颅外颈动脉和椎动脉狭窄支架置入术围术期并发症及危险因素分析  

Perioperative complications of and risk factors for extracranial carotid artery and vertebral artery stenting

作　　者：霍颖超[1] 严家川[1] 周华东[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所神经内科,重庆400042

出　　处：《中华老年心脑血管病杂志》2016年第11期1124-1128,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金："十一五"国家科技支撑计划项目(2006BAI01A10)

摘　　要：目的探讨血管内支架置入术治疗颅外颈动脉和椎动脉狭窄患者围术期并发症特点及危险因素,制订术前评估策略。方法连续选择我院行血管内支架置入术的患者279例,根据手术方式分为:颈动脉支架组207例及椎动脉支架组72例,术后随访30d,根据围术期内是否存在并发症分为并发症组144例和无并发症组135例。结果颈动脉支架组心动过缓(10.6%vs 1.4%,P=0.027)及血压降低(22.7%vs 5.6%,P=0.001)的比例明显高于椎动脉支架组。并发症组患者随着年龄、狭窄程度的增加,并发症比例明显升高,而无并发症组明显降低(P<0.05)。logistic回归分析显示,年龄、高血压、动脉狭窄程度、狭窄长病变、Ⅲ型主动脉弓、术者操作经验及操作时间为围术期并发症的独立危险因素,球囊预扩为围术期并发症的保护因素。结论患者相关因素及术中因素均可显著影响围术期并发症的发生,术前充分准备、术中规范操作及术后严密监测对防治围术期并发症尤为重要。Objective To study the perioperative complications and risk factors for extracranial carotid artery and vertebral artery stenting in order to make their preoperative assessment strategies.Methods Two hundredand and seventy-nine carotid or vertebral artery stenosis patients who underwent extracranial carotid artery or vertebral artery stenting in our hospital were divided into carotid artery stenting group（n=207）and vertebral artery stenting group（n=72）according to their surgical procedure.The patients were followed up for 30 days after operation.Their perioperative complications were recorded.The patients were further divided into complication group（n=144）and complication-free group（n=135）.Results The incidence of bradycardia and hypotension was significantly higher in carotid artery stenting group than in vertebral artery stenting group（10.6%vs 1.4%,P=0.027 and 22.7%vs 5.6%,P=0.001）.The complications increased with the increasing age and severity of stenosis in complication group and decreased with the increasing age and severity of stenosis in complication-free group（P〈0.05）.Logistic regression analysis showed that age,hypertension,artery stenosis,long and narrow lesions,typeⅢarcus aortae,experience of surgical operators and time of operation were the independent risk factors for perioperative complications whereas balloon expansion was the protective factor for perioperative complications.Conclusion Patients-related factors and intraoperative factors can significantly influence the occurrence of perioperative complications.

关 键 词：颈动脉狭窄 椎底动脉供血不足 支架 手术中并发症 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]