术前纤维蛋白原水平对高血压脑出血微创穿刺引流术后再出血的预测价值

Predictive value of preoperative fibrinogen on rebleeding after minimally invasive puncture and drainage of hypertensive intracerebral hemorrhage

目的探讨术前纤维蛋白原(FIB)水平对高血压脑出血(HICH)微创穿刺引流术后再出血的预测价值。方法回顾性分析2018年1月至2020年2月川北医学院附属三台医院神经外科收治的177例HICH患者的临床资料,患者均采用微创穿刺引流术治疗,术前ELISA法检测血清FIB,判断术后再出血发生率,分析术前FIB水平对术后再出血的预测价值,采用单因素和多因素Logistic回归分析再出血的影响因素。结果本研究177例患者中,23例(12.99%)发生术后再出血;再出血患者术前FIB为(4.64±1.03)g/L,未再出血患者术前FIB为(3.07±0.50)g/L,2组比较差异有统计学意义(t=11.829,P<0.05)。术前FIB临界值为4.190 g/L时,预测术后再出血的ROC曲线下面积为0.894,敏感度为73.91%,特异度为98.05%。单因素分析结果显示,HICH微创穿刺引流术后再出血与患者发病至手术时间、术前FIB水平、术后收缩压、术后舒张压均有关;多因素Logictic回归分析显示,发病至手术时间≥6 h、术前FIB≥4.190 g/L、术后收缩压≥200 mmHg、术后舒张压≥120 mmHg均是HICH微创穿刺引流术后再出血的危险因素,OR值分别为1.844、3.297、2.469、2.459。结论术前FIB水平是HICH微创穿刺引流术后再出血较灵敏的预测指标,临床需要对再出血高危人群采取针对性预防措施以降低再出血风险。

Objective To investigate the predictive value of preoperative fibrinogen(FIB)on rebleeding after minimally invasive puncture and drainage of hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 177 HICH patients admitted to the Neurosurgery Department of Santai Hospital Affiliated to North Medical College from January 2018 to February 2020 were retrospectively analyzed,and all patients were treated with minimally invasive puncture and drainage.Preoperative ELISA was used to detect the serum FIB level and the incidence of postoperative rebleeding was determined,the predictive value of preoperative FIB for postoperative rebleeding was analyzed,and the influencing factors of rebleeding were analyzed by using single-factor and multiple-factor Logistic regression analysis.Results Among the 177 patients surveyed,23 cases(12.99%)had rebleeding after surgery.The preoperative FIB level of the patients with rebleeding was(4.64±1.03)g/L,and that of the non-bleeding patients was(3.07±0.50)g/L,the difference between the two groups was statistically significant(t=11.829,P<0.05).When the critical value of preoperative FIB was 4.190 g/L,the area under the ROC curve for predicting postoperative bleeding was 0.894,the sensitivity was 73.91%,and the specificity was 98.05%.The univariate results showed that the time from symptom onset to surgery,preoperative FIB level,postoperative systolic blood pressure and postoperative diastolic blood pressure were related to rebleeding after minimally invasive puncture and drainage of HICH,and multiple-factor Logistic regression analysis showed the time from symptom onset to surgery≥6 hours,preoperative FIB level≥4.190 g/L,postoperative systolic blood pressure≥200 mmHg and postoperative diastolic blood pressure≥120 mmHg were the risk factors for rebleeding after minimally invasive puncture and drainage of HICH with OR values of 1.844,3.297,2.469,2.459.Conclusion Preoperative FIB is a more sensitive predictive indicator of rebleeding after minimally invasive puncture and drainage of HICH.Clinical prevention is needed to reduce the risk of rebleeding for those with high risk for rebleeding.