颈动脉支架植入术后低血压危险因素分析

Analysis of risk factors for hypotension occurring after carotid artery stenting

目的 探讨颈动脉狭窄患者颈动脉支架植入术(CAS)后产生低血压的危险因素。方法 回顾性分析2018年1月至12月在首都医科大学宣武医院接受CAS治疗的137颈动脉狭窄患者临床资料。患者平均年龄66.3岁,手术侧颈动脉重度狭窄98例,中度狭窄39例。采用单因素和多因素logistic回归法分析评价持续性低血压的危险因素。结果 137例颈动脉狭窄患者CAS术后有51例(37.2%)发生低血压。单因素分析提示,与CAS术后低血压相关的因素,包括颈动脉狭窄部位在球部、术前存在未控制的高血压、钙通道阻滞剂(CCB)类药物史、尿素氮、术后24 h静脉液体入量。多因素logistic回归分析结果显示,有溃疡斑块、术前存在未控制高血压、术后24 h静脉液体入量,是CAS术后低血压的独立危险因素。结论 有溃疡斑块、术前高血压未控制、术后24 h液体入量较多患者,更易发生CAS术后低血压。

Objective To investigate the risk factors related to the hypotension occurring after carotid artery stenting(CAS) in patients with carotid artery stenosis.Methods The clinical data of 137 patients with carotid artery stenosis,who were treated with CAS at the Xuanwu Hospital of Capital Medical University of China during the period from January 2018 to December 2018,were retrospectively analyzed.The mean age of the patients was 66.3 years.Severe carotid stenosis and moderate carotid stenosis on the surgical side were detected in 98 patients and 39 patients respectively.Both univariate and multivariate logistic regression analyses were used to evaluate the risk factors for persistent hypotension.Results Among the 137 patients,51(37.2%) developed hypotension after CAS.Univariate analysis indicated that the factors related to the occurrence of postoperative hypotension included stenosis located the carotid bulb,preoperative presence of uncontrolled hypertension,history of taking calcium channel blocker(CCB),urea nitrogen level,and the amount of intravenous fluid intake within the first 24 hours after CAS.Multivariate logistic regression analysis revealed that the presence of ulceration plaque,preoperative presence of uncontrolled hypertension,and the amount of intravenous fluid intake within the first 24 hours after CAS were the independent risk factors related to the occurrence of postoperative hypotension after CAS.Conclusion In the patients,who have ulceration plaque and uncontrolled hypertension before CAS,and who receive large amount of intravenous fluid intake within the first 24 hours after CAS,the post-CAS hypotension is more likely to occur.(J Intervent Radiol,2022,31:394-396)