颈动脉支架植入术继发持续性血流动力学损害的危险因素分析  

Analysis of the risk factors for persistent hemodynamic depression after carotid angioplasty and stenting

作　　者：叶强[1] 黄海波[1] 范良好[2] 章云军[2] 伍晓扬[2] 王金凤[2] 

机构地区：[1]温州医学院附属第一医院脑血管科,325000 [2]温州医学院附属第一医院介入科,325000

出　　处：《中国医师进修杂志》2010年第8期1-4,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨颈动脉支架植入术（CAS）继发持续性血流动力学损害的危险因素。方法选择行CAS患者61例。先采用单因素Logistic回归分析CAS继发持续性血流动力学损害的危险因素，再经非条件Logistic多因素回归分析并校正年龄和性别因素后，分析持续性血流动力学损害的独立危险因素。结果61例患者术中、术后发生低血压25例、心动过缓25例，发生率均为41．0％。根据患者术中、术后的血压、心率状况及血流动力学损害持续时间，分为持续性血流动力学损害者20例，非持续性血流动力学损害者41例。单因素logistic回归分析提示与持续性血流动力学损害有关的因素：症状性狭窄、重度狭窄、球囊后扩张、采用激光雕刻支架（P值均〈0．05）；非条件Logistic多因素回归分析，发现球囊后扩张、采用激光雕刻支架是持续性血流动力学损害的独立危险因素，OR值分别为5．046（95％CI1．342～18．977，P=0．017）和4．142（95％CI1．151～14．902．P=0．030）；症状性狭窄为持续性血流动力学损害的独立保护因素，OR值为0．264（95％C10．073-0．964，P=0．044）。结论GAS继发持续性血流动力学损害为常见的并发症，行球囊后扩张、采用激光雕刻支架的CAS患者更易发生持续性血流动力学损害，而症状性狭窄为其保护性因素。Objective To investigate the risk factors for persistent hemodynamic depression after carotid angioplasty and stenting（CAS）. Methods Sixty-one patients with CAS were included. By univariate Logistic regression analysis, the influencing factors for persistent hemedynamic depression were analyzed, by stepwise Logistic regression analysis and adjustment for age and gender factors,the independent risk factors for persistent hemodynamic depression were analyzed. Results In 61 patients, 25 cases had hypotension, 25 cases had bradycardia, all for 41.0% incidence. According to the patients intraoperative and postoperative blood pressure,heart rate conditions,the duration of hemodynamic depression,the cases were divided into persistent hemodynamic depression group （20 cases ） and no-persistent hemodynamic depression group （41 cases ）. Univariate Logistic regression analysis indicated that persistent hemodynamic depression influencing factors were the symptomatic stenosis, severe stenosis, using balloon dilatation, implantation of laser-carving stent（P〈 0.05 ）. With adjustment for age and gender factors, stepwise Logistic regression analysis showed that using balloon dilatation,implantation of laser-carving stent were the independent risk factors for persistent hemodynamie depression（OR = 5.046,95%CI 1.342-18.977,P= 0.017;OR = 4.142,95%CI 1.151-14.902, P = 0.030）, symptomatic stenosis was the independent protective factor for persistent hemodynamic depression （OR = 0.264,95% CI 0.073-0.964,P = 0.044）. Conclusions Persistent hemodynamie depression after CAS is a common complication.CAS patients with using balloon dilatation, implantation of laser-carving stent are more susceptible to persistent hemodynamic depression, while symptomatic stenosis is its protective factor.

关 键 词：压力感受器反射 血液动力学过程 脑损害 危险因素 颈动脉支架植入术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]