Zhongguo cuzhong zazhi (Aug 2018)
颈动脉支架成形术围手术期血流动力学损害的相关危险因素研究 Risk Factors of Hemodynamic Depression in Perioperative Period of Carotid Angioplasty and Stenting
Abstract
目的 探讨颈动脉支架成形术（carotid angioplasty and stenting，CAS）围手术期血流动力学损害的危 险因素。 方法 选择行CAS患者86例，根据患者术中术后的血压、心率状况，将其分为有、无血流动力学损害 两组，采用单因素分析颈动脉支架置入术后发生血流动力学损害的危险因素，再经Logistic回归法分 析血流动力学损害的独立危险因素。 结果 86例患者中42例在球囊扩张时均出现心动过缓、血压降低。血流动力学损害比率为48.8%， 单因素分析显示，高龄（≥75岁）（χ 2=4.076，P =0.040）、颈内动脉重度狭窄（70%～99%）（χ 2=5.010， P =0.029）、钙化斑块（χ 2=4.432，P =0.035）、狭窄距分叉处距离≤10 mm（χ 2=9.704，P =0.002）、球 囊后扩张（χ 2=6.635，P =0.025）是发生血流动力学损害的相关因素。Logistic回归分析显示，狭窄距分 叉处距离≤10 mm[比值比（odds ratio，OR）2.487，95%可信区间（confidence interval，CI）1.129～3.479， P =0.021]、重度狭窄（OR 1.650，95%C I 1.142～4.156，P =0.035）、球囊后扩张（OR 2.628， 95%CI 1.763～4.508，P =0.019）是血流动力学损害的独立危险因素。 结论 C A S围手术期血流动力学损害是常见的并发症，狭窄距分叉处距离≤10 m m、重度狭窄 （70%～99%）、球囊后扩张是CAS相关性血流动力学损害的独立危险因素。 Abstract: Objective To investigate risk factors for hemodynamic depression in perioperative period of carotid angioplasty and stenting (CAS). Methods A total of 86 patients who underwent CAS were enrolled. According to the patients’ intraoperative and postoperative blood pressure and heart rate, the patients were divided into no hemodynamic depression and hemodynamic depression groups. Univariate analysis was used to find the risk factors of hemodynamic depression, then the logistic regression analysis was used to determine the dependent risk factors after adjusting for age and sex. Results Among all 86 patients, 42 (48.8%) had hemodynamic depression of hypotension and bradycardia. Univariate analysis showed that hemodynamic depression was associated with the age ≥75 years (χ 2=4.076, P =0.040), severe internal carotid stenosis (70%-99%) (χ 2=5.010, P =0.029), calcified plaque (χ 2=4.432, P =0.035), the distance from stenosis to bifurcation ≤10 mm (χ 2=9.704, P =0.002), post-balloon dilatation (χ 2=6.635, P =0.025). Multivariate logistic regression analysis showed that the distance from stenosis to bifurcation ≤10 mm [odds ratio (OR) 2.487, 95% confidence interval (CI) 1.129-3.479, P =0.021], severe internal carotid stenosis (OR 1.650, 95%CI 1.142-4.156, P =0.035), post-balloon dilatation (OR 2.628, 95%CI 1.763-4.508, P =0.019) were independent risk factors of hemodynamic depression. Conclusions Hemodynamic depression is a common complication in perioperative period of CAS. The distance from stenosis to bifurcation ≤ 10 mm, severe internal carotid stenosis (70%-99%), and post-balloon dilatation are independent risk factors of hemodynamic depression related with CAS.
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