付煜,李舜,蒋汉刚,葛俊林,罗松,苑文成

• 1:岳池县人民医院神经外科
• 2:川北医学院附属医院神经外科

摘要(Abstract)：

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。

关键词(KeyWords)： 老年Ⅳ～Ⅴ级颅内动脉瘤;介入栓塞术;术中血压管理;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 付煜,李舜,蒋汉刚,葛俊林,罗松,苑文成

DOI: 10.16780/j.cnki.sjssgncj.20230145

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