颈动脉支架置入术后发生持续性低血压的危险因素分析

Analysis of the risk factors for prolonged hypotension after carotid artery stenting

目的探讨颈动脉支架置入（CAS）术后发生持续性低血压的危险因素。方法选择行颈动脉颅外段支架置入术的患者105例。根据患者术后的血压状况，将其分为无低血压者、短暂性低血压者（收缩压〈90mmHg，或平均动脉压〈50mmHg，持续时间〈24h）及持续低血压者（上述低血压状态持续时间超过24h）。采用Cox多元回归法分析颈动脉支架置入术后发生持续性低血压的危险因素。结果105例患者中，术后29例（27．6％）出现短暂性低血压；16例（15．2％）出现持续低血压状态，其中3例低血压状态持续超过10d。16例持续低血压状态的患者持续时间为Md=3d（1～21d）。单因素分析发现，高龄（年龄〉75岁）、术前有低血压病史、狭窄程度≥80％、使用球囊后扩张、使用激光雕刻支架、操作时间超过1．5h与术后发生持续性低血压状态有关（P〈0．05）。经Cox比例风险分析并校正年龄和性别因素后，术前低血压病史（RR=4．53；95％CI1．39～9．72；P=0．008）、狭窄程度≥80％（RR=4．09；95％CI1．27～8．97；P=0．014）、使用球囊后扩张（RR=3．57；95％CI1．13～7．25；P=0．025）和操作时间〉1．5h（RR=4．87；95％C11．81～9．55；P=0．004）为术后发生持续性低血压的独立危险因素。结论术前有低血压病史、重度颈动脉狭窄、使用球囊后扩张和介入治疗操作时间较长的患者，术后更容易发生持续性低血压。

Objective To investigate the risk factors for prolonged hypotension after carotid artery stenting （CAS）. Methods A total of 105 patients treated with CAS were enrolled. The patients were divided into non-hypotension, transient hypotension （systolic pressure 〈 90 mm Hg, or mean arterial pressure 〈 50 mm Hg, lasted less than 24 hours）, and prolonged hypotension （the hypotensive status lasted more than 24 hours）. The risk factors for prolonged hypotension were analyzed by Cox multiple regression model. Results Among the 105 patients, 29 （27.6%） had transient hypotension, 16 （ 15. 2% ） had prolonged hypotensive status, and 3 of them lasted for more than 10 hours. The 16 patients with prolonged hypotensive status lasted for 1 -21 clays （Md =3 d）. Univariate analysis found that the advanced age （≥ 75 years）, previous hypotension before the procedure, stenosis ≥70% , balloon pre-dilatation, implantation of laser-carving stent and procedure time lasting more than 1.5 hours were associated with the prolonged hypotension （ P 〈 0. 05 ）. After Cox proportional hazard analysis, and adjusting for age and sex, the previous hypotension before the procedure （ RR = 4.53 ; 95% CI 1.39 - 9. 72 ; P = 0. 008 ） , stenosis ≥70% （RR = 4. 09 ; 95% CI 1.27 - 8.97 ; P = 0. 014）, balloon post-dilatation （ RR = 3.57 ; 95 % CI 1. 13 -7.25; P =0. 025） and the procedure time lasting more than 1.5 hours （RR =4.87 ; 95% CI 1.81 - 9.55 ; P = 0. 004） were the independent risk factors for post-procedural prolonged hypotension. Conclusion The patients with previous hypotension, severe carotid stenosis, using balloon dilatation, and longer duration of intervention may be more likely to develop prolonged procedural hypotension.