手术治疗高血压脑出血患者再次出血的影响因素

Influence factors of surgical treatment of hypertensive intracerebral hemorrhage

目的分析手术治疗高血压脑出血患者再次出血的影响因素,为临床预防提供理论依据。方法回顾性分析2011年11月-2015年3月在我院神经外科住院并经微创手术治疗的164例血压脑出血患者的临床资料和手术病例,其中术后再出血16例,术后再出血发生率大约为9.8%,选取患者年龄、性别、伴随糖尿病病程、术前口服药物、手术时机、手术持续时间、出血部位、有无凝血异常、术后血压控制等影响手术治疗高血压脑出血后再出血的因素进行Logistic多元逐步回归分析。结果本研究中术后再出血发生率大约为9.8%。单因素Logistic结果显示:年龄≥55岁,术前口服药物、手术时机、出血部位、凝血异常、术后血压波动等与术后再出血显著相关(P<0.05);多因素Logistic结果显示:手术时机、出血部位、凝血异常是术后再出血的危险因素(P<0.05)。结论手术治疗高血压脑出血后再出血的发生率较高,把握最佳的手术时机、纠正凝血功能以及争取术中确切部位彻底止血对预防再出血有重要意义。

Objective To analyze the influencing factors of hemorrhage in patients with hypertensive cerebral hemorrhage after operation,and to provide theoretical basis for clinical prevention.Methods A retrospective analysis in November 2011-2015 march in the Department of neurosurgery in our hospital inpatients and the minimally invasive surgery in the treatment of 164 cases of hypertensive cerebral hemorrhage in patients with clinical data and surgical cases.The postoperative rebleeding in 16 cases,postoperative rebleeding rate is about 9.8%,select the age and sex of the patient,with the duration of diabetes,preoperative oral medications,surgery time,the operation continued time,bleeding site,there is no coagulation abnormalities and postoperative blood pressure control and effect of surgical treatment of hypertensive cerebral hemorrhage after rebleeding factors were analyzed by logistic multivariate stepwise regression analysis.Results The incidence of postoperative bleeding was about 9.8% in the study.Univariate logistic regression results showed that 55 years of age or older,preoperative oral medication,operation time,bleeding location,coagulation abnormalities,postoperative fluctuation of blood pressure and postoperative rebleeding was significantly correlated（P〈0.05）;multivariate logistic regression results show：operation time,bleeding and coagulation ISO is often postoperative rebleeding risk factors（P〈0.05）.Conclusion Surgical treatment of hypertensive intracerebral hemorrhage after the high incidence of re bleeding,grasp the best timing of surgery,to correct the coagulation function and to fight for the exact location of the bleeding is important to prevent re bleeding.