围术期血压变异性与颈动脉支架置入术后脑高灌注综合征的相关性研究

Association between perioperative blood pressure variability and cerebral hyperperfusion syndrome after CAS

目的探讨颈动脉支架置入术围术期血压变异性(BPV)与术后脑高灌注综合征(CHS)的关系。方法选择行颈动脉支架置入术患者418例,根据术后是否发生CHS分为高灌注组20例和非高灌注组398例,回顾性分析入选者一般资料,计算BPV指标。结果CHS组年龄、双侧颈动脉狭窄及慢性肾病比例明显高于非CHS组[72(68,80)岁vs 68(55,78)岁,P=0.001,60.0%vs 19.6%,P=0.000,40.0%vs 11.8%,P=0.000],2组侧支循环分级比较,差异有统计意义(P<0.01)。术后CHS组平均收缩压、最大收缩压、收缩压标准差、收缩压变异系数(CV)、收缩压连续变异度(SV)、收缩压最大最小差值(max-min)、最大舒张压、舒张压标准差、舒张压CV、舒张压SV、收缩压max-min明显高于非CHS组(P<0.01)。最大收缩压、最小收缩压、收缩压max-min、收缩压CV、舒张压标准差、最大舒张压、最小舒张压、舒张压max-min、舒张压CV与CHS明显相关(P<0.01)。结论不仅围术期绝对血压升高可增加CHS发生,围术期BPV增加也可增加CHS风险。

Objective To study the association between perioperative BPV and CHS after carotid artery stenting.Methods Four hundred and eighteen patients who underwent carotid stenting were divided into hyperperfusion group(n=20)and hyperperfusion-free group(n=398).Their general clinical data were recorded.Their BPV parameters were measured.Results The age was significantly older,the incidence of bilateral carotid stenosis and chronic renal disease was significantly higher in CHS group than in CHS-free group(72 years vs 68 years,60.0%vs 19.6%,40.0%vs 11.8%,P<0.01).Significant difference was detected in collateral circulation between the two groups(P<0.01).The mean SBP,maximum SBP,SBP standard deviation,SBP CV and SV,maximum and minimum SBP,maximum DBP,DBP standard deviation,DBP CV and SV,maximum and minimum DBP were significantly higher in CHS group than in CHS-free group after operation(P<0.01).The maximum SBP,minimum SBP,maximum and minimum SBP,SBP CV and SV,DBP standard deviation,maximum DBP,minimum DBP,maximum and minimum DBP,DBP CV and SV were closely associated with CHS(P<0.01).Conclusion Elevated perioperative absolute blood pressure and BPV increase the risk of CHS after carotid artery stenting.