实时动脉测压装置在脑动脉支架植入术中的应用  

Application ofreal-time arterial pressure measuring device in cerebral artery stenting

作　　者：刘艳艳 曹辉[2] 刘犇[3] 杜明洋[2] 张尧[2] 蓝文雅[2] 姜海波[2] 许丽丽 马志 邱峰[2] LIU Yanyan;CAO Hui;LIU Ben(Department of Neurology,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,210029 [2]南京医科大学附属脑科医院脑血管病救治中心 [3]南京医科大学附属脑科医院物理诊断科

出　　处：《临床神经病学杂志》2024年第3期179-183,共5页Journal of Clinical Neurology

基　　金：南京市医学科技发展资金项目(QRX17086);南京市医学科技发展专项资金项目(ZKX23039)。

摘　　要：目的采用实时动脉测压装置评估脑动脉支架植入术前后狭窄近端动脉压力及外周血压变化的情况,同时评估该动脉测压装置的安全性及有效性。方法选取经DSA诊断为颈动脉狭窄者50例和椎动脉狭窄患者50例,行脑血管支架植入治疗过程为将导引导管送至治疗血管的狭窄近端,连接实时动脉测压装置测量动脉压力,同时测量相应上肢平均外周血压,同样方法记录支架植入术后近端平均动脉血压及上肢平均外周血压,比较支架前后狭窄近端压力差均值变化并评估影响因素,同时评估动脉测压装置的安全性及有效性。结果100例脑动脉狭窄患者术前术后近端压力差获取率100%,且患者术前术后狭窄近端平均动脉压力差差异有统计学意义(P<0.001)。同组重度狭窄患者治疗前平均动脉压明显高于中度狭窄患者(P<0.05);椎动脉组中仅重度狭窄患者在支架植入术后平均外周血压较术前明显减低(P<0.05)。颈动脉组动脉压力差值明显高于椎动脉组患者(P<0.05)。对于颈动脉狭窄行支架植入术的患者,术前术后平均动脉压力差为(18.03±17.28)mmHg(1 mmHg=0.133 kPa),压力差变化与外周血压相关性差异无统计学意义(r=0.448,P>0.05),与血管狭窄程度呈正相关(r=0.827,P<0.001)。对于椎动脉狭窄行支架植入术的患者,术前术后平均动脉压力差为(10.25±16.75)mmHg,与外周血压呈现正相关(r=0.664,P<0.05),与血管狭窄程度呈正相关(r=0.843,P<0.005)。所有患者术前术后动脉压力差值相关性分析也显示血管狭窄程度与狭窄近端术前术后的动脉压力差呈正相关(r=0.693,P<0.005)。采用动脉测压装置在监测过程中无斑块脱落,未出现血管夹层及栓塞出血等相关并发症。结论采用实时动脉测压装置可安全有效监测脑动脉支架植入术中及术后动脉压力变化情况,动脉支架植入可有效降低狭窄近端的动脉压力,对于早期预估血管狭窄程度及�Objective To evaluate the changes of proximal arterial pressure and peripheral blood pressure in patients with symptomatic cerebral artery stenosis before and after cerebral artery stenting,and to evaluate the safety and efficacy of real-time arterial pressure measurement device.Methods Fifty patients with carotid artery stenosis and 50 patients with vertebral artery stenosis diagnosed by digital subtraction angiography were selected.During the treatment of cerebral vascular stent implantation,the guiding catheter was sent to the proximal stenosis of the treated vessel,the real-time arterial pressure measuring device was connected to measure the arterial pressure,and the average peripheral blood pressure of the corresponding upper limb was measured at the same time.The proximal mean arterial blood pressure and upper limb mean peripheral blood pressure were recorded after stent angioplasty in the same way,and the mean pressure difference of proximal stenosis was compared before and after stent angioplasty,and the influencing factors were evaluated,as well as the safety and effectiveness of arterial pressure measurement device.Results The acquisition rate of proximal pressure difference before and after operation was 100%in 100 patients with cerebral artery stenosis,the difference of proximal pressure difference before and after operation was statistically significant(P<0.001).In the same group,the mean arterial pressure of patients with moderate and severe stenosis was significantly higher than that of patients with moderate stenosis before treatment(P<0.05);in the vertebral artery group,only the mean peripheral blood pressure of patients with severe stenosis after stenting was significantly lower than that before stenting(P<0.05).The difference of arterial pressure in the carotid artery group was significantly higher than that in the vertebral artery group(P<0.05).For patients with carotid artery stenosis undergoing stent implantation,the mean arterial pressure difference was(18.03±17.28)mmH g(1 mmHg=0.133kPa)be

关 键 词：实时动脉测压 脑血管介入治疗 颈动脉 椎动脉 动脉压力差 

分 类 号：R741.05[医药卫生—神经病学与精神病学]