颈动脉血管成形和支架植入患者术前术后血压变化与再狭窄发生的相关性研究

Correlation between preoperative and postoperative blood pressure changes and the occurrence of restenosis in patients with carotid angioplasty and stent implantation

目的 分析首次接受颈动脉血管成形和支架植入(CAS)患者手术前后血流动力学情况以及术后再狭窄的发生情况,探究手术前后颈动脉收缩期峰值血流速度(PSV)变化与血压变化的相关性。方法 选择186例在我院首次接受CAS的患者,采集基线评估资料后,比较患者手术前后血流动力学情况,根据随访结果分为支架内再狭窄(ISR)组36和例非ISR组150例,比较两组患者手术前后血流动力学变化情况,利用Pearson相关性分析两组患者手术前24 h、术后24 h血压变化与ISR发生的相关性。结果(1)首次接受颈动脉血管成形和支架植入术后平均收缩压(MSBP)、平均舒张压(MDBP)、PSV较术前明显降低(P<0.05);(2)与非ISR组手术前后血流动力学变化量比较,ISR组患者手术前后MSBP、MDBP、PSV的变化量明显降低(P<0.05);(3)非ISR组患者手术前后MSBP、MDBP的变化量与PSV的变化量均有极显著正相关性(P<0.05),且相关性大小依次为MDBP的变化量(r=0.994)>MSBP的变化量(r=0.980)。结论 首次接受CAS患者术后血压下降可预测ISR的低发生率。

Objective To analyze the hemodynamics and restenosis of patients undergoing carotid angioplasty and stent implantation(CAS)for the first time before and after operation,and to explore the correlation between the changes of peak systolic velocity(PSV)of carotid artery and the changes of blood pressure before and after operation.Methods 186 patients who received CAS for the first time in our hospital were selected.After collecting the baseline evaluation data,the hemodynamics of the patients before and after operation were compared.According to the follow-up results,they were divided into 36 cases in the in stent restenosis(ISR)group and 150 cases in the non-ISR group.The hemodynamic changes of the two groups were compared before and after operation.The correlation between the changes of blood pressure 24 hours before and 24 hours after operation and the occurrence of ISR was analyzed by Pearson correlation.Results(1)Mean systolic blood pressure(MSBP),mean diastolic blood pressure(MDBP)and PSV of carotid artery after carotid angioplasty and stent implantation for the first time were significantly lower than those before operation(P<0.05).(2)Compared with the hemodynamic changes before and after operation in the non ISR group,the changes of MSBP,MDBP and PSV before and after operation in the ISR group were significantly reduced(P<0.05).(3)In the non ISR group,the changes of MSBP and MDBP before and after operation were significantly positively correlated with the changes of PSV(P<0.05),and the correlation was in the order of MDBP(r=0.994)>MSBP(r=0.980).Conclusion The decrease of postoperative blood pressure in patients receiving CAS for the first time can predict the low incidence of ISR.