高血压脑出血术后再出血危险因素的Meta分析

Meta-analysis on risk factors for postoperative rebleeding of hypertensive intracerebral hemorrhage

目的通过Meta分析探讨高血压脑出血(HICH)术后再出血的相关危险因素,为防止发生术后再出血提供循证医学依据。方法通过检索中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学数据库(CBM)及PubMed、Embase、Web of Science、Cochrane Library数据库,查找2015年1月1日—2020年1月31日发表的,关于高血压脑出血术后再出血危险因素研究的相关文献;同时追溯纳入文献的参考文献,以尽可能查全文献。采用Stata15.1、RevMan5.3软件对纳入文献的研究结果进行Meta分析。结果最终纳入17篇文献,总样本例数为3544例。Meta分析结果显示,高血压脑出血术后再出血的危险因素为发病至手术时间≤6 h(OR=3.98,95%CI:2.98~5.33)、凝血功能异常(OR=3.13,95%CI:2.28~4.30)、术前收缩压≥200 mmHg(OR=2.91,95%CI:1.94~4.36)、术前舒张压≥120 mmHg(OR=6.28,95%CI:3.58~10.99)、术后收缩压≥200 mmHg(OR=6.48,95%CI:3.60~11.65)、术前血肿量≥60 mL(OR=2.23,95%CI:1.72~2.88)、术中止血困难(OR=4.14,95%CI:2.47~6.92)及合并糖尿病(OR=1.84,95%CI:1.27~2.65)。结论发病至手术时间≤6 h、凝血功能异常、术前收缩压≥200 mmHg、术前舒张压≥120 mmHg、术后收缩压≥200 mmHg、术前血肿量≥60 mL、术中止血困难、合并糖尿病是高血压脑出血术后再出血的危险因素;了解及预防、处理这些危险因素可降低高血压脑出血术后再出血的发生率。

Objective To explore the risk factors of postoperative rebleeding in patients with hypertensive intracerebral hemorrhage(HICH)by meta-analysis,and to provide evidence-based medicine basis for preventing postoperative rebleeding.Methods By searching CNKI,Wanfang,VIP,CBM,PubMed,EMBASE,web of science and Cochrane Library,the related literatures published from January 1,2015 to January 31,2020 on the risk factors of rebleeding after HICH surgery were collected.At the same time,the references of the included literatures were traced,so as to search the whole literature as far as possible.Stata15.1 and revman5.3 software were used for meta-analysis.Results A total of 17 articles were eventually enrolled,including 3544 patients.The results of Meta-analysis showed that the risk factors of postoperative rebleeding of hypertensive intracranial hemorrhage were the time from onset to operation≤6 h(OR=3.98,95%CI:2.98-5.33),coagulation disorder(OR=3.13,95%CI:2.28-4.30),preoperative systolic blood pressure≥200 mmHg(OR=2.91,95%CI:1.94-4.36),preoperative diastolic blood pressure≥120 mmHg(OR=6.28,95%CI:3.58-10.99),postoperative systolic blood pressure≥200 mmHg(OR=6.48,95%CI:3.60-11.65),hematoma volume≥60 mL(OR=2.23,95%CI:1.72-2.88),difficult hemostasis during operation(OR=4.14,95%CI:2.47-6.92),history of diabetes mellitus(OR=1.84,95%CI:1.27-2.65).Conclusion The risk factors of postoperative rebleeding of HICH include the time from onset to operation≤6 h,coagulation disorder,preoperative systolic blood pressure≥200 mmHg,preoperative diastolic blood pressure≥120 mmHg,postoperative systolic blood pressure≥200 mmHg,hematoma volume≥60 mL,difficult hemostasis during operation,history of diabetes mellitus.Understanding these risk factors can effectively reduce the rate of rebleeding after operation of HICH.