不同手术方式治疗幕上高血压脑出血的疗效及术后再出血的影响因素分析

Comparison of therapeutic effects of different surgical methods in patients with supratentorial hypertensive intracerebral hemorrhage and the analysis of influencing factors of postoperative rebleeding

目的探讨不同手术方式治疗幕上高血压脑出血的效果及术后再出血的影响因素。方法80例高血压脑出血患者根据手术方法的不同分为微创穿刺血肿引流术(MIPHD)组42例和小骨窗血肿清除术(SWC)组38例,比较2组患者的治疗效果和术后并发症及再出血发生情况,单因素和Logistic回归分析导致术后再出血的危险因素。结果MIPHD组患者治疗优良率(26/42,61.9%)与SWC组优良率(23/38,60.5%)差异无统计学意义(P>0.05),2组术后消化道出血、电解质紊乱、肺部感染、颅内感染及再出血情况比较差异无统计学意义(P>0.05)。经Logistic回归分析表明患者入院时收缩压≥200 mmHg、入院时舒张压≥120 mmHg、发病距手术时间≤6 h及手术非准确操作是导致术后再出血的主要危险因素。结论MIPHD和SWC治疗高血压脑出血均可取得较好的疗效,血压升高、超早期手术、手术过程中医师非准确操作是导致患者术后再出血的危险因素。

Objective To investigate the effect of different surgical methods on supratentorial hypertensive intracerebral hemorrhage and the influencing factors of postoperative rebleeding.Methods Eighty patients with hypertensive intracerebral hemorrhage admitted to our hospital from August 2016 to August 2018 were selected as subjects.According to the different surgical methods,it was divided into minimally invasive hematoma drainage(MIPHD)group and small bone window hematoma evacuation(SWC)group,42 cases in MIPHD group and 38 cases in SWC group.The clinical outcomes and postoperative complications and rebleeding were compared between the two groups.Univariate and Logistic regression analysis led to risk factors for postoperative rebleeding.Results There were excellent as well as good rate 61.9%(26/42)in the MIPHD group and excellent and good rate 60.5%(23/38)in the SWC group.There was no significant difference between the two groups(P>0.05);There were no significant differences in postoperative gastrointestinal bleeding,electrolyte imbalance,pulmonary infection,intracranial infection and rebleeding between the two groups(P>0.05).Logistic regression analysis showed that patients with systolic blood pressure≥200 mmHg at admission,diastolic blood pressure≥120 mmHg at admission,operative time≤6h,and non-accurate operation were the main risk factors for postoperative rebleeding.Conclusions Both MIPHD and SWC can achieve satisfactory treatment outcomes on hypertensive cerebral hemorrhage.The high blood pressure,ultra-early surgery,and inaccurate technique of the surgeon during the operation are the risk factors for postoperative rebleeding.