颈动脉支架成形术后持续性血流动力学抑制的预测指标及其对预后的影响  

Predictors for persistent hemodynamic depression after CAS and its effect on clinical outcome

作　　者：唐文雄[1] 田朝晖[1] 刘蕾[1] 张志勇[1] 刘尊敬[1] Chen Jing 刘恒方[3] 

机构地区：[1]中日友好医院神经内科,北京100029 [2]Division of Biomedical Sciences,Warwick Medical School University of Warwick [3]郑州大学第五附属医院神经内科,郑州河南450052

出　　处：《中风与神经疾病杂志》2015年第10期877-880,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金资助(81173595);中日友好医院科技青年英才计划资助(2014-QNYC-A-04)

摘　　要：目的探讨颈动脉支架成形术(carotid angioplasty stenting,CAS)术后持续性血流动力学抑制(persistent hemodynamic depression,PHD)相关的预测因子,总结对这种情况的处理经验,阐明PHD对术后患者预后的影响。方法连续收集184例患有重度颈动脉狭窄并接受CAS的患者。采用单因素分析及和二分类Logistic回归分析鉴别PHD的预测因子,同时分析PHD对术后缺血性卒中、心脏及肾脏并发症的影响。结果既往心肌梗死(P=0.04)、术中血管升压药支持(P=0.01)、钙化斑块(P=0.02)及重复血管扩张(P=0.003)是术后PHD的独立危险因素;术中血管升压药支持(P=0.003)、钙化斑块(P=0.04)、重复血管扩张(P=0.02)外,年龄>80 y(P=0.02)和女性(P=0.01)是术后需要血管升压药使用>24 h的PHD的独立危险因素。围手术期缺血性卒中、心脏并发症及肾脏并发症的发生率在3组患者中间无差别。结论老年女性、术中存在HD、钙化斑块及反复球囊扩张是PHD的预测指标。发生PHD的患者给予适当治疗后并不影响患者总体预后。Objective To investigate predictors for post-procedural persistent hemodynamic depression（ PHD） after carotid angioplasty stenting（ CAS） and to summarize our experience in the treatment of this situation and interpret its effect on clinical outcomes. Methods 184 consecutive patients with high-grade carotid artery stenosis were treated with CAS in our center. Predictors for persistent HD requiring continuous vasopressors were analyzed by univariate and binary logistic regression analysis; and the effect of PHD on ischemic stroke,cardiac and renal complications were analyzed. Results Binary logistic regression analysis revealed that prior cardiac infarction（ P = 0. 04）,intraoperative vasopressor use（ P = 0. 01）,calcified plaques（ P = 0. 02） and repeated balloon inflation（ P = 0. 003） were independent risk factors for post-procedural PHD. Intraoperative vasopressor use（ P = 0. 003）,calcified plaques（ P = 0. 04） and repeated balloon inflation（ P =0. 02）,older than 80 y（ P = 0. 02） and female gender（ P = 0. 01） were independent risk factors for PHD requiring vasopressor 〉24 hours. The incidence of periprocedural cardiac and renal complications,ischemic stroke was indifference between each group. Conclusion Female,older than 80 years,intraoperative vasopressor use,calcified plaques and repeated balloon inflation were predictors of post-procedural PHD. Post-procedural PHD did not increase the incidence of ischemic stroke,cardiac and renal complications if treated appropriately.

关 键 词：颈动脉支架成形术 血流动力学抑制 

分 类 号：R743.4[医药卫生—神经病学与精神病学]