大脑中动脉狭窄支架置入术后并发症相关因素分析

Evaluation of relevant factors affecting complication in patients receiving stent implantation for middle cerebral artery stenosis

目的研究大脑中动脉狭窄患者支架植入术后发生灌注压突破综合征的相关因素。方法选择经临床证实的发生灌注压突破综合征的6例患者作为实验组,在支架植入术患者中随机抽取未发生灌注压突破综合征的8例患者作为对照组。首先,对14例患者病变侧与对侧头颅CT灌注的最大峰值时间的差异性(TTP)进行统计学分析。其次,对可能影响支架置入术后并发症发生的相关因素进行分析。结果 14例入选者术前TTP与对侧比均明显延长。其病变侧及对侧的达峰时间分别为(13.19±3.98)s和(9.325±3.87)s,经配对t检验差异有统计学意义(P<0.001)。对支架置入术后可能导致并发症发生的相关指标进行秩转换的非参数检验,认为术前脑血流量下降率、术前罪犯血管狭窄率可能与其并发症发生有关(P<0.001)。结论 TTP是评价缺血的一种敏感方法,对于CBF下降率或罪犯血管狭窄率严重患者,应高度警惕术后并发症的发生。

Objective To investigate relevant factors affecting complication in patients receiving implantation for middle cerebral artery stenosis.Methods Six patients were clinically proven to be perfusion pressure breakthrough syndrome as experimental group,8 patients without perfusion pressure breakthrough syndrome were randomly selected as control group.TTP differences of lesion side and contralateral cranial CT perfusion in 14 patients were statistically analyzed.The relevant factors affecting complication of stent implantation were analyzed.Results Preoperative TTP in 14 patients were remarkably delayed.TTP of diseased side and normal side were（13.19±3.98）seconds and（9.325±3.87）seconds,and the paired t test demonstrated that there was a statistically significant difference（P0.001）.Relevant factors which may affect complication of stent implantation were analyzed by rank conversion of non-parametric tests,preoperative cerebral blood flow rate of decline and preoperative culprit artery stenosis rate was correlated with complication occurrence（P0.01）.Conclusion TTP is a sensitive assessment for the evaluation of cerebral ischemia.We should be alert complication when rCBF decreased of diseased side and serious angiostenosis.