Abstract:

Objective To construct a perioperative blood pressure management plan for patients undergoing carotid artery stenting（CAS） and evaluate its application effectiveness，and to provide references for clinical practice. Methods The relevant literature on perioperative blood pressure management for CAS patients was retrieved from domestic and foreign databases，and a preliminary draft of a perioperative blood pressure management plan for CAS patients was constructed. The preliminary draft was discussed and modified through expert meetings，and 2 rounds of expert inquiries were conducted using the Delphi method from June 2023 to August 2023 to determine the final plan. 32 patients who received CAS in the neurology department of a tertiary comprehensive hospital in Zhejiang Province were selected from May to July 2024 as an experimental group，and 33 patients who received CAS in the same ward from January to March 2024 as a control group. The experimental group applied the constructed CAS patient perioperative blood pressure management plan，while the control group applied routine perioperative nursing measures. The incidence of postoperative hypertension，postoperative hypotension，and postoperative adverse events was compared between 2 groups. Results A total of 13 experts completed 2 rounds of inquiries. The effective questionnaire response rate for the second round of inquiry was 100%，with an authority coefficient of 0.897. The coefficients of variation for the importance and feasibility scores of each item were 0~0.19 and 0~0.18，respectively，and the Kendall harmony coefficients were 0.224 and 0.201，respectively（P<0.05）. The final construction plan includes 3 primary indicators，15 secondary indicators，and 40 tertiary indicators. Ultimately，32 cases were included in the experimental group and 33 cases in the control group. The incidence of postoperative hypertension，postoperative hypotension，and adverse events in the experimental group was lower than that in the control group，and the difference was statistically significant（P<0.05）. Conclusion The perioperative blood pressure management plan for CAS patients constructed in this study has good scientificity and practicality，which can improve the stability of patients’ perioperative blood pressure and reduce the occurrence of adverse events.

Key words: Carotid Artery Stenting, Blood Pressure Management, Perioperative Period, Nursing Care

摘要：

目的 构建颈动脉支架植入术（carotid artery stenting，CAS）患者围手术期血压管理方案并评价其应用效果，为临床实践提供参考。方法 检索国内外数据库中CAS患者围手术期血压管理的相关文献，构建CAS患者围手术期血压管理方案初稿，通过专家会议对方案初稿进行论证、修改，于2023年6月—8月采用德尔菲专家函询法进行2轮专家函询，确定最终方案。采用类实验研究设计，选取2024年5月—7月在浙江省某三级甲等综合医院神经内科接受CAS的33例患者作为试验组，将2024年1月—3月接受CAS的33例患者作为对照组。试验组应用构建的CAS患者围手术期血压管理方案，对照组应用常规围手术期护理措施。比较两组术后高血压、术后低血压以及不良事件的发生率。结果 共13名专家完成2轮函询，第2轮函询的有效问卷回收率为100%，权威系数为0.897，各条目的重要性与可行性评分的变异系数分别0~0.19、0~0.18，肯德尔和谐系数分别为0.224、0.201（P<0.05）。最终构建的方案包括3个一级指标、15个二级指标、40个三级指标。试验组最终纳入32例，对照组最终纳入33例。试验组术后高血压、术后低血压以及不良事件的发生率均低于对照组，差异有统计学意义（P<0.05）。结论 该研究构建的CAS患者围手术期血压管理方案，具有较好的科学性和实用性，可提高患者围手术期血压的稳定性，降低不良事件的发生率。

关键词: 颈动脉支架植入术, 血压管理, 围手术期, 护理