立体定向联合显微手术治疗高血压性脑出血疗效及再出血危险因素分析

The combined micro- surgery stereotactic treatment of hypertensive cerebral hemorrhage and analysis of risk factors for rebleeding analysis

目的探讨立体定向联合显微外科手术治疗高血压性脑出血的疗效,以及手术再出血等危险因素分析。方法选取我科2010年1月~2013年1月的200例高血压脑出血病例,随机分为观察组与对照组,对比两组疗效;分析术后再出血原因、筛查其危险因素采用Logistic回归分析。结果术后早期,观察组在手术时间、术中出血量、下床活动时间、留院时间等指标明显优于对照组（P〈0.05）;术后1 m观察组NIHSS评分,明显低于对照组（P〈0.05）;对照组术后再出血发生率明显高于观察组（P〈0.05）。危险因素中,伴有糖尿病、凝血功能异常、脑中线偏移程度、血肿破入脑室、手术时间过早、出血部位、血肿形状规则与否以及手术方式等,与术后再出血有显著相关（P〈0.05）。结论立体定向联合显微外科治疗高血压脑出血较之传统开颅手术,能缩短手术时间、减少术中出血、促进患者神功功能恢复,还能减少再出血的发生率、提高患者生存质量;再出血危险因素分析提示,凝血功能异常（OR〉2）、手术时间（〈6 h）、出血部位为非基底节、血肿形状不规则等均提示为术后再出血发生的重要原因。

Objective To investigate the combined micro-surgery stcreotactic treatment of hypertensive cerebral hemorrhage and analysis of risk factors for rebleeding analysis. Methods Our hospital in January 2010 - 2013 in January of 200 cases of hypertensive cerebral hemorrhage patients in our hospital from January 2010 to January 2013 were randomly divided into observation group and control group, comparative analysis of the two groups were performed, while patients with risk factors for rebleeding were screened for risk factors Logistic regression analysis. Results The The observation group in operative time, blood loss, time on the bed, and other indicators of hospital stay was significantly better than the control group （P 〈 0.05 ） , after one month later, January observation group NIHSS score was significantly lower than the control group （ P 〈 0.05 ） , thethe incidence of postoperative bleeding in control group the incidence of postoperative bleeding was significantly higher than in the observation group （ P 〈 0.05 ） , diabetes, blood clotting abnormalities, midline shift, hematoma ruptured into the ventricle,operation time,bleeding site, hematoma shape,the use of mannitol, surgical procedures were as- sociated correlated with postoperative bleeding relationship （ P 〈 0.05 ）, OR 〉 2 risk factors for were coagulation dysfunc- tion, surgery time （ 〈 6 h） , part of the non-basal ganglia hemorrhage, hematoma, irregular shape, OR 〈 1 compared with pro- tective factors, stereotactic surgical joint microsurgery can effectively reduee the incidence of rebleeding, as protective fac- tors. Conclusion Combined stereotactic microsurgical treatment of hypertensive intracerebral hemorrhage can effectively shorten the operation time, reduce blood loss, and promote functional recovery in patients with magic, can effectively reduce reblceding occurrence,improve the survival rate of patients, analysis of postoperative bleeding risk factors found in coagula- tion dysfunction, surgery time （ 〈 6h） , part of the non-basal ganglia hemorrhage, hcmatoma, irregular shape, high-risk pa- tients after surgery should closely be monitored to prevent rebleeding.