颈动脉支架术中发生颈动脉窦反射的危险因素  

Analysis of the Risk Factors of Carotid Sinus Reflex during Carotid Artery Stenting

作　　者：宋西方 万敏 胡苏姗 李军[3] 李兆圣 秦荣荣 贾伟华 Song Xifang;Wan Min;Hu Sushan;Li Jun;Li Zhaosheng;Qin Rongrong;Jia Weihua(Department of Neurology,Shijingshan Teaching Hospital of Capital Medical University,Beijing Shijiangshan Hospital,Beijing,100041;不详)

机构地区：[1]首都医科大学石景山教学医院,北京市石景山医院神经内科,北京市100041 [2]中国人民解放军火箭军特色医学中心,北京市100088 [3]北京市垂杨柳医院,北京市100022 [4]浙江大学医学院附属第四医院,浙江省义乌市322000 [5]南通市通州区人民医院,江苏省南通市226300

出　　处：《中国病案》2022年第11期66-69,共4页Chinese Medical Record

摘　　要：目的回顾性分析颈动脉支架术中颈动脉窦反射发生的危险因素,为术中颈动脉窦反射的评估及临床诊疗提供依据。方法连续入组5家合作医院2019年5月1日-2020年4月30日64例接受颈动脉支架手术的患者,按照是否存在颈动脉窦反射分为颈动脉窦反射组26例及无颈动脉窦反射组38例,记录各组患者临床基线特征、血管特征、手术情况对颈动脉窦反射的影响及并发症,应用统计学方法分析发生颈动脉窦反射的危险因素。结果高血压、糖尿病史、狭窄处至颈动脉分叉处距离<10mm、斑块性质和术前狭窄程度是颈动脉窦反射发生的危险因素;26例发生颈动脉窦反射,其中20例术中咳嗽或使用阿托品、多巴胺静脉给药后恢复,2例继续泵入多巴胺治疗24小时内恢复,4例持续泵入多巴胺并间断予以阿托品推注均于5天内恢复,该26例患者均无缺血事件发生。结论颈动脉支架术中出现颈动脉窦反射的概率较高,其中高血压病史、糖尿病史、狭窄处至颈动脉分叉处距离<10mm、钙化斑块及术前高狭窄率是导致颈动脉窦反射发生的危险因素,但经及时有效处理,可预防缺血事件的发生。Objectives This study aims to analyze the risk factors of carotid sinus reflex during carotid stenting in order to provide the basis for the evaluation of intraoperative carotid sinus reflex and clinical diagnosis and treatment.Methods A total of 64 patients who underwent carotid artery stenting in five hospitals from May 1,2019 to April 30,2020 were consecutively selected and were divided into the carotid sinus reflex group(26 cases)and non-carotid sinus reflex group(38 cases)according to the presence or absence of carotid sinus reflex.The clinical baseline characteristics,vascular characteristics,surgical conditions,and complications in each group were recorded.The risk factors of carotid sinus reflex were analyzed by statistical method.Results History of hypertension,diabetes,the distance between stenosis and carotid bifurcation<10mm,the nature of plaque,and the degree of stenosis were related to the occurrence of carotid sinus reflex.Among the 64 patients,26 patients suffered from carotid sinus reflex.Among them,20 cases recovered after coughing or using atropine and dopamine during the operation,2 cases recovered within 24 hours after continuous infusion of dopamine,and 4 cases recovered within 5 days after continuous infusion of dopamine and intermittent injection of atropine.No ischemic event occurred in these 26 patients.Conclusions The incidence rate of carotid artery reflex during carotid stenting is high.Hypertension,diabetes,the distance between stenosis and carotid bifurcation<10mm,calcified plaque,and high stenosis rate before the operation are the risk factors for carotid sinus reflex.However,timely and effective treatment can prevent the occurrence of ischemic events.

关 键 词：颈动脉支架 颈动脉窦反射 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]