摘要
目的 通过回顾性分析筛选颈动脉狭窄患者行颈动脉支架置入术(CAS)治疗发生术后脑高灌注综合征(CHS)的主要术前危险因素以期为制定CHS防治措施提供参考依据。方法 选取2022年10月至2023年10月我院行CAS治疗的210例颈动脉狭窄患者根据是否发生术后CHS分为CHS组和非CHS组,收集所有患者一般情况、既往疾病史、侧支循环代偿情况、术前血管狭窄率、术前脑血流不对称指数(AI)和术前平均大脑中动脉血流速度(MCAVmean)和手术时间窗(发病至治疗时间)等资料,分析比较2组患者基本情况并行单因素分析和多因素Logistic回归分析,受试者工作特征(ROC)曲线分析独立危险因素对颈动脉狭窄患者行CAS治疗发生术后CHS的预测效能。结果 210例行CAS治疗的颈动脉狭窄患者中有发生术后CHS(CHS组)12例,未发生CHS(非CHS组)198例,即行CAS治疗的颈动脉狭窄患者术后CHS发生率为5.71%(12/210)。2组患者糖尿病史、1个月内新发脑梗死史、侧支循环代偿情况、术前血管狭窄率、AI、术前MCAVmean和手术时间窗等资料比较差异有统计学意义(P<0.05)。Logistic回归分析发现,糖尿病、1个月内新发脑梗死、侧支循环代偿差、低AI和术前MCAVmean慢是颈动脉狭窄患者行CAS治疗后发生术后CHS的独立危险因素(P<0.05)。ROC曲线分析发现,糖尿病、1个月内新发脑梗死、侧支循环代偿、AI和术前MCAVmean对颈动脉狭窄患者行CAS治疗后发生术后CHS的预测AUC分别为0.677、0.638、0.756、0.734和0.743,敏感度分别为60.00%、57.50%、78.50%、70.00%和72.50%,特异度分别为50.00%、62.50%、71.50%、71.50%和82.50%。结论 既往合并糖尿病、1个月内新发脑梗死、侧支循环代偿差、低AI和MCAVmean缓慢为颈动脉狭窄患者行CAS治疗发生术后CHS的主要术前危险因素,并且均具有一定的预测效能,临床上可重点关注患者是否包含以上危险因素,及早采取预防控制措施,以降低CHS的发生率。
Objective To analyze the main preoperative risk factors for cerebral hypoperfusion syndrome(CHS)after carotid artery stenting(CAS)in patients with carotid stenosis via a retrospective analysis,thus providing references for formulating prevention and treatment measures of CHS.Methods A total of 210 patients with carotid artery stenosis who underwent CAS treatment in our hospital from October 2022 to October 2023 were selected.They were divided into the CHS group and the non-CHS group based on whether postoperative CHS occurred.General information,past disease history,collateral circulation compensation,preoperative vascular stenosis rate,preoperative cerebral blood flow asymmetry index(AI),preoperative mean blood flow velocity in the middle cerebral artery(MCAVmean)and surgical time window(onset to treatment time)were collected.Baseline characteristics were analyzed via univariate and multivariate logistic regression and compared between groups.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of independent risk factors for postoperative CHS in patients with carotid stenosis.Results Among 210 patients with carotid stenosis treated with CAS,12 cases experienced postoperative CHS(CHS group)and 198 patients did not experience CHS(non CHS group),showing an incidence of postoperative CHS of 5.71%(12/210).Significant differences in history of diabetes,new cerebral infarction within 1 month,collateral circulation compensation,preoperative vascular stenosis rate,AI,preoperative MCAVmean and operation time window were found between groups(P<0.05).Logistic regression analysis showed that diabetes,new cerebral infarction within 1 month,poor collateral circulation compensation,low AI and slow preoperative MCAVmean were independent risk factors for postoperative CHS in patients with carotid stenosis after CAS treatment(P<0.05).The ROC curve showed that the predicted AUC of diabetes,new cerebral infarction within 1 month,collateral circulation compensation,AI and preoperative MCAVmean for postoperative CHS in patients with carotid stenosis after CAS treatment was 0.677,0.638,0.756,0.734 and 0.743,respectively,with a sensitivity of 60.00%,57.50%,78.50%,70.00%and 72.50%,and a specificity of 50.00%,62.50%,71.50%,71.50%,71.50%and 82.50%,respectively.Conclusion Previous complications of diabetes,new cerebral infarction within 1 month,poor collateral circulation compensation,low AI and slow MCAVmean are the main preoperative risk factors for postoperative CHS in patients with carotid stenosis treated with CAS,all of which have certain predictive effect.Clinical attention should be focused on whether patients contain the above risk factors,and preventive control measures should be taken as early as possible to reduce the incidence of CHS.
作者
谢静
姜海英
缪苏宇
章希炜
XIE Jing;JIANG Haiying;MIAO Suyu(Department of General Surgery and Vascular Surgery,Jiangsu Province Hospital,Jiangsu,Nanjing 210000,China)
出处
《河北医药》
2026年第2期274-278,共5页
Hebei Medical Journal
基金
国家自然科学基金资助项目(编号:81702830)。
关键词
颈动脉支架置入术
颈动脉狭窄
脑高灌注综合征
术前
危险因素
预防控制措施
carotid artery stenting
carotid stenosis
cerebral hyperperfusion syndrome
preoperative
risk factors
preventive control measures
