颅脑穿刺术治疗高血压脑出血术后再出血危险因素分析

Risk factors of hematoma enlargement in hypertensive intracerebral hematoma after microinvasive craniopuncture

目的探讨影响CT监视下颅脑穿刺术治疗高血压脑出血术后再出血的危险因素。方法回顾性分析本院2006年1月至2010年1月CT监视下颅脑穿刺术治疗的490例高血压脑出血患者的临床资料,通过单因素和多因素Logistic回归分析对再出血的可能相关因素进行分析。结果 490例患者再出血48例(9.7%)。手术时机(比值比=2.401,P=0.035)、术中首次抽吸量(比值比=3.012,P=0.001)、术后高血压控制情况(比值比=2.562,P=0.028)、肝脏疾病(比值比=1.987,P=0.037)等4个因素是影响CT监视下颅脑穿刺术后再出血的独立危险因素。结论 CT监视下颅脑穿刺术后再出血主要受手术时机、术中首次抽吸量、术后高血压控制情况、肝脏疾病影响,重视这些因素有利于再出血的早期识别与及时处理。

Objective To elucidate risk factors of hematoma enlargement in hypertensive intracerebral hematoma（HICH） after microinvasive craniopuncture with CT monitoring.Methods A total of 490 cases who were performed CT monitored microinvasive craniopuncture from January 2006 to January 2010 were analyzed retrospectively.Post-operative hematoma enlargement was found in 48 patients.The risk factors of hematoma enlargement were analyzed by single factor analysis and multivariate Logistic retrospective analysis.ResultsAmong all the cases,48 cases suffered from early rebleeding（9.7%）.Logistic regression analysis showed a significant correlation between hemotoma enlargement with duration from HICH onset to commencement of operation（odd ratio=2.401,P=0.035）,intra-operative first aspiration volume（odd ratio=3.012,P=0.001）,post-operative blood pressure（systolic and diastolic blood pressure）（odd ratio=2.562,P=0.028）,liver diseases（odd ratio=1.987,P=0.037） and hematoma enlargement in hypertensive intracerebral hematoma after CT monitored craniopuncture.Conclusion Operative timing,intra-operative first aspiration volume,post-operative blood pressure and liver diseases are the risk factors for hematoma enlargement in hypertensive intracerebral hematoma after CT monitored microinvasive craniopuncture.