高血压脑出血术后再出血的原因探讨

Analysis of the causes of postoperative bleeding in hypertensive intracerebral hemorrhage patients

目的：对高血压脑出血（hypertensive intracerebral hymorrhage, HICH）术后再出血病例进行回顾性分析,研究导致再出血的原因及探讨应对策略。方法从手术操作、术后血压状态、患者术前的机体功能等多方面入手分析本院神经外科2008~2012年高血压脑出血行开颅术后再出血患者51例患者的病历资料。结果42例再出血患者中有21例6 h以内复查头颅CT显示原出血部位再次出现较大血肿,同时高血压脑出血患者中25例凝血功能异常,27例肝功能或肾功能障碍。结论术中止血操作不规范、术后早期血压控制不稳及患者术前即存在的凝血功能异常是造成术后再出血的主要原因。针对以上原因,规范术中止血技术、控制术后血压平稳并对患者存在的凝血功能异常及时采取措施,籍以降低高血压脑出血术后再出血的发生率。

Objective To retrospectively analyze the hypertensive intracerebral hemorrhage postoperative bleeding to explore the reasons for rebleeding and its coping strategies. Methods From the surgical procedure, postoperative blood pressure status, preoperative body functions such as multi-pronged approach, to study the 51 hypertensive intracerebral hemorrhage patients’medical records who suffered postoperative rebleeding in our neurosurgery department from 2008 to 2012. Results 21 cases review within 6 h, their head CT showed that the original bleeding area appeared larger hematoma, coagulant function abnormality in 42 postoperative bleeding patients, at the same time, 25 cases of blood coagulation dysfunction in hypertensive cerebral hemorrhage patients, 27 cases of liver or kidney failure. Conclusion Intraoperative bleeding operation is not standardized, early postoperative blood pressure control failure in patients, preoperative instability function and the presence of coagulopathy are the main causes of postoperative bleeding. For the above reasons, the specification intraoperative hemostasis, control blood pressure to stable after surgery and patients with coagulopathy take timely measures to reduce the membership of hypertensive intracerebral hemorrhage incidence of postoperative bleeding.