目的 探讨颈动脉内膜剥脱术（CEA）后血流动力学不稳定（HI）危险因素及HI对预后的影响。方法 收集2015年1月—2020年12月在复旦大学附属华山医院行CEA的363例患者资料,根据CEA术后是否出现HI分为正常组（n=291）和HI组（n=72）。采用logistic回归模型分析CEA术后发生HI的危险因素。结果 单因素和多因素分析显示,短暂性脑缺血发作（TIA）是CEA后HI的独立危险因素。两组患者在近期心肌梗死发生率、远期全因死亡率、心脑血管死亡率及血压控制方面具有统计学差异（P<0.05）。结论 TIA是CEA术后HI发生的独立危险因素;HI可增加术后30 d内心肌梗死发生率以及术后5年内心脑血管死亡率、全因死亡率,增加远期血压控制难度。
Objective To explore the risk factors for hemodynamic instability （HI） after carotid endarterectomy （CEA） and its impact on prognosis. Methods Data from 363 patients who underwent CEA at Huashan Hospital, Fudan University between January 2015 and December 2020 were collected. Based on the occurrence of HI after CEA, the patients were divided into a control group （n=291） and an HI group （n=72）. Logistic regression models were used to analyze the risk factors for HI following CEA. Results Univariate analysis and multiple analysis showed that transient ischemic attack （TIA） was an independent risk factor for HI after CEA. Statistically significant differences （P<0.05） were observed between the two groups in terms of the incidence of short-term myocardial infarction, long-term all-cause mortality, cardio-cerebrovascular mortality, and blood pressure control. Conclusion TIA is an independent risk factor for HI after CEA. HI increases the incidence of myocardial infarction within 30 d after surgery, as well as cardio-cerebrovascular mortality and all-cause mortality within 5 years after surgery, making long-term blood pressure control more challenging.
[1] Zhang T, Chen R, Yan G, et al.Global burden of ischemic stroke attributable to physical inactivity among adults aged 55 and above: a 32-year analysis (1990-2021)[J]. Arch Med Sci, 2025, 21(5): 1683-1696.
[2] 唐春花, 郭露, 张莉莉. 2025年全球卒中报告数据解读:卒中疾病负担的梯度演变与精准治理[J]. 诊断学理论与实践, 2025, 24(5): 485-497.
[3] Zhu W, He X, Huang D, et al.Global and regional burden of ischemic stroke disease from 1990 to 2021: an age-period-cohort analysis[J]. Transl Stroke Res, 2025, 16(5): 1474-1485.
[4] Debakey ME.Successful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up[J]. JAMA, 1975, 233(10): 1083-1085.
[5] Ferguson GG, Eliasziw M, Barr HW, et al.The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients[J]. Stroke, 1999, 30(9): 1751-1758.
[6] Naylor R, Rantner B, Ancetti S, et al.Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease[J]. Eur J Vasc Endovasc Surg, 2023, 65(1): 7-111.
[7] Rothwell PM, Warlow CP.Interpretation of operative risks of individual surgeons. European Carotid Surgery Trialists' Collaborative Group[J]. Lancet, 1999, 353(9161): 1325.
[8] 刘博, 张宗强, 何博,等. 颈动脉内膜剥脱术治疗颈内动脉重度狭窄60例临床分析[J]. 外科研究与新技术, 2022, 11(2): 87-89.
[9] Wong JH, Findlay JM, Suarez-Almazor ME.Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications[J]. J Neuro Surg, 1997, 41(1): 35-41.
[10] Farah M, Moghaddam M, Zarrintan S, et al.The effect of controlled vs uncontrolled hypertension on outcomes of carotid revascularization procedures[J]. J Vasc Surg, 2024, 80(3): 765-773.
[11] Jacome F, Costa-Pereira T, Dionisio A, et al.Contemporary open surgical approaches for the management of carotid stenosis: a comprehensive review[J]. Int Angiol, 2024, 43(3): 348-357.
[12] Newman JE, Bown MJ, Sayers RD, et al.Post-carotid endarterectomy hypertension. Part 2: association with peri-operative clinical, anaesthetic, and transcranial doppler derived parameters[J]. Eur J Vasc Endovasc Surg, 2017, 54(5): 564-572.
[13] Demirel S, Goossen K, Bruijnen H, et al.Systematic review and meta-analysis of postcarotid endarterectomy hypertension after eversion versus conventional carotid endarterectomy[J]. J Vasc Surg, 2017, 65(3): 868-882.
[14] Kakkos SK, Gohel M, Baekgaard N, et al.Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis[J]. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
[15] Qureshi AI, Luft AR, Sharma M, et al.Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting[J]. Stroke, 1999, 30(10): 2086-2093.
[16] Ben Ahmed S, Daniel G, Benezit M, et al.Does the technique of carotid endarterectomy determine postoperative hypertension?[J]. Ann Vasc Surg, 2015, 29(6): 1272-1280.
[17] Hadjiev DI, Mineva PP.A reappraisal of the definition and pathophysiology of the transient ischemic attack[J]. Med Sci Monit, 2007, 13(3): 50-53.
[18] Chandratheva A, Mehta Z, Geraghty OC, et al.Population-based study of risk and predictors of stroke in the first few hours after a TIA[J]. Neurology, 2009, 72(22): 1941-1947.
[19] 艾尼瓦尔·艾赛特, 牛海亚, 徐文丽,等. CTP联合CTA在评价短暂性脑缺血发作的应用价值[J]. 新疆医学, 2025, 55(11): 1376-1379.
[20] Elsayed N, Chow C, Ramachandran M, et al.Hemodynamic instability predicts in-hospital and 1-year mortality after transcarotid artery revascularization and transfemoral carotid stenting[J]. J Vasc Surg, 2023, 78(2): 446-453.
[21] Xu D, Varshney A, Ma X, et al.Nonlinear hydrodynamic instability and turbulence in pulsatile flow[J]. Proc Natl Acad Sci USA, 2020, 117(21): 11233-11239.
