高血压脑出血再出血的危险因素及治疗策略

Risk factors and treatment strategies of hypertensive intracerebral hemorrhage and rebleeding

目的探讨高血压脑出血再出血的相关危险因素及治疗策略。方法选择济南军区总医院神经外科自2010年2月至2017年12月行手术治疗的320例高血压脑出血患者为研究对象,对其临床资料进行回顾性分析,探讨高血压脑出血再出血发生的危险因素。结果高血压脑出血再出血发生率为11.25%(36例),经CT检查为原出血部位再出血及其他部位出血,且患者病死率为61.11%。高血压脑出血患者再出血与出血量、血压控制、发病后是否使用镇静处理、长期服用抗凝药物、凝血机制、国际标准化比值(INR)、手术时机等相关,差异具有统计学意义(P<0.05);而与患者年龄、性别、入院时GCS评分、高血压病家族史、是否长期规律服用降压药物、脑出血的部位、脱水药使用、手术方式等无关,差异无统计学意义(P>0.05)。将单因素分析有统计学意义的变量引Logistic回归方程,证明出血量>60 mL、收缩压>140 mmHg、凝血机制异常、长期服用抗凝药物、术前2 h内INR值≥1.4、发病后进行镇静治疗、发病至手术时间≤2.5 h是高血压脑出血术后再出血的独立危险因素(P<0.05)。结论高血压脑出血再出血与出血量、血压控制、发病后是否使用镇静处理、凝血功能、长期口服抗凝药物、INR值、手术时机等因素显著相关,针对上诉因素采取合适的临床处理,可以降低脑出血再出血率。

Objective To explore the risk factors and treatment strategies of rebleeding in hypertensive intracerebral hemorrhage. Methods Three hundred and twenty patients with hypertensive intracerebral hemorrhage who underwent surgical treatment, admitted to Department of Neurosurgery of General Hospital of Ji’nan Military Area from February 2010 to December 2017, were selected as clinical research cases. Their clinical data were retrospectively analyzed to explore the risk factors of hypertensive intracerebral hemorrhage. Results The incidence of recurrent hemorrhage in hypertensive intracerebral hemorrhage was 11.25%(36 cases). The original hemorrhage site and other hemorrhage sites were detected by CT, and the mortality rate was 61.11%. Rehemorrhage in patients with hypertensive intracerebral hemorrhage was correlated with bleeding volume, blood pressure control, patient agitation, long-term anticoagulant use, coagulation mechanism, INR value and timing of operation (P<0.05); and with age, sex, GCS score at admission, family history of hypertension, whether to take antihypertensive drugs regularly for a long time, and whether to take antihypertensive drugs regularly, location of cerebral hemorrhage, the use of dehydrating agents, and surgical methods were not related (P>0.05). Logistic regression equation was used to analyze the statistical significance of single factor analysis. It was concluded that bleeding volume (>60 mL), systolic blood pressure (≤140 mmHg), long-term oral anticoagulant, abnormal coagulation mechanism, INR value (≥1.4) and time from onset to operation (≤2.5 h) were independent risk factors for recurrent hemorrhage after hypertensive intracerebral hemorrhage (P<0.05). Conclusion Rehaemorrhage of hypertensive intracerebral hemorrhage is significantly correlated with the amount of bleeding, blood pressure control, agitation, coagulation function, long-term oral anticoagulant, INR value, timing of operation and other factors. Appropriate clinical treatment of appeal factors can reduce the rebleeding rate of cerebral hemorrhage.