Zhongguo cuzhong zazhi (Apr 2023)
颈动脉支架置入术后发生需药物干预低血流动力学状态的危险因素分析 Predictors of Hemodynamic Depression Requiring Vasoactive Agent after Carotid Artery Stenting
Abstract
目的 探索颈动脉支架置入术（carotid artery stenting，CAS）后发生需药物干预低血流动力学（hemodynamic depression，HD）状态的危险因素。 方法 回顾性分析潍坊市中医院脑病科2017年2月—2021年12月因颈动脉狭窄行择期单侧CAS治疗患者的临床资料，记录患者CAS后24 h内的生命体征。根据CAS后24 h内是否发生HD状态[定义为收缩压＜90 mmHg（1 mmHg=133.3 Pa）或心率＜50 次/分且需要血管活性药物干预]分为HD组和非HD组。采用多因素logistic回归分析CAS后发生需药物干预HD的独立危险因素。 结果 研究共纳入130例CAS患者，其中有42例（32.3%）发生了需药物干预的HD。单因素分析示，HD组的糖尿病病史（28.57% vs. 48.86%，P=0.034）、空腹血糖[（5.46±1.71）mmol/L vs. （6.69±2.06）mmol/L，P＜0.001]低于非HD组，责任血管最狭窄处距颈动脉分叉≤10 mm的比例（71.43% vs. 47.73%，P=0.021）、责任血管高回声斑块发生率（7.14% vs. 3.41%，P=0.043）和使用开环支架的比例（85.71% vs. 56.82%，P=0.024）高于非HD组。多因素logistic回归分析显示，责任血管最狭窄处距颈动脉分叉≤10 mm（OR 3.10，95%CI 1.23～8.11，P=0.028）和高回声斑块（OR 3.28，95%CI 1.45～9.36，P=0.021）是CAS后发生需药物干预HD的独立危险因素，而糖尿病病史（OR 0.25，95%CI 0.07～0.91，P=0.031）和高空腹血糖水平（OR 0.18，95%CI 0.02～0.51，P=0.024）是CAS后发生需药物干预HD的独立保护因素。 结论 责任血管高回声斑块和最狭窄处距颈动脉分叉≤10 mm是CAS后发生需药物干预HD的独立危险因素。 Objective To determine the predictors of hemodynamic depression (HD) requiring vasoactive agent following carotid artery stenting (CAS). Methods Patients who underwent unilateral CAS in Department of Neurology, Weifang Hospital of Traditional Chinese Medicine between February 2017 and December 2021 were enrolled in this retrospective study. Patient vital sign records within 24 hours post-CAS were analyzed. The HD was defined as sustained systolic blood pressure <90 mmHg (1 mmHg=133.3 Pa) or heart rate <50 beats per minute requiring vasoactive agent after CAS. The patients were divided into HD group (n=42) and non-HD group (n=88) according to having HD or not. The multivariate logistic regression analysis was used to identify independent risk factors of HD following CAS. Results A total of 130 patients were included in this study, and HD occured in 42 pationts (32.3%) . Univariate analysis showed that the HD group had a lower proportion of diabetes mellitus (28.57% vs. 48.86%, P=0.034), lower level of fasting blood glucose [(5.46±1.71) mmol/L vs. (6.69±2.06) mmol/L, P<0.001], higher proportion of hyperechoic plaques (7.14% vs. 3.41%, P=0.043) and the distance from carotid bifurcation to maximum vascular stenosis (MVS) ≤ 10 mm (71.43% vs. 47.73%, P=0.021), and a higher use rate of open-cell stent (85.71% vs. 56.82%, P=0.024), compared to the non-HD group. Multivariate logistic regression analysis showed that hyperechoic plaques (OR 3.28, 95%CI 1.45-9.36, P=0.021) and the distance from carotid bifurcation to MVS≤ 10 mm (OR 3.10, 95%CI 1.23-8.11, P=0.028) were independent risk factors for HD requiring vasoactive agent after CAS, while diabetes mellitus (OR 0.25, 95% CI 0.07-0.91, P=0.031) and high fasting blood glucose level (OR 0.18, 95%CI 0.02-0.51, P=0.024) could provide protection against HD following CAS. Conclusions The hyperechoic plaques and the distance from carotid bifurcation to MVS≤10 mm were independent risk factors for HD requiring administration of vasoactive agent after CAS.
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