微创穿刺血肿引流术与小骨窗血肿清除术治疗高血压脑出血的疗效及术后再出血的影响因素分析

Analysis on the effect of minimally invasive puncture hematoma drainage and small bone window hematoma re-moval on hypertensive intracerebral hemorrhage and the influencing factors of postoperative rebleeding

目的分析微创穿刺血肿引流术与小骨窗血肿清除术治疗高血压脑出血的疗效及术后再出血的影响因素。方法选取2018年6月至2019年7月本院收治的90例高血压脑出血患者为研究对象,采用随机数表法将患者分为对照组与观察组,每组45例。对照组采用微创穿刺血肿引流术治疗,观察组采用小骨窗血肿清除术治疗,比较2组患者的手术效果、并发症发生率以及再出血发生率。随后根据有无再出血将患者分为未出血组与再出血组,并通过单因素与多因素Logistic回归分析影响高血压脑出血患者术后再出血的危险因素。结果对照组的总有效率(84%)、并发症发生率(22%)与再出血发生率(18%)与观察组(89%、18%、20%)相比较,差异无统计学意义(P>0.05);经多因素Logistic回归分析结果显示,高血压病程(≥10年)、手术时机(<6 h)、术前收缩压(≥200 mmHg)与术前舒张压(≥120 mmHg)是影响高血压脑出血患者术后再出血的独立危险因素(P<0.05)。结论微创穿刺血肿引流术与小骨窗血肿清除术治疗高血压脑出血均有着良好的治疗效果,而对于术后再出血患者,高血压病程≥10年、手术时机、术前血压状况是主要危险因素。

Objective To analyze the effect of minimally invasive puncture hematoma drainage and small bone window hematoma removal in the treatment of hypertensive intracerebral hemorrhage and the influencing factors of postoperative rebleeding.Methods A total of 90 patients with hypertensive intracerebral hemorrhage admitted to our hospital from June 2018 to July 2019 were selected as the study objects.The patients were divided into control group and observation group by random number table method,with 45 cases in each group.The control group was treated with minimally invasive puncture hematoma drainage,and the observation group was treated with small bone window hematoma removal.Subsequently,the patients were divided into unbleeding group and rebleeding group according to the presence or absence of rebleeding,and univariate and multivariate Logistic regression analysis was conducted to analyze the risk factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage.Results The total effectiverate(84%),complication rate(22%)and rebleeding rate(18%)of the control group were similar to that of the obser-vation group(89%),(18%)and(20%),with no significant difference(P>0.05).Multivariate Logistic regression analysis showed that duration of hypertension(≥10 years),timing of surgery(<6 h),preoperative systolic blood pres-sure(≥200 mmHg)and preoperative diastolic blood pressure(≥120 mmHg)were independent risk factors for posto-perative rebleeding in patients with hypertensive intracranial hemorrhage(P<0.05).Conclusion Minimally invasive puncture hematoma drainage and small bone window hematoma removal for the treatment of hypertensive intracerebral hemorrhage have good therapeutic effect,and for patients with postoperative rebleeding,duration of hypertension≥10 years,preoperative blood pressure status is the main risk factor.