颈动脉支架置入术血流动力学不稳定的相关危险因素:系统回顾和Meta分析  

Risk factors associated with hemodynamic instability in carotid artery stenting:a systematic review and meta-analysis

作　　者：张腊婷 王晓庆 韩琳 梁新慧 贾瑶 高丽娟 姜雪 ZHANG La-ting;WANG Xiao-qing;HAN Lin;LIANG Xin-hui;JIA Yao;GAO Li-juan;JIANG Xue(School of Nursing,Shaanxi University of Chinese Medicine,Xianyang 712046,China;Department of Neurosurgery,Tangdu Hospital,Air Force Medical University,Xi’an 710038,China;Offi ce of Infection Management,Affi liated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712046,China)

机构地区：[1]陕西中医药大学护理学院,陕西咸阳712046 [2]空军军医大学唐都医院神经外科,陕西西安710038 [3]陕西中医药大学附属医院感染管理办公室,陕西咸阳712046

出　　处：《中国介入心脏病学杂志》2025年第4期201-214,共14页Chinese Journal of Interventional Cardiology

摘　　要：目的应用Meta分析方法探讨颈动脉支架置入术后血流动力学不稳定的危险因素。方法检索PubMed、ProQuest、ScienceDirect、Embase、Cochrane Library、Web of Science、中国知网、万方数据、维普、中国生物医学文献数据库10个数据库。检索时限从建库至2024年2月2日,采用Stata 16.0统计软件进行Meta分析。结果共纳入27项研究,4199例受试者,22项影响因素。研究显示颈动脉支架置入术后出现血流动力学不稳定的发生率为37.4%(95%CI 30.3%~44.8%),Meta分析确定年龄>60岁(P<0.001)、高血压(P<0.001)、钙化斑块(P<0.001)、狭窄程度>70%(P=0.008)、偏心性斑块(P=0.002)、最大狭窄到颈动脉分叉的距离≤10 mm(P<0.001)、狭窄累及球部或分叉部(P<0.001)、球囊后扩张(P=0.003)、开环支架(P<0.001)、扩张球囊直径≥5 mm(P=0.002)、重复球囊扩张(P=0.011)及球囊扩张压力≥8 atm(P<0.001)是颈动脉支架置入术患者术中及术后血流动力学不稳定的危险因素。他汀类药物的使用(P<0.001)是保护因素。结论临床工作的医务人员应在术前对患者的情况进行评估,识别可能导致血流动力学不稳定的危险因素,避免对已经处于高危状态的患者进行不必要的术中刺激。减少颈动脉狭窄患者术后临床并发症,提高患者康复能力。Objective To investigate the risk factors of hemodynamic instability after carotid artery stenting by meta-analysis.Methods Ten databases were searched:PubMed,ProQuest,ScienceDirect,Embase,Cochrane Library,Web of Science,China Knowledge Network,Wanfang Data,VIP Information Database,and China Biomedical Database.The search date was from inception until 2 February 2024,and meta-analysis was performed using Stata 16.0 statistical software.Results A total of 27 studies with 4199 subjects and 22 infl uencing factors were included.The studies showed a 37.4%(95%CI 30.3%–44.8%)incidence of haemodynamic instability after carotid stenting,Meta-analysis determined that age>60 years(P<0.001),hypertension(P<0.001),calcified plaque(P<0.001),stenosis>70%(P=0.008),eccentric plaque(P=0.002),distance from the largest stenosis to the carotid bifurcation≤10 mm(P<0.001),stenosis involvement of the balloon or bifurcation(P<0.001),balloon post-dilation(P=0.003),open-loop stenting(P<0.001),dilated balloon diameter≥5 mm(P=0.002),repeat balloon dilation(P=0.011)and balloon dilation pressure≥8 atm(P<0.001)are risk factors for intraoperative and postoperative haemodynamic instability in patients undergoing carotid artery stenting surgery.Statin use was a protective factor(P<0.001).Conclusions Medical staff working in the clinic should assess the patient’s condition preoperatively,identify risk factors that may lead to haemodynamic instability,and avoid unnecessary intraoperative stimulation of patients who are already in a high-risk state.Reduce postoperative clinical complications in patients with carotid artery stenosis and improve patient recovery.

关 键 词：颈动脉支架置入 血流动力学不稳定 危险因素 META分析 

分 类 号：R5[医药卫生—内科学]