对手术治疗未破裂动脉瘤的风险分层进行最佳的PHAZES评分
Stefan W Koester1, Emmajane G Rhodenhiser1, Stephen J Dabrowski1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World neurosurgery
|December 28, 2023
概括
一个PHASES分数为6或更高的预测,在未破裂的内动脉瘤 (UIAs) 接受手术的患者中,神经学结果不佳. 这一门有助于UIA管理的风险分层.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 医学风险分层医学风险分层.
背景情况:
- 未破裂的内动脉瘤 (UIA) 需要谨慎管理,以防止破裂.
- 该PHASES (人口,高血压,年龄,体型,早些时候的甲状腺下出血,地点) 评分有助于分层UIA风险.
- 在预测外科手术结果时,PHASES得分的最佳截止值尚未确定.
研究的目的:
- 为了确定最佳的PHASES分数截止值来预测手术治疗UIA患者的神经学结果.
- 为了评估PHASES得分和手术后神经系统不良结果之间的关联.
主要方法:
- 375名接受微神经外科治疗UIA的患者的回顾性审查.
- 录取标准:修改的兰金级别 (mRS) 评分在录取时≤2.
- 主要结局:一年的mRS得分;糟糕的结局定义为mRS>2.
主要成果:
- 确定PHASES分数为6或更高 (≥6) 是最佳的切线值,最大限度地预测了神经系统不良结果.
- 与分数<6.6的患者相比,PHASES分数≥6的患者在出院和随访时神经病情不良的发病率显著更高.
- 在多变量调整后,PHASES分数≥6仍然是随访时神经学结果不佳的重要独立预测因素 (OR,2.75;P=0.003).
结论:
- 6或更高的PHASES得分与UIA手术治疗后神经系统不良结果的比例显著增加.
- 这一门对于UIA患者的风险分层和指导管理决策有价值.
- 意识到PHASES得分≥6的截止值可能会改善患者选择和UIA手术规划.
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