PCI术后诱发迷走神经反射的危险因素及临床急救

摘要

目的:探讨经皮冠状动脉介入(PCI)术后诱发迷走神经反射的危险因素及其急救策略.方法:回顾性分析我院成功行PCI的214例患者的资料,以是否发生迷走神经反射分为迷走神经反射组(56例)和无迷走神经反射组(158例),比较两组患者的临床特征,运用Logistic分析PCI术后诱发迷走神经反射的相关危险因素,同时对发生迷走神经反射的患者进行急救治疗及观察,分析防治方案.结果:单因素Logistic回归分析显示,年龄、糖尿病、反复穿刺、留置鞘管、既往行经皮冠状动脉介入、压迫止血时间是诱发迷走神经反射的危险因素(OR=1.155~3.005,P<0.05或<0.01).多因素Logistic分析发现糖尿病、鞘管留置时间及压迫止血时间是诱发迷走神经反射的独立危险因素(OR=1.846~2.998,P均<0.05).通过迅速给予静脉补液、扩充血容量、静脉注射多巴胺、阿托品等及时的处理,出现迷走神经反射患者的症状得到了有效控制.结论:影响经皮冠状动脉介入术后诱发迷走神经反射的相关因素有糖尿病、鞘管留置时间及压迫止血时间;对高危患者应当密切观察病情,迅速给予规范化治疗.%Objective: To explore risk factors of percutaneous coronary intervention (PCI)-induced vagal reflex and its emergency treatment strategies.Methods: Clinical data of 214 patients undergoing successful PCI in our hospital were retrospectively analyzed.According to presence of vagal reflex or not, they were divided into vagal reflex group (n=56) and no vagal reflex group (n=158).Clinical features were compared between two groups.Logistic analysis was used to analyze related risk factors for PCI-induced vagal reflex, meanwhile, those patients with vagal reflex received emergency treatment and observation;and prevention and treatment plans were analyzed.Results: Single factor Logistic regression analysis indicated that age, diabetes mellitus, repeated puncture, indwelling sheath, previous PCI and hemostasis time by compression were risk factors for induced vagal reflex (OR=1.155~3.005, P<0.05 or <0.01).Multifactor Logistic analysis found that diabetes mellitus, indwelling sheath time and hemostasis time by compression were independent risk factors for induced vagal reflex (OR=1.846~2.998, P<0.05 all).Symptoms of those patients with vagal reflex were effectively controlled via rapid intravenous rehydration, blood volume expansion, intravenous injection of dopamine and atropine etc.Conclusion: Diabetes mellitus, indwelling sheath time and hemostasis time by compression are related factors for PCI-induced vagal reflex;high risk patients should be closely monitored, given standardized treatment rapidly.