高血压脑出血患者术后重症监护治疗与早期再出血的相关因素分析

Analysis of Correlative Factors between Post-operative Intensive Care and Early Rebleeding in Patients with Hypertensive Intracerebral Hemorrhage

目的:探究高血压脑出血患者术后重症监护治疗与早期(24 h内)再出血的相关因素。方法:回顾性分析2014年1月至2018年10月于中山大学附属第一医院及中山市人民医院行手术治疗并进行重症监护的高血压脑出血患者的相关资料,记录术后早期发生再出血情况,比较其相关因素,包括年龄、性别、术前格拉斯哥昏迷量表(GCS)评分、出血量、术前收缩压、术后收缩压、镇静时间、插管时间、有无使用止血药、血压波动、血压差、有无镇痛情况,分析术后早期再出血的影响因素。结果:本研究共纳入465例患者,其中术后早期再出血患者44例,未再出血患者421例,再出血发生率为9.46%(44/465)。高血压脑出血术后早期再出血患者的术后收缩压、有无镇痛、血压差、血压波动与未再出血患者比较差异具有统计学意义(P<0.05)。术后早期再出血患者的年龄、性别及术前GCS评分、出血量、术前收缩压、镇静时间、插管时间、有无使用止血药与未再出血患者比较差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,患者血压波动大是术后早期再出血的危险因素,手术前后血压差大、术后使用镇痛治疗是其保护因素。结论:高血压脑出血患者术后血压波动、手术前后血压差及术后镇痛治疗均是早期再出血的影响因素,合理降压及镇痛治疗可减少脑出血术后早期再出血的发生。

Objective:To explore the correlative factors between postoperative intensive care and early(within 24 hours)rebleeding in patients with hypertensive intracerebral hemorrhage.Methods:The data of patients with hypertensive intracerebral hemorrhage who underwent surgical treatment and intensive care in First Affiliated Hospital of Sun Yat-sen University and Zhongshan People's Hospital from January 2014 to October 2018 were retrospectively analyzed.The situation of postoperative early rebleeding were recorded,relevant factors were compared,including age,sex,preoperative Glasgow coma scale(GCS)scores,bleeding volume,preoperative systolic blood pressure,postoperative systolic blood pressure,sedation time,intubation time,use of hemostatic drugs,blood pressure fluctuation,blood pressure difference and analgesia,the influencing factors of postoperative early rebleeding were analyzed.Results:A total of 465 patients were enrolled in this study,among them,44 had postoperative early rebleeding,421 had no rebleeding,the incidence of rebleeding was 9.46%(44/465).There were significant differences in postoperative systolic blood pressure,analgesia,blood pressure difference and blood pressure fluctuation between patients with postoperative early rebleeding after hypertensive intracerebral hemorrhage and those no rebleeding(P<0.05).There was no significant difference in age,sex,preoperative GCS score,bleeding volume,preoperative systolic blood pressure,sedation time,intubation time,use of hemostatic drugs between patients with postoperative early rebleeding after hypertensive intracerebral hemorrhage and those no rebleeding(P>0.05).Multivariate Logistic regression analysis showed that the high fluctuation of blood pressure was the risk factor of postoperative early rebleeding,the large difference of blood pressure before and after operation and the use of analgesic treatment after operation were the protective factors.Conclusion:Postoperative blood pressure fluctuation,blood pressure difference before and after operation and postoperative analgesic treatment are the influencing factors of early rebleeding in patients with hypertensive intracerebral hemorrhage,rational blood pressure lowering and analgesia treatment can reduce the occurrence of early rebleeding after intracerebral hemorrhage.