颈动脉支架置入术围手术期血压调控的探讨

目的探讨粥样硬化性颈动脉狭窄患者,经皮血管内支架置入血管成形术(PTAS)围手术期血压调控的必要性及初步经验。方法回顾性分析293例粥样硬化性颈动脉狭窄患者经全脑数字减影血管造影术诊断后,采用自膨式支架经股动脉入路行PTAS,围手术期对血压严密监控,并根据血压的高低采取综合措施及时进行调整,以避免发生高灌注性脑病或心、脑缺血。结果 293例患者中支架置入成功292例(99.7%)。术前狭窄率70%～95%平均(82.0±13.1)%,术后残余狭窄率为0～20%,平均(9.2±6.8)%,术后患者脑缺血症状及体征均有明显改善。有1例患者在术中及术后血压控制不理想,发生了高灌注性脑出血而死亡。通过采取综合措施调节血压后未再发生高灌注性脑病,血压降至90～120/60～90 mm Hg(1 mm Hg=0.133 kPa)后,所有患者均未发生心、肾、脑等脏器缺血。结论 PTAS微创安全有效,但术中及术后调整血压非常必要,围手术期有效地调控血压是减少术后高灌注性综合征发生的重要手段之一。

Study on peri-operative management of blood pressure during PTAS for atherosclerotic carotid stenosis

Objective To discuss the necessity and preliminary experience of perioperative regulation of blood pressure during percutaneous transluminal angioplasty and stenting(PTAS) for atherosclerotic carotid stenosis.Methods 293 cases were diagnosed as atherosclerotic carotid stenosis by digital subtraction angiography(DSA) and underwent PTAS with self-expand stent by the approach of femoral artery.The blood pressure was strictly monitored and comprehensive measures were taken to regulate blood pressure during peri-operative period to prevent hyperperfusion syndrome or ischemia of brain and heart.Results The success rate of stenting was 99.7%.The post-operative average rate of stenosis was decreased from(82.0±13.1)% before operation to (9.2 ± 6.8)%.The clinical symptom and sign of cerebral ischemia were improved obviously after PTAS in those with ischemia.Cerebral hemorrhage and death occurred in one case because of unsatisfactory regulation of blood pressure.After comprehensive measures were taken to control the blood pressure during the peri-operative period,no hyperperfusion occurred again.When the blood pressure was controlled at between 90—120/60 — 90 mm Hg,no ischemic symptom of heart,kidney or brain occurred.Conclusions PTAS is a minimally invasive,safe and effective therapy for atherosclerotic carotid stenosis.Effective management of the blood pressure during peri-operative period is an important measure to decrease the occurrence of hyperperfusion syndrome after operation.