三种不同手术方式治疗高血压性脑出血的疗效及术后再出血危险因素探讨

The effect of three different surgical methods on hypertensive cerebral hemorrhage and the risk factors of postoperative rebleeding

目的探讨三种不同手术方式治疗高血压性脑出血(HICH)的疗效及术后再出血的危险因素。方法2017年5月~2019年8月本院收治的HICH病人126例,按手术方式不同分为传统骨瓣开颅组(A组,30例)、小骨窗开颅组(B组,46例)和微创血肿引流组(C组,50例)3组。比较各组手术时间、住院时间、出血量及近期疗效,并分析术后再出血的危险因素。结果B组、C组病人的手术时间、住院时间、出血量均低于A组;3组病人的优良率比较差异均无统计学意义(P>0.05);单因素Logistic分析表明,收缩压、出血量、凝血功能障碍、镇痛镇静药、GCS评分、出血部位、手术方式等指标与HICH术后再出血的发生具有相关性(P<0.05);多因素非条件Logistic分析提示,收缩压>160 mmHg、出血量≥60 ml、凝血功能障碍、无使用镇痛镇静药、GCS评分<8分、出血部位为基底节区、不同手术方式等指标是HICH术后再出血的独立危险因素(P<0.05)。结论与传统骨瓣开颅术比,小骨窗血肿清除术和微创穿刺血肿引流术具有手术时间短、出血量少、住院时间短及再出血率低等特点;HICH术后再出血有较多因素,高收缩压、出血量多、凝血功能障碍、GCS评分等是术后发生再出血的危险因素。

Objective To explore the effect of three different surgical methods in the treatment of hypertensive cerebral hemorrhage(HICH)and the risk factors of postoperative rebleeding.Methods The clinical data of 126 patients with hich from May 2017 to August 2019 were analyzed retrospectively.All the patients were divided into three groups according to the operation mode:the traditional craniotomy group(group A)30 cases,the small bone window craniotomy group(group B)46 cases,the minimally invasive hematoma drainage group(Group C)50 cases.The operation time,hospitalization time,bleeding volume and short-term effect were compared among the groups,and the risk factors of postoperative rebleeding were analyzed.Results The operation time,hospitalization time and bleeding volume of patients in group B and group C were lower than those in group A;the excellent and good rate of patients in the three groups was not statistically significant(P>0.05).By univariate unconditional logistic analysis,systolic blood pressure,bleeding volume,coagulation dysfunction,analgesics and sedatives,GCS score,bleeding site,operation mode and other indicators were correlated with the occurrence of postoperative rebleeding in hich(P<0.05).The results of multivariate unconditional logistic analysis showed that systolic blood pressure>160 mmhg,bleeding volume≥60 ml,coagulation dysfunction,no use of analgesics and sedatives,GCS score<8,bleeding site in basal ganglia,different operation methods and other indicators were independent risk factors for bleeding after hich(P<0.05).Conclusion Compared with the traditional craniotomy,small bone window hematoma removal and minimally invasive puncture hematoma drainage have the advantages of short operation time,less bleeding,short hospitalization time and low postoperative rebleeding rate;There are many factors of postoperative rebleeding in patients with hypertensive cerebral hemorrhage.High systolic pressure,large amount of bleeding,coagulation dysfunction and GCS score are the risk factors of postoperative rebleeding.