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目的探讨颈动脉支架成形术(carotid angioplasty stenting,CAS)术后持续性血流动力学抑制(persistent hemodynamic depression,PHD)相关的预测因子,总结对这种情况的处理经验,阐明PHD对术后患者预后的影响。方法连续收集184例患有重度颈动脉狭窄并接受CAS的患者。采用单因素分析及和二分类Logistic回归分析鉴别PHD的预测因子,同时分析PHD对术后缺血性卒中、心脏及肾脏并发症的影响。结果既往心肌梗死(P=0.04)、术中血管升压药支持(P=0.01)、钙化斑块(P=0.02)及重复血管扩张(P=0.003)是术后PHD的独立危险因素;术中血管升压药支持(P=0.003)、钙化斑块(P=0.04)、重复血管扩张(P=0.02)外,年龄>80 y(P=0.02)和女性(P=0.01)是术后需要血管升压药使用>24 h的PHD的独立危险因素。围手术期缺血性卒中、心脏并发症及肾脏并发症的发生率在3组患者中间无差别。结论老年女性、术中存在HD、钙化斑块及反复球囊扩张是PHD的预测指标。发生PHD的患者给予适当治疗后并不影响患者总体预后。
Objective To investigate the prognostic factors associated with persistent hemodynamic depression (PHD) after carotid angioplasty stenting (CAS) and to summarize the experience of this situation, and to clarify the effect of PHD on postoperative patients The impact of prognosis. Methods A total of 184 patients with severe carotid artery stenosis undergoing CAS were enrolled in a consecutive series. Univariate analysis and binary logistic regression analysis were used to identify the predictors of PHD. The effects of PHD on postoperative ischemic stroke, heart and kidney complications were also analyzed. Results Previous myocardial infarction (P = 0.04), intraoperative vasopressor support (P = 0.01), calcified plaque (P = 0.02) and recurrent vasodilation (P = 0.003) were independent risk factors for postoperative PHD. (P = 0.02) and female (P = 0.01) after surgery (P = 0.003), calcified plaque (P = 0.04) and repeated vasodilation (P = 0.02) Vasopressors require an independent risk factor for PHD> 24 h. Perioperative ischemic stroke, cardiac complications and the incidence of renal complications in the three groups of patients no difference. Conclusion In elderly women, intraoperative HD, calcified plaque and recurrent balloon dilation are the predictors of PHD. Patients with PHD given appropriate treatment does not affect the overall prognosis of patients.