颈动脉支架术对血流动力学的急性影响

发布时间：2019-02-24 15:18

【摘要】：目的:调查颈动脉支架术(CAS)对血流动力学的急性影响。方法:回顾性分析我院2014-09至2015-09期间连续170例CAS患者围术期资料,调查跨颈内动脉近端支架置入对血压、心率的急性影响,并随访1个月,观察其与围术期不良事件发生的关系。结果:(1)与术前相比,颈动脉支架置入后全天平均收缩压从126.6±15.1(93~175)mm Hg(1mm Hg=0.133k Pa)下降为117.7±13.7(87~158)mm Hg(P0.01),全天平均舒张压从72.8±11.5(49~100)mm Hg下降为67.3±10.3(48~90)mm Hg(P0.01);全天平均心率由66.3±6.8(49~84)次/min下降为62.6±7.2(49~88)次/min(P0.01)。(2)血流动力学不稳定(HI)发生率为51.8%(88/170),其中高血压、低血压和心动过缓的发生率分别为3.5%(6/170)、39.4%(67/170)和22.4%(38/170)。多因素回归分析发现HI的发生与性别、高血压病史、双侧CAS及颈动脉分叉病变关系密切。HI发生后,通过静脉输注血管活性药物血压、心率均可恢复正常水平,其中6例(3.5%)用药时间超过24小时。(3)围术期共有8例(4.7%)患者出现不良事件,包括4例短暂性脑缺血发作、2例小卒中和2例大卒中(其中1例死亡)。非HI患者发生不良事件的比例为2.4%(2/82),HI患者为6.8%(6/88),两者相比,P值为0.32。HI患者中高血压、低血压、心动过缓及低血压合并心动过缓发生不良事件的比例分别为16.7%(1/6)、6.8%(3/44)、0%(0/15)和8.7%(2/23),与整体患者相比,P值分别为0.669、0.723、0.793和0.658。结论:CAS围术期HI患者发生比例较高,性别、高血压病史、双侧CAS和颈动脉分叉病变是其独立预测因素;及时合理地使用血管活性药物对于预防或者减少HI相关不良事件的发生意义重大。
[Abstract]:Objective: to investigate the acute effect of (CAS) on hemodynamics in carotid stenting. Methods: the perioperative data of 170 consecutive patients with CAS from 2014-09 to 2015-September in our hospital were retrospectively analyzed. The acute effects of transcarotid artery proximal stenting on blood pressure and heart rate were investigated and followed up for 1 month. To observe its relationship with adverse events in perioperative period. Results: (1) compared with preoperative, the mean systolic blood pressure (SBP) decreased from 126.6 卤15.1 (93 / 175) mm Hg (1mm Hg=0.133k Pa) to 117.7 卤13.7 (87 / 158) mm Hg (/ P0.01) after carotid stenting. The mean daily diastolic blood pressure (DBP) decreased from 72.8 卤11.5 (49 卤100) mm Hg) to 67.3 卤10.3 (48V 90) mm Hg (P0.01). The mean daily heart rate decreased from 66.3 卤6.8 (4984) times / min to 62.6 卤7.2 (4988) times / min (P0.01). (2) the incidence of hemodynamic instability (HI) was 51.8% (88 / 170). The incidence of hypotension and bradycardia were 3.5% (6 / 170), 39.4% (67 / 170) and 22.4% (38 / 170), respectively. Multivariate regression analysis showed that the occurrence of HI was closely related to sex, history of hypertension, bilateral CAS and carotid artery bifurcation lesions. After HI occurred, the heart rate could return to normal level by intravenous infusion of vasoactive drugs. Among them, 6 cases (3.5%) were treated for more than 24 hours. (3) there were 8 cases (4.7%) with adverse events in perioperative period, including 4 cases of transient ischemic attack. 2 cases of minor stroke and 2 cases of major stroke (one of them died). The incidence of adverse events in non HI patients was 2.4% (6.8%, 6 / 88) in 2 / 82), HI patients, compared with the P value of hypertension and hypotension in patients with 0.32.HI. The incidence of adverse events in bradycardia and hypotension with bradycardia was 16.7% (1 / 6), 6.8% (3 / 44), 0% (0 / 15) and 8.7% (2 / 23), respectively. P values were 0.669, 0.723, 0.793 and 0.658, respectively. Conclusion: the incidence of HI in perioperative period of CAS is high. Sex, history of hypertension, bilateral CAS and carotid artery bifurcation are independent predictors. Timely and rational use of vasoactive drugs is of great significance to prevent or reduce the occurrence of HI related adverse events.
【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外医院心内科;
【分类号】：R54

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