术前颈动脉窦阻滞预防颈动脉支架成形术围手术期低血流动力学状态

Preoperative carotid sinus block prevents the low hemodynamic state in the perioperative period of carotid artery stenting

目的探讨术前颈动脉窦阻滞预防颈动脉支架成形术(carotid artery stenting, CAS)围手术期低血流动力学状态的临床效果。方法采用前瞻性单中心随机对照研究,纳入2015年5月至2018年5月拟行CAS的颈内动脉狭窄患者共172例,根据入组标准将所有患者随机分为两组:A组术前在超声引导下行患侧颈动脉窦部局麻阻滞,B组术前不做处理。监测并比较两组术前、术后颈动脉狭窄率,术中血压、心率最大降幅,阿托品使用例数及剂量,术后低血流动力学状态发生人数及需使用升压药物时间。结果两组患者术前一般资料、狭窄程度、斑块性质、术后残余狭窄程度等因素差异均无统计学意义(均P>0.05)。A组术中血压、心率最大降幅明显低于B组、术中阿托品使用例数及剂量均小于B组,差异有统计学意义(P<0.05);A组术后发生低血流动力学状态例数及使用升压药物时间明显少于B组,差异有统计学意义(PV0.05)。结论术前颈动脉窦阻滞预防CAS围手术期低血流动力学状态安全有效。

Objective To evaluate carotid sinus block ( CAS) in preventing the low hemodynamic state in the perioperative period of carotid artery stenting ( CAS). Method A prospective single-center randomized controlled study was conducted on 172 patients with internal carotid artery stenosis receiving CAS from May 2015 to May 2018. Patients were randomly divided into group A treated with local anesthesia of the carotid artery sinus of the trouble side under the guidance of ultrasound preoperatively and group B without local block anesthesia. The carotid artery stenosis rate, the maximum intraoperative reduction of blood pressure and heart rate, the use of atropine and vasopressor were monitored and compared between the two groups. Results There were no significant differences between the two groups in preoperative general data, degree of stenosis, plaque nature, degree of residual stenosis ( P > 0. 05 ). The maximum reduction of intraoperative blood pressure and heart rate in group A was significantly lower than that in group B, and the number and dose of intraoperative atropine were smaller than those in group B ( P V 0. 05 ). The number of postoperative patients with low hemodynamic status in group A and the time period of vasopressor use were significantly less than those in group B ( P < 0. 05 ). Conclusion Preoperative carotid sinus block anesthesia is safe and effective in preventing low hemodynamic status in perioperative period of CAS.