支架置入治疗颈动脉狭窄发生重度低血流动力学状态的危险因素分析

目的分析颈动脉支架置入术(CAS)治疗颈动脉狭窄后发生重度低血流动力学(HD)状态的危险因素。方法回顾性分析85例接受CAS手术的患者,其中男70例,女15例。按照是否发生重度HD(血压≤90/60 mm Hg或心率≤50次/min)状态分为重度HD组18例和非重度HD组67例,观察相关因素对重度HD的影响,并应用多因素Logistic回归分析确定重度HD的独立危险因素。结果多因素Logistic回归分析显示,颈动脉彩色多普勒血流显像(CDFI)高回声斑块(OR=6.219,95%CI:1.163~33.266;P=0.033)、最狭窄处距颈动脉分叉处距离1 cm(OR=8.360,95%CI:1.372~50.930;P=0.021)、基础收缩压120 mm Hg(OR=6.384,95%CI:1.217~33.486;P=0.028)、扩张球囊直径≥5 mm(OR=8.028,95%CI:1.462~44.091;P=0.017)为CAS术后发生重度HD状态的独立危险因素。结论 CDFI高回声斑块、最狭窄处距颈动脉分叉处距离1 cm、基础收缩压120 mm Hg、扩张球囊直径≥5 mm为CAS术后发生重度HD状态的独立危险因素。

Analysis of the risk factors of severe hemodynamic depression in carotid stenosis stenting

Objective To analyze the risk factors of severe hemodynamic depression （HD） in carotid artery stenting （CAS） for the treatment of carotid stenosis. Methods Eighty-five patients （70 males and 15 females） treated with CAS were analyzed retrospectively.They were divided into either a severe HD group （n=18） or a non-severe HD group （n=67） according to whether they had severe HD （blood pressure ≤90/60 mm Hg or heart rate ≤50/min） or not.The effects of all relevant factors on severe HD were observed,and Logistic regression analysis was used to define the independent risk factors for severe HD. Results Multivariate Logistic regression analysis showed the hyperechoic plaques of color Doppler flow imaging （OR=6.219,95%CI 1.163 - 33.266;P=0.033）,the distance from the most stenotic site to carotid bifurcation 〈 1 cm （OR=8.360,95%CI 1.372 - 50.930;P=0.021）,the baseline systolic pressure 〈120 mm Hg （OR=6.384,95%CI 1.217 - 33.486;P=0.028）,and the dilatation of balloon diameter ≥5 mm （OR=8.028,95%CI 1.462 - 44.091;P=0.017） were the independent risk factors for severe HD after CAS. Conclusion The hyperechoic plaques,distance from the most stenotic site to carotid bifurcation ＜1 cm,baseline systolic pressure ＜120 mm Hg,and dilatation balloon diameter ≥5 mm are the independent risk factors for severe HD after CAS.