高血压脑出血微创治疗后再出血的临床分析

Clinical Analysis of Rebleeding after Treatment of Hypertensive Intracerebral Hemorrhage by Minimally Invasive Surgery

目的探讨高血压脑出血微创治疗后再出血的原因及防治对策。方法232例高血压脑出血患者均行颅内血肿粉碎穿刺术,对其中24例发生再出血患者进行临床分析。结果本组24例患者中,再出血发生在术后6h内12例,术后7～24h8例,术后25～72h4例。再出血的发生与术前、术后收缩期血压的变化明显相关(P<0.05),而与舒张期血压无关。24例患者,治愈好转19例,自动出院1例,死亡4例。结论微创术治疗高血压脑出血损伤小、恢复快、费用低,但手术应在再出血6h后、积极控制血压的条件下才能减少再出血的风险,从而降低死亡率,改善病人预后。

Objective To explore the cause, prevention and treatment of rebleeding after treatment hypertensive intracerebral hemorrhage by minimally invasive surgery. Methods Twenty-four patients of 236 patients with hypertensive intracerebral hemorrhage who underwent paracentesis and drainage of intracranial hematomas suffered from intracranial rebleeding and their clinical data were analysed retrospectively. Results The rebleeding occurred within 6 hours after the operation in 12 patients （50.0%, 12/24） from 7 to 24 hours after the operation in 8 patients （33.3%, 8/24） and from 25 to 72 hours after the operation in 4 patients （16.7%, 4/24）. The rebleeding was significantly related to the pre-operative and postoperative systolic blood pressure（P〈0.05）, while not to diastolic blood pressure of 24 patients, 19 were cured, 1 was discharged from hospital according to his demand and 4 died. Conclusions The advantages of minimally invasive surgery for hypertensive intracerebral hemorrhage include less trauma, patients quick recovery and low expense, but the operation should be performed within 6 hours after hemorrhage and the preoperative and postoperative blood pressure should keep stable in order to decrease rebleeding.