心血管介入术后医源性假性动脉瘤危险因素分析  

Analysis of risk factors for iatrogenic pseudoaneurysm after cardiovascular interventional procedures

作　　者：王国运 陈黄卓楠 武志慧 毕梦露 刘核秀 曲妮娜 曹小丽[1] WANG Guoyun;CHEN Huangzhuonan;WU Zhihui;BI Menglu;LIU Hexiu;QU Nina;CAO Xiaoli(Department of Ultrasound,Afiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai,Shandong Province 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院超声科,山东烟台264000 [2]潍坊医学院医学影像学院 [3]滨州医学院医学影像学院

出　　处：《介入放射学杂志》2024年第6期646-650,共5页Journal of Interventional Radiology

基　　金：山东省自然科学基金面上项目(ZR2021MH398);山东省助力攀登医疗科研能力提升项目。

摘　　要：目的分析心血管介入术后发生医源性假性动脉瘤(PSA)的危险因素。方法回顾性分析2018年1月至2022年12月在烟台毓璜顶医院接受心血管介入手术后发生PSA的48例患者临床资料。对照组纳入192例无PSA患者,以病例对照1∶4配对,配对条件为年龄、穿刺部位。对患者基本资料、血液学检查、介入手术情况进行单因素及多因素logistic回归分析,筛选出独立危险因素。结果多因素logistic回归分析显示,高BMI(OR=1.324,95%CI=1.097~1.598,P=0.003)、吸烟史(OR=4.477,95%CI=1.599~12.536,P=0.004)、使用抗血小板药(OR=4.861,95%CI=1.018~23.214,P=0.047)、抗血小板和抗凝药联合(OR=26.994,95%CI=2.353~309.686,P=0.008)、介入手术操作者为主治医师(OR=5.817,95%CI=1.139~29.717,P=0.034)、低血红蛋白(OR=0.946,95%CI=0.922~0.971,P<0.01)、D-二聚体增高(OR=2.407,95%CI=1.367~4.239,P=0.002)、介入手术时间长(OR=1.019,95%CI=1.005~1.033,P=0.009)、鞘管>6 F(OR=4.368,95%CI=1.196~15.947,P=0.026)为心血管介入术后PSA发生的独立危险因素。结论高BMI、吸烟史、使用抗血小板药、抗血小板和抗凝药联合、介入手术操作者为主治医师、低血红蛋白、D-二聚体增高、介入手术时间长、鞘管>6 F为心血管介入术后PSA发生的高危因素,可为PSA早期预防提供依据。Objective To analyze the risk factors for iatrogenic pseudoaneurysm(PSA)occurring after cardiovascular interventional procedures.Methods The clinical data of 48 patients,who developed PSA after receiving cardiovascular interventional procedure at the Yantai Yuhuangding Hospital of China between January 2018 and December 2022,were retrospectively analyzed.The control group included 192 patients who had no PSA.At a case-control ratio of 1∶4,the PSA patients and non-PSA patients were paired,and the paired indicators included age,and puncture site.Univariate and multivariate logistic regression analyses were used to analyze the patients'basic data,hematological examination,and situation of the interventional procedure,and the independent risk factors were screened out.Results Multivariate logistic regression analysis showed that the high body mass index(BMI,OR=1.324,95%CI=1.097-1.598,P=0.003),smoking history(OR=4.477,95%CI=1.599-12.536,P=0.004),use of antiplatelet agents(OR=4.861,95%CI=1.018-23.214,P=0.047),combination use of antiplatelet and anticoagulant(OR=26.994,95%CI=2.353-309.686,P=0.008),the operator of the interventional procedure being an attending physician(OR=5.817,95%CI=1.139-29.717,P=0.034),low haemoglobin level(OR=0.946,95%CI=0.922-0.971,P<0.01),elevated D-dimer level(OR=2.407,95%CI=1.367-4.239,P=0.002),long-time interventional operation(OR=1.019,95%CI=1.005-1.033,P=0.009),and sheath size>6 F(OR=4.368,95%CI=1.196-15.947,P=0.026)were the independent risk factors for PSA occurring after cardiovascular interventional surgery.Conclusion High BMI,smoking history,use of antiplatelet agents,combination use of antiplatelet and anticoagulant,the operator of the interventional procedure being an attending physician,low haemoglobin level,elevated D-dimer level,long-time interventional operation,and sheath size>6 F are the independent risk factors for PSA occurring after cardiovascular interventional procedure,which can provide a basis for the early prevention of PSA.

关 键 词：假性动脉瘤 医源性 心血管介入 危险因素 

分 类 号：R654.4[医药卫生—外科学]