颈动脉支架术对血流动力学的急性影响  

Acute Effect of Carotid Artery Stenting on Hemodynamics

作　　者：熊洪亮[1] 车武强[1] 蒋雄京[1] 邹玉宝[1] 董徽[1] 王鹏[1] 刘加林[1] XIONG Hong-liang CHE Wu-qiang JIANG Xiong-jing ZOU Yu-bao DONG Hui WANG Peng LIU Jia-lin.(Department of Cardiology, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS and PUMC, Beijing （100037）, China)

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2017年第10期999-1004,共6页Chinese Circulation Journal

摘　　要：目的:调查颈动脉支架术(CAS)对血流动力学的急性影响。方法:回顾性分析我院2014-09至2015-09期间连续170例CAS患者围术期资料,调查跨颈内动脉近端支架置入对血压、心率的急性影响,并随访1个月,观察其与围术期不良事件发生的关系。结果:(1)与术前相比,颈动脉支架置入后全天平均收缩压从126.6±15.1(93~175)mm Hg(1mm Hg=0.133k Pa)下降为117.7±13.7(87~158)mm Hg(P<0.01),全天平均舒张压从72.8±11.5(49~100)mm Hg下降为67.3±10.3(48~90)mm Hg(P<0.01);全天平均心率由66.3±6.8(49~84)次/min下降为62.6±7.2(49~88)次/min(P<0.01)。(2)血流动力学不稳定(HI)发生率为51.8%(88/170),其中高血压、低血压和心动过缓的发生率分别为3.5%(6/170)、39.4%(67/170)和22.4%(38/170)。多因素回归分析发现HI的发生与性别、高血压病史、双侧CAS及颈动脉分叉病变关系密切。HI发生后,通过静脉输注血管活性药物血压、心率均可恢复正常水平,其中6例(3.5%)用药时间超过24小时。(3)围术期共有8例(4.7%)患者出现不良事件,包括4例短暂性脑缺血发作、2例小卒中和2例大卒中(其中1例死亡)。非HI患者发生不良事件的比例为2.4%(2/82),HI患者为6.8%(6/88),两者相比,P值为0.32。HI患者中高血压、低血压、心动过缓及低血压合并心动过缓发生不良事件的比例分别为16.7%(1/6)、6.8%(3/44)、0%(0/15)和8.7%(2/23),与整体患者相比,P值分别为0.669、0.723、0.793和0.658。结论:CAS围术期HI患者发生比例较高,性别、高血压病史、双侧CAS和颈动脉分叉病变是其独立预测因素;及时合理地使用血管活性药物对于预防或者减少HI相关不良事件的发生意义重大。Objective： To investigate the acute effect of carotid artery stenting （CAS） on hemodynamics. Methods： We retrospectively analyzed 170 consecutive patients who received CAS in our hospital from 2014-09 to 2015-09. The acute effects of proximal internal CAS on blood pressure （BP） and heart rate （HR） were studied, the patients were followed-up for a month to observe the relationship between CAS and peri-operative adverse events occurrence. Results： ① Compared with pre-operative condition, the all day mean systolic blood pressure （SBP） from （126.6±15.1, 93-175） mmHg decreased to （117.7±13.7, 87-158） mmHg, P〈0.01, all day mean DBP from （72.8±11.5, 49-100） mmHg decreased to （67.3±10.3, 48-90） mmHg, P〈0.01, and all day HR from （66.3±6.8, 49-84） bpm decreased to （62.6±7.2, 49-88） bpm, P〈0.01. ② The incidence of hemodynamic instability （HI） was 51.8% （88/170） and the occurrence rates of thypertension, hypotension and bradycardia were 3.5% （6/170）, 39.4 % （67/170） and 22.4% （38/170） respectively. Multivariate regression analysis showed that HI was closely related to gender, history of hypertension, bilateral CAS and carotid bifurcation lesions. Upon HI onset, BP and HR could be restored to normal via intravenous infusion of vasoactive drugs and 6 （3.5%） patients having the medication time more than 24 hours. ③ Peri-operative adverse events happened in 8 （4.7%） patients including 4 transient ischemic attack, 2 minor stroke and 2 major stroke （1 patient died）. The ratio of adverse events was 2.4% （2/82） in Non-HI group and 6.8% （6/88） in HI group, P=0.32. In HI group, the incidences of hypertension, hypotension, bradycardia and hypotension combining bradycardia were 16.7% （1/6）, 6.8% （3/44）, 0% （0/15） and 8.7% （2/23） respectively, compared with the overall patients＇ group, P=0.669, P=0.723, P=0.793 and P=0.658 respectively. Conclusion： HI incidence was relatively high in peri-operative period of CAS; ge

关 键 词：颈动脉支架术 血流动力学 术后并发症 

分 类 号：R541[医药卫生—心血管疾病]