微创穿刺血肿引流术与小骨窗血肿清除术治疗高血压性脑出血的效果比较及再出血影响因素分析

Comparison effect of minimally invasive evacuation of hematoma and small-window craniotomy evacuation of hematoma in the treatment of hypertensive intracerebral hemorrhage and the analysis of influencing factors of postoperative rebleeding

目的分析微创穿刺血肿引流术、小骨窗血肿清除术治疗高血压性脑出血(HIH)的效果以及影响再出血的相关因素。方法回顾性分析菏泽市牡丹人民医院2015年1月～2017年12月收治106例HIH患者的临床资料,根据手术方式分为S组(n=49)和M组(n=57)。S组采用小骨窗血肿清除术,M组采用微创穿刺血肿引流术。比较两组患者的治疗效果以及并发症、再出血发生率;并通过单因素分析、多因素Logistic回归分析影响术后再出血的影响因素。结果两组患者的总有效率、并发症及再出血发生率比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,手术时机(<6 h)、高血压病程(≥10年)、术前舒张压(≥120 mmHg)以及术前收缩压(≥200 mmHg)为影响HIH患者术后再出血的独立危险因素(P<0.05)。结论微创穿刺血肿引流术、小骨窗血肿清除术治疗HIH的疗效相当;手术时机、术前血压以及高血压病程>10年为影响HIH术后再出血的独立危险因素。

Objective To analyze the effect of minimally invasive evacuation of hematoma and small-window craniotomyevacuation of hematoma in the treatment of HIH and the influencing factors of postoperative rebleeding. Methods Theclinical data of 106 patients with HIH from January 2015 to December 2017 admitted to Heze Peony People＇s Hospitalwere retrospectively analyzed, the patients were divided into group S （n=49） and group M （n=57）. Group S was treatedwith small-window craniotomy evacuation of hematoma, and group M was treated with minimally invasive evacuation ofhematoma. The treatment effects, incidence of complications and rebleeding were compared between the two groups.The factors influencing postoperative rebleeding were analyzed by single factor analysis and Logistic multivariate regression analysis. Results There were no statitically significant differences in effective rate, incidence of complicationsand rebleeding between the two groups （P〉0.05）. Multifactor Logistic regression analysis showed that timing of surgery（〈6 h）, hypertension （≥10 years）, preoperative diastolic blood pressure （≥120 mmHg） and preoperative systolic bloodpressure （≥200 mmHg） were independent factors influencing rebleeding in HIH patients （P〈0.05）. Conclusion Minimally invasive evacuation of hematoma and small-window craniotomy evacuation of hematoma are effective on the samelevel in the treatment of HIH. The timing of surgery, preoperative blood pressure, and duration of hypertension 〉10years are independent risk factors for postoperative rebleeding.