颈动脉狭窄支架植入术后并发持续性低血压的危险因素分析及护理对策-现代医学

颈动脉狭窄支架植入术后并发持续性低血压的危险因素分析及护理对策

单位：1. 南京大学医学院附属鼓楼医院南部院区心血管医学中心, 江苏南京 210000;
2. 南京大学医学院附属鼓楼医院江北院区血管外科, 江苏南京 210000

分类号：R473.5

出版年·卷·期（页码）：2025·53·第二期（293-299）

摘要：

目的：研究颈动脉狭窄支架植入术后并发持续性低血压的风险因素，探讨相应的护理对策，以提高护理质量。方法：回顾性分析2021年3月至2024年3月于南京大学医学院附属鼓楼医院行颈动脉支架植入术(CAS)的242例患者资料，采用单因素分析进行初步筛选，多因素Logistic回归明确术后严重持续性低血压的独立危险因素。结果：本研究共纳入242例CAS术后患者，术后持续性低血压发生率为28.10%(68/242)。多因素分析显示最小管腔水平至颈动脉分叉距离＜1 cm (OR=2.410,95%CI:1.168~7.383)、偏心性狭窄(OR=2.014,95%CI:1.138~6.995)、钙化斑块(OR=2.717,95%CI:1.249~8.215)、球囊扩张直径＞5 mm (OR=1.834，95%CI:1.109~6.741)以及双侧颈动脉狭窄(OR=1.534,95%CI:1.091~6.095)是CAS术后发生持续性低血压的独立风险因素。结论： CAS术后患者持续性低血压的发生率较高，基于对其风险因素的识别，制定针对性的护理对策对于降低术后持续性低血压的发生率、改善患者预后、提升护理质量具有重要意义。

Objective: To investigate the risk factors for persistent hypotension following carotid artery stenting and to explore corresponding nursing strategies to improve the quality of care. Methods: A retrospective analysis was conducted on the data of 242 patients who underwent carotid artery stenting in Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital between March 2021 and March 2024. Univariate analysis was used for preliminary screening, and multivariate logistic regression was employed to identify independent risk factors for severe persistent hypotension after the procedure. Results: A total of 242 patients who underwent CAS were included in this study, with an incidence of postoperative persistent hypotension of 28.10%(68/242). Multivariate analysis revealed that a minimum luminal distance between bifurcation and lesion<1 cm(OR=2.410, 95%CI:1.168-7.383), eccentric stenosis(OR=2.014, 95%CI:1.138-6.995), calcified plaque(OR=2.717, 95%CI:1.249-8.215), balloon dilation diameter>5 mm(OR=1.834, 95%CI:1.109-6.741), and bilateral carotid stenosis(OR=1.534, 95%CI:1.091-6.095) were independent risk factors for persistent hypotension after CAS. Conclusion: The identification of risk factors and the development of targeted nursing strategies are of great importance in reducing the incidence of postoperative persistent hypotension, improving patient outcomes, and enhancing the quality of care.

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