Wong J H, Findlay J M, Suarez-Almazor M E
Division of Neurosurgery, MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Canada.
Neurosurgery. 1997 Jul;41(1):35-41; discussion 41-3. doi: 10.1097/00006123-199707000-00009.
To examine the incidences of hypertension, hypotension, and bradycardia after carotid endarterectomy (CEA) and to identify any hemodynamic variables predictive of postoperative stroke, death, or cardiac complications.
Retrospective population-based cohort study of 291 consecutive patients undergoing CEA using hospital chart review. Hemodynamic data collected from time of arrival in the recovery room until the end of the 1st postoperative day. Primary and secondary outcome events were stroke or death within 30 days of surgery and any postoperative cardiac complication (angina, congestive heart failure, dysrhythmia, or myocardial infarction), respectively.
The incidences of postoperative hypertension (systolic blood pressure > 220 mm Hg), hypotension (systolic blood pressure < 90 mm Hg), and bradycardia (pulse < 60 beats/min) were 9% (26 of 290 cases), 12% (36 of 290 cases), and 55% (159 of 290 cases), respectively. The stroke or death rate was 5.2% (15 of 291 cases). Postoperative hypertension was associated significantly with stroke or death (P = 0.04) and by a statistical trend with cardiac complications (P = 0.07). Independent preoperative risk factors for postoperative hypertension by multivariate analysis included angiographic intracranial carotid stenosis greater than 50%, cardiac dysrhythmia, preoperative systolic blood pressure greater than 160 mm Hg, neurological instability, and renal insufficiency. Postoperative hypotension and bradycardia did not correlate with primary or secondary outcomes.
Hemodynamic instability was commonly observed after CEA, but only postoperative hypertension was associated with stroke or death and, possibly, with cardiac complications. Patients undergoing CEA, especially those at risk for postoperative hypertension, may be monitored best in settings suited to the expeditious management of neurological and cardiovascular emergencies.
研究颈动脉内膜切除术（CEA）后高血压、低血压和心动过缓的发生率，并确定任何可预测术后中风、死亡或心脏并发症的血流动力学变量。
采用医院病历回顾，对291例连续接受CEA的患者进行基于人群的回顾性队列研究。收集从进入恢复室到术后第1天结束时的血流动力学数据。主要和次要结局事件分别为术后30天内的中风或死亡以及任何术后心脏并发症（心绞痛、充血性心力衰竭、心律失常或心肌梗死）。
术后高血压（收缩压>220 mmHg）、低血压（收缩压<90 mmHg）和心动过缓（脉搏<60次/分钟）的发生率分别为9%（290例中的26例）、12%（290例中的36例）和55%（290例中的159例）。中风或死亡率为5.2%（291例中的15例）。术后高血压与中风或死亡显著相关（P = 0.04），与心脏并发症有统计学趋势相关（P = 0.07）。多变量分析显示，术前高血压的独立危险因素包括血管造影显示颅内颈动脉狭窄大于50%、心脏心律失常、术前收缩压大于160 mmHg、神经功能不稳定和肾功能不全。术后低血压和心动过缓与主要或次要结局无关。
CEA术后常见血流动力学不稳定，但只有术后高血压与中风或死亡相关，可能还与心脏并发症相关。接受CEA的患者，尤其是有术后高血压风险的患者，可能在适合快速处理神经和心血管紧急情况的环境中得到最佳监测。
