| 付煜
，李舜
，蒋汉刚
，葛俊林
，罗松
，苑文成.老年Ⅳ～Ⅴ级颅内动脉瘤介入栓塞术中血压管理策略对预后的影响[J].神经损伤功能重建,2024,(3):130-135 |
| 老年Ⅳ～Ⅴ级颅内动脉瘤介入栓塞术中血压管理策略对预后的影响 |
| Blood Pressure Management Strategy and Its Effect on Prognosis during InterventionalEmbolization of Grade Ⅳ ～V Intracranial Aneurysms in the Elderly |
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| DOI： |
| 中文关键词: 老年Ⅳ～Ⅴ级颅内动脉瘤 介入栓塞术 术中血压管理 预后 |
| 英文关键词: senile grade Ⅳ ～V intracranial aneurysms interventional embolization intraoperative blood pressure management prognosis |
| 基金项目: |
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| 中文摘要: |
| 目的：探究介入栓塞术中不同血压管理策略对老年Ⅳ～Ⅴ级颅内动脉瘤患者的预后影响。方法：回
顾性选取我院收治的老年Ⅳ～Ⅴ级颅内动脉瘤患者110例，并纳入训练集。使用随机数字表法将患者分为
观察组（55例）和对照组（55例），比较训练集两组患者的临床资料；使用Kaplan-Meier法进行生存曲线的绘
制，比较不同血压管理策略患者的2年预后不良发生率；Cox单因素和多因素回归分析患者术后预后不良
的影响因素；构建预测患者术后预后不良的列线图模型；通过验证集患者以受试者工作特征曲线（ROC）
和校准曲线对模型效能进行评价。依据模型预测个体风险评分，构建危险分层系统。结果：观察组患者的
2年预后不良发生率明显低于对照组（P＜0.05）；高血压、手术时机为中期和晚期、平均动脉压≥65 mmHg、
血压波动幅度≥16 mmHg、瘤体长径与瘤颈宽度的比值（AR）>2.0是老年Ⅳ～Ⅴ级颅内动脉瘤患者介入栓
塞术预后不良的独立危险因素（P＜0.05），术中血压管理策略为控制性降压是老年Ⅳ～Ⅴ级颅内动脉瘤患
者介入栓塞术预后不良的保护因素（P＜0.05）；列线图预测模型有较好的区分度及准确度。危险分层系统
将所有患者分为4个危险分组：极低风险组（总分＜30分）、低风险组（30分≤总分＜78分）、中风险组（78分
≤总分＜106分）和高风险组（总分≥106分）。该危险分层系统能区分不同术中血压管理策略患者的预后
不良发生情况（P＜0.05）。结论：在手术过程中应实施瑞芬太尼联合尼莫地平控制性降压的血压管理策略，
可以提高患者的预后水平。 |
| 英文摘要: |
| To explore the effect of different blood pressure management strategies on the prognosis
of elderly patients with grade IV-V intracranial aneurysms during interventional embolization. Methods: A total
of 110 elderly patients with grade Ⅳ～V intracranial aneurysms treated in our hospital were retrospectively
selected and included in the training set. The patients were randomly divided into the observation group (n=55)
and the control group (n=55) using the random number table method. The clinical data from the two groups in
the training set were compared. The Kaplan-Meier survival curve was used to compare the incidence of 2-year
poor prognosis in patients with different blood pressure management strategies. Cox univariate and multivariate
regression analyses were conducted to assess factors influencing postoperative prognosis. A nomogram
prediction model was constructed to predict the poor prognosis of patients after operation. The efficacy of the
model was evaluated by the receiver operating characteristic curve and the calibration curve. Individual risk
scores were generated according to the model, establishing a risk stratification system. Results: The incidence
of poor 2-year prognosis in the observation group was significantly lower than that in the control group (P<
0.05). Hypertension, operation timing in the middle and late stages, mean arterial pressure ≥ 65 mmHg, blood
pressure fluctuation ≥ 16 mmHg, and a tumor length-to-neck width ratio > 2.0 were independent risk factors for
poor prognosis of interventional embolization in elderly patients with grade Ⅳ～V intracranial aneurysms (P<
0.05). Intraoperative blood pressure management strategy of controlled hypotension was a protective factor for
poor prognosis in elderly patients with grade Ⅳ ～V intracranial aneurysms undergoing interventional
embolization (P<0.05). The nomogram prediction model had good differentiation and accuracy. The risk
stratification system divided all patients into four distinct risk groups: very low risk group (total score<30), low
risk group (30≤total score<78), medium risk group (78≤total score<106) and high risk group (total score≥
106). This risk stratification system was able to differentiate the occurrence of poor prognosis among patients
with different intraoperative blood pressure management strategies (P<0.05). Conclusion: During the
operation, the blood pressure management strategy of remifentanil combined with nimodipine controlled hypotension should be
implemented, as it can improve the prognosis of patients. |
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