颈动脉支架置入术后血流动力学变化的相关因素分析  

The brain hemodynamics regression analysis after carotid angioplasty and stenting

作　　者：王君[1] 李宝民[1] 李生[1] 曹向宇[1] 郭梅[1] 龚海芬[1] 

机构地区：[1]中国人民解放军总医院介入医学科,北京100853

出　　处：《中国现代神经疾病杂志》2005年第2期88-92,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨经皮血管内支架置入手术后血流动力学的变化规律,找出影响其变化的相关因素。方法对78例经皮血管内支架置入手术治疗的症状性和非症状性颈动脉狭窄患者的临床特点及影像学资料进行回顾性分析。通过脑血管造影检查评估支架置入手术前后对比剂在脑内的灌注变化,同时按照血流灌注积分表获得具体分值;经Logistic统计回归模型筛选、分析影响手术后脑血流循环灌注程度的相关因素,并对手术前后血流动力学的改变进行半定量分析,从而确定重要相关因素。结果手术后,78例患者中58例(74.36%)对比剂灌注流速明显改善,其中血流灌注1级者46.15%(36/78),2级者20.51%(16/78),3级者7.69%(6/78)。经直线回归分析显示,手术后脑血流灌注改善程度与手术侧动脉狭窄严重程度呈显著正相关(P<0.001),在所构建的Logistic多因素回归模型中,对比剂灌注流速的改善程度分别与手术侧颈动脉狭窄程度(O R=2.1×1010,P<0.01)、患者年龄(OR=0.8791,P=0.017)以及对侧颈动脉狭窄程度(OR=0.0149P=0.014)呈显著相关;而与手术后颈动脉狭窄改善程度无关。结论,经皮血管内支架置入术可有效改善脑血流灌注;其血流动力学得到改善的作用机制是解除狭窄后多因素的相互作用结果。Objective To explore the nature and influence determinants of cerebral hemodynamical change after carotid percutaneous transarterial stenting (PTAS). Methods The clinical characteristics and imaging records of 78 patients accepted PTAS for symptomatic or asymptomatic carotid stenosis reviewed and analyzed. Perfusion changes of contrast medium was assessed semiquantitatively with cerebral angiography by comparing pre-and post-stenting images according to the hemoperfusion scale: perfusion-chang grade 0, no change; grade 1, more distal small arteries visible; grade 2, time-matched capillary visible; grade 3, time-matched veins visible or contralateral blood perfusion visible significantly. The clinical data and perfusion changes were analyzed. Results Faster perfusion was observed in 74.36% of patients: grade 1, 46.15%; grade 2, 20.51%; grade 3, 7.69%. In linear regression analysis, the greater changes of carotid diameter after stenting were strongly associated with higher degrees of ipsilateral stenosis (P < 0.001). The Logistic regression model showed that the greater perfusion changes were associated with higher degree ipsilateral stenosis (OR = 2.1 × 10 10, P < 0.01) and such positive changes were negatively associated with age (OR = 0.879 1, P = 0.017) or the degree of contralateral carotid stenosis (OR = 0.014 9, P = 0.014). The Logistic regression model showed that the greater perfusion changes were associated with higher degree of ipsilateral stenosis (P < 0.01) and such positive changes were negatively associated with age or the degree of contralateral carotid stenosis (P < 0.05), but there was no correlation with the degree of stenosis change. Conclusion The cerebral hemoperfusion can be effectively improved by percutaneous transluminal stenting and the improvement is resulting in the intereaction of multiple factors after relieving arterial stenting.

关 键 词：血流动力学变化 相关因素分析 颈动脉支架 置入术后 Logistic 症状性颈动脉狭窄 血管内支架置入术 脑血管造影检查 脑血流灌注 直线回归分析 手术前后 回归模型 狭窄程度 回顾性分析 影像学资料 半定量分析 手术后 对比剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]