老年患者颈动脉支架术后血流动力学异常危险因素分析  

Risk factors of hemodynamic instability after carotid artery stenting in elderly patients

作　　者：余雪渊 王春梅[1] 张帆[1] 黄莹[1] 闫彬 宁雅婵[1] 杨金铭 郭连瑞[1] Yu Xueyuan;Wang Chunmei;Zhang Fan;Huang Ying;Yan Bin;Ning Yachan;Yang Jinming;Guo Lianrui(Intensive Care Unit,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院重症医学科,北京100053

出　　处：《国际外科学杂志》2021年第9期622-626,共5页International Journal of Surgery

基　　金：首都医科大学宣武医院院级课题(XWJL-2019037)。

摘　　要：目的:探讨颈动脉狭窄老年患者颈动脉支架成形术(CAS)后产生血压异常的危险因素。方法:回顾性分析2018年1~12月在首都医科大学宣武医院接受CAS治疗的80例颈动脉狭窄的老年患者的病例资料,记录人口学特征(年龄、性别、身高、体重),基础疾病史(高血压、糖尿病、肾脏病、心功能不全等),用药史等。观察肌酐、血尿素氮(BUN)、尿量、出入量、白蛋白、血红蛋白、狭窄部位、狭窄程度等临床参数。符合正态分布的计量资料以均数±标准差( Mean± SD)表示,组间比较采用 t检验;不符合正态分布的计量资料以中位数(四分位间距)[ M( P25, P75)]表示,组间比较采用秩和检验;计数资料组间比较采用 χ^(2)检验。有关变量做单因素分析,根据单因素分析结果选择差异具有统计学意义的指标纳入多因素Logistic回归分析。 结果:80例颈动脉狭窄患者CAS术后有37例(46.25%)发生血压异常。单因素分析结果显示,CAS术后血压异常相关的因素包括身高、血小板计数、有溃疡斑块、术后第1个24 h液体入量;多因素分析结果显示,有溃疡斑块( OR=11.559,95% CI:1.232~108.495)、术后第1个24 h液体入量( OR=1.001,95% CI:1.000~1.001)是CAS术后血压异常的独立危险因素。 结论:有溃疡斑块、术后第1个24 h液体入量多的患者CAS术后更易发生血压异常。Objective:To investigate the risk factors related to the hemodynamic instability occurring after carotid artery stenting(CAS)in elderly patients with carotid artery stenosis.Methods:The clinical data of 80 patients with carotid artery stenosis,who were treated with CAS at Xuanwu Hospital,Capital Medical University during the period from January 2018 to Decmber 2018,were retrospectively analyzed.Record demographic characteristics(age,gender,height,weight),history of underlying diseases(hypertension,diabetes,kidney disease,heart failure,etc.),history of medications,etc.Observe the clinical parameters such as creatinine,blood urea nitrogen(BUN),urine volume,input and output,albumin,hemoglobin,location of stenosis,and degree of stenosis.Measurement data conforming to the normal distribution were expressed as the mean±standard deviation(Mean±SD),and the t-test was used for comparison between groups;the measurement data that does not conform to the normal distribution were expressed as the median(interquartile range)[M(P25,P75)]indicates that the rank sum test was used for comparison between groups;the Chi-square test was used for comparison of count data between groups.Relevant variables were subjected to single factor analysis,and statistically significant indicators were selected according to the results of single factor analysis to be included in the multivariate Logistic regression analysis.Results:After CAS,a total of 37 patients among the 80 patients developed hemodynamic instability,the incidence rate was 46.25%.Univariate analysis indicated that the factors associated with the occurrence of postoperative hemodynamic instability included height,platelet count,ulceration plaque and the fluid intake in the first 24 hours after surgery;Multivariate regression analysis revealed that the presence of ulceration plaque(OR=11.559,95%CI:1.232-108.495)and the fluid intake in the first 24 hours after surgery(OR=1.001,95%CI:1.000-1.001)were the independent risk factors related to the hemodynamic instability after CAS.Con

关 键 词：颈动脉支架成形术 血压异常 老年人 危险因素 

分 类 号：R651.12[医药卫生—外科学]