【摘要】 目的探讨颈动脉内膜切除术患者术后发生中重度高血压的危险因素。方法回顾性分析2016年1月至2018年12月在复旦大学附属华山医院行颈动脉内膜切除术的217例患者的临床资料,术后中重度高血压(post-endarterectomy hypertension,PEH)定义为术后收缩压高于160 mmHg且需使用静脉血管活性药物控制血压。76例患者(35.02%)出现PEH分为PEH组,其余141例患者分为无PEH组。比较两组患者手术相关因素并对患者围术期相关因素进行多元回归分析,筛选PEH的危险因素。结果患者均成功施行颈动脉内膜切除术,两组均无死亡病例。PEH组发现高灌注综合征4例,心梗1例,脑卒中2例,脑出血1例;无PEH组出现心梗2例,脑卒中1例,无高灌注综合征及脑出血发生。两组住院时间比较差异无统计学意义[PEH组vs无PEH组:(11.96±6.80)d和(11.06±3.65)d,P=0.209],住院费用比较差异有统计学意义[PEH组vs无PEH组:(41152.22±19278.75)元和(35662.28±7552.31)元,P=0.003]。多因素回归分析提示高龄(OR=1.130,95%CI=1.038～1.229),术前高血压(OR=1.046,95%CI=1.002～1.092),低身体体重指数(OR=0.742,95%CI=0.609～0.905),高糖化血红蛋白(OR=1.881,95%CI=1.117～3.168)可能是发生PEH的高危因素。结论 PEH将影响颈动脉内膜切除术的手术结果和住院费用。术前全面评估患者的相关高危因素,早期识别PEH高危患者具有重要意义。更多还原

【Abstract】 Objective To investigate the risk factors of moderate to severe post-endarterectomy hypertension(PEH) in patients underwent carotid endarterectomy. Methods The clinical data of 217 patients who underwent carotid endarterectomy in Huashan Hospital from January 2016 to December 2018 were analyzed retrospectively. PEH was defined as postoperative systolic blood pressure greater than 160 mmHg and needed to use intravenous vasoactive drugs to control blood pressure. 76 patients(35.02%) diagnosed PEH and were divided into PEH group, while the remaining 141 patients were divided into non-PEH group.Surgery-related factors were compared between the two groups and perioperative related factors were analyzed by multiple regression to screen the risk factors of PEH. Results All patients were performed carotid endarterectomy successfully. There were no death cases in the two groups. Four cases occurred hyperperfusion syndrome, one case occurred myocardial infarction, two cases occurred stroke, and one case occurred cerebral hemorrhage in the PEH group, while two cases occurred myocardial infarction, one case occurred stroke and no hyperperfusion syndrome and cerebral hemorrhage occurred in the non-PEH group.There was no significant difference in the length of hospitalization between the two groups [PEH group vs non-PEH group:(11.96±6.80)d vs(11.06±3.65)d, P=0.209]. There was a statistically significant differencein hospitalization costsgroup vs no PEH group:yuan and(35662.28±7552.31)yuan,Multivariate regression analysis indicated that advanced age(95%CI=1.038～1.229),preoperative hypertension(95%CI=1.002～1.092),and low body mass index(95%CI=0.609～0.905),high glycated hemoglobin(95%CI=1.117～3.168)may be the high risk factor for PEH.Conclusion PEH will affect the surgery outcome and the cost of hospitalization of carotid endarterectomy.It is important to evaluate the high-risk factors of patients before surgery and to identify high-risk patients with hypertension after surgery.更多还原