88(7):1108-1112.DOI:10.1002/ccd.26690.
[6] 蒋顺仙,袁建君,王盼盼,等.罂粟碱注射液给药途径的现状调查分析[J].实用手外科杂志,2016,30(4):499-500.DOI:10.3969/j.issn.1671-2722.2016.04.047. Jiang SX,Yuan JJ,Wang PP,et al.Investigation and analysis of the current situation of papaverine injection administration route[J].J Pract Hand Surg,2016,30(4):499-500.DOI:10.3969/j.issn.1671-2722.2016.04.047.
[7] Vargas CR,Iorio ML,Lee BT.A systematic review of topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery[J].Plast Reconstr Surg,2015,136(2):411-422.DOI:10.1097/PRS.0000000000001431.
[8] 黄芳芳,王平,邹华仁.肝素钠联合罂粟碱对断指再植术后凝血功能及血管危象发生的影响[J].实用中西医结合临床,2023,23(12):105-108.DOI:10.13638/j.issn.1671-4040.2023.12.030. Huang FF,Wang P,Zou HR.Effect of heparin sodium combined with papaverine on coagulation function and vascular crisis after finger replantation[J].Pract Clin J Integr Tradit Chin West Med,2023,23(12):105-108.DOI:10.13638/j.issn.1671-4040.2023.12.030.
[9] 苏杭,沈君高.罂粟碱联合低分子右旋糖酐在断指再植中的应用价值及对血管危象、血液流变学指标的影响[J].临床医学研究与实践,2023,8(15):99-102.DOI:10.19347/j.cnki.2096-1413.202315026. Su H,Shen JG.Application value of papaverine combined with low molecular dextran in replantation of severed fingers and its influences on vascular crisis and hemorheological indexes[J].Clin Res Pract,2023,8(15):99-102.DOI:10.19347/j.cnki.2096-1413.202315026.
[10] 刘刚义,郑龙,刘宗义,等.邻指指动脉岛状皮瓣修复手指软组织缺损并重建血运[J].中华手外科杂志,2017,33(5):352-354.DOI:10.3760/cma.j.issn.1005-054X.2017.05.014. Liu GY,Zheng L,Liu ZY,et al.Application of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation[J].Chin J Hand Surg,2017,33(5):352-354.DOI:10.3760/cma.j.issn.1005-054X.2017.05.014.
[11] Panigrahy N,Kumar PP,Chirla DK,et al.Papaverine for ischemia following peripheral arterial catheterization in neonates[J].Indian Pediatr,2016,53(2):169.
[12] 王丽萍.罂粟碱不良反应文献概述[J].中国药物滥用防治杂志,2020,26(4):233-236.DOI:10.15900/j.cnki.zylf1995.2020.04.014. Wang LP.Literature review of adverse drug reactions induced by papaverine[J].Chin J Drug Abuse Prev Treat,2020,26(4):233-236.DOI:10.15900/j.cnki.zylf1995.2020.04.014.
[13] Gautam NK,Griffin E,Hubbard R,et al.Intraarterial papaverine for relief of catheter-induced peripheral arterial vasospasm during pediatric cardiac surgery:a randomized double-blind controlled trial[J].Paediatr Anaesth,2022,32(6):764-771.DOI:10.1111/pan.14442.
[14] Sadat U,Hayes PD,Varty K.Acute limb ischemia in pediatric population secondary to peripheral vascular cannulation:literature review and recommendations[J].Vasc Endovascular Surg,2015,49(5/6):142-147.DOI:10.1177/1538574415604059.
[15] 夏源园,吴秀静.婴幼儿先天性心脏病术后肢体动脉栓塞的临床分析[J].中华小儿外科杂志,2021,42(7):598-603.DOI:10.3760/cma.j.cn421158-20201021-00668. Xia YY,Wu XJ.Clinical analysis in infants with limb arterial embolism after cardiac surgery[J].Chin J Pediatr Surg,2021,42(7):598-603.DOI:10.3760/cma.j.cn421158-20201021-00668.
Memo
收稿日期:2023-4-15。
基金项目:国家自然科学基金(82271725);泰山学者工程资助(2018)
通讯作者:泮思林,Email:silinpan@126.com