高血压脑出血术后再出血的危险因素探讨

Risk factors of postoperative rebleeding of hypertensive intracerebral hemorrhage

目的探讨高血压脑出血术后再出血的相关危险因素。方法选择行手术治疗的270例高血压脑出血患者为临床研究病例,对其临床资料进行回顾性分析,探讨术后再出血发生的危险因素。结果高血压脑出血术后再出血发生率为9.63%,经CT检查均为原出血部位再出血,且患者病死率61.54%。高血压脑出血患者术后再出血与患者发病至手术时间、凝血机制、术前血肿量、术后收缩压及术后躁动等有关(P<0.05);而与患者年龄、性别、入院时格拉斯哥昏迷(GCS)评分、手术方式、出血部位无关(P>0.05)。将单因素分析有统计学意义的变量引入Logistic回归方程,分析得出发病至手术时间、凝血机制、术前血肿量、术后收缩压及术后躁动是高血压脑出血术后再出血的独立危险因素(P<0.05)。结论高血压脑出血术后再出血与发病至手术之间时间、术前血肿量、血肿形态、术后血压控制、凝血功能及术后躁动情况有显著相关性,临床应给予高度重视并积极处理,以降低术后再出血发生率,提高手术疗效,改善预后。

Objective To explore the related risk factors of postoperative rebleeding of hypertensive intracerebral hemorrhage.Methods Two hundred and seventy cases of hypertensive cerebral hemorrhage treated by surgery were selected as the clinical study cases,the clinical data of which were retrospectively analyzed to explore the risk factors of rebleeding after operation.Results The incidence of rebleeding after operation was 9.63%,CT examination showed that the rebleeding all occurred at the original bleeding sites,and the mortality rate of patients was 61.54%.Rebleeding of hypertensive intracerebral hemorrhage patients was relevant with bleeding time from onset to surgery,coagulation mechanism,preoperative hematoma volume,postoperative systolic blood pressure and postoperative agitation(P < 0.05),while it was irrelevant with age,gender,admission GCS score,surgical way and bleeding site(P > 0.05).By introducing the variables with univariate analysis significance into Logistic regression analysis,the results showed that time from onset to surgery,coagulation mechanism,surgical approach,preoperative hematoma volume,postoperative systolic blood pressure and postoperative agitation were independent risk factors(P < 0.05).Conclusions There was a significant correlation between the rebleeding and the time from onset to surgery,postoperative hematoma volume,the shape of hematoma,the postoperative control of blood pressure,blood coagulation function and postoperative agitation in patients with hypertensive cerebral hemorrhage.Therefore,we should attach great importance to and actively deal with the rebleeding in order to reduce the incidence of postoperative bleeding,to improve the efficacy and to promote prognosis.