颈动脉支架术前血压变异性与术后颈动脉窦反应的相关性研究

殷亮; 赵新秀; 许娟娟; 李倩倩

doi:10.13898/j.cnki.issn.1000-2200.2023.09.003

颈动脉支架术前血压变异性与术后颈动脉窦反应的相关性研究

Study on the correlation between preoperative blood pressure variability and postoperative carotid sinus reaction in carotid artery stenting

摘要

摘要:
目的探讨颈动脉支架术前24 h动态血压变异性(BPV)与术后颈动脉窦反应(CSR)之间的关系，以期寻找具有预测CSR及类型的BPV指标。
方法纳入行颈动脉起始部支架置入术的颈动脉狭窄病人59例，根据CSR的定义分为CSR组和非CSR组，进一步将CSR组病人分别归类为低血压型、心动过缓型以及混合型三种亚型。使用无创性便携式血压监测仪监测术前24 h血压变化，比较病人24 h、日间和夜间平均收缩压(MSBP)、舒张压(MDBP), 以及各自的标准差(SD)和变异系数(CV)。
结果59例病人中25例未发生CSR，34例发生CSR，其中低血压型19例，心动过缓型8例，混合型7例。CSR组病人的高血压、吸烟史和血管狭窄程度均高于非CSR病人组(P<0.05)，高血压为CSR的独立风险因素(P<0.01)。CSR病人24 h MDBP、DBP-SD/CV、SBP-SD/CV均高于非CSR病人(P<0.01)，同时2组病人日间、夜间SBP-SD/CV和DBP-SD/CV差异均有统计学意义(P<0.01)，进一步分析显示24 h SBP和DBP的SD和CV均与病人术后CSR的发生呈正相关关系(P<0.01)。单因素方差分析显示，混合型CSR病人24 h DBP的CV高于低血压型和心动过缓型病人(P<0.05)，混合型日间和夜间SBP的SD和CV均高于低血压型和心动过缓型(P<0.05)，在夜间混合型病人的DBP的SD和CV也均高于低血压型病人(P<0.05)。多元logistic回归显示，24 h DBP的CV以及日间和夜间的SBP的SD/CV均是混合型的独立风险因素(P<0.05)。
结论颈动脉支架术前BPV与CSR的发生及类型相关，提示BPV可作为预测病人术后发生特定类型CSR的指标。

Abstract:
ObjectiveTo investigate the relationship between preoperative 24 h ambulatory blood pressure variability (BPV) and postoperative carotid sinus reaction (CSR) in carotid artery stenting, and to find BPV indicators that can predict CSR.
MethodsA total of 59 patients with carotid artery stenosis undergoing carotid artery stenting were selected and divided into CSR group and non-CSR group according to the definition of CSR.The patients in the CSR group were further divided into three subtypes: hypotension type, bradycardia type, and mixed type.The preoperative 24 h blood pressure changes were monitored with a non-invasive portable blood pressure monitor, and the 24 h, daytime and nighttime mean systolic blood pressure (MSBP), diastolic blood pressure (MDBP) of patients were compared, as well as their standard deviation (SD) and coefficient of variation (CV).
ResultsAmong the 59 patients, 25 cases did not have CSR, and 34 cases had CSR, among which, 19 cases were hypotension type, 8 cases were bradycardia type, and 7 cases were mixed type.The hypertension, smoking history, and degree of vascular stenosis in the CSR group were higher than those in the non-CSR group (P<0.05), and hypertension was an independent risk factor for CSR (P<0.01).The 24 h MDBP, DBP-SD/CV, and SBP-SD/CV of CSR patients were higher than those of non-CSR patients (P<0.01).At the same time, there were statistically significant differences in daytime and nighttime SBP-SD/CV and DBP-SD/CV of patients between the two groups (P<0.01).Further analysis showed that the SD and CV of 24 h SBP and DBP were positively correlated with the occurrence of postoperative CSR in patients (P<0.01).Univariate analysis of variance showed that the CV of 24 h DBP in mixed type CSR patients was higher than that in hypotensive and bradycardia patients (P<0.05), the daytime and nighttime SD and CV of SBP in mixed type patients were higher than those in hypotensive and bradycardia patients (P<0.05), and the nighttime SD and CV of DBP in mixed type patients were also higher than those in hypotensive patients (P<0.05).Multiple logistic regression showed that 24 h CV of DBP and the SD/CV of SBP in day and night were independent risk factors for mixed type (P<0.05).
ConclusionsPreoperative BPV is associated with the occurrence and type of CSR in carotid artery stenting, indicating that BPV can be used as a predictor of specific types of CSR in patients after surgery.

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