颅内压监测在高血压脑出血患者治疗中的指导价值及 术后再出血的危险因素分析

The Guiding Value of Intracranial Pressure Monitoring in the Treatment ofPatients with Hypertensive Intracerebral Hemorrhage and the Risk Factors ofPostoperative Rebleeding

目的:探讨颅内压监测在高血压脑出血患者治疗中的指导价值,并分析术后再出血的危险因素。方法:选取我院于2017年2月~2020年7月期间收治的70例高血压脑出血患者的临床资料进行回顾性分析,根据有无颅内压监测将患者分为对照组31例和监测组39例。对比对照组、监测组围术期指标情况,对比对照组、监测组术后并发症发生情况,采用单因素及多因素Logistic回归分析患者术后再出血的影响因素。结果:监测组甘露醇使用剂量少于对照组,重症监护室(ICU)住院时间、甘露醇使用天数短于对照组(P<0.05)。监测组术后并发症总发生率低于对照组(P<0.05)。本次研究纳入的70例高血压脑出血患者中,13例发生术后再出血纳为再出血组,再出血发生率为18.57%(13/70);剩余的57例未再出血患者纳为未出血组。单因素分析结果可知,高血压脑出血患者术后再出血与发病至手术时间、凝血机制、术前血肿量、入院时收缩压(SBP)有关(P<0.05)。多因素Logistic回归分析结果显示,发病至手术时间≤6 h、凝血机制异常、术前血肿量>60 mL、入院时SBP≥200 mmHg均是高血压脑出血患者术后再出血的危险因素(P<0.05)。结论:颅内压监测在高血压脑出血患者治疗中的指导价值较高,高血压脑出血患者术后再出血与发病至手术时间、凝血机制、术前血肿量、入院时SBP相关,临床应给予高度重视并积极干预,以降低术后再出血发生率。

Objective: To investigate the guiding value of intracranial pressure monitoring in the treatment of patients with hypertensive intracerebral hemorrhage, and to analyze the risk factors of postoperative rebleeding. Methods: The clinical data of 70 patients with hypertensive intracerebral hemorrhage in our hospital from February 2017 to July 2020 were retrospectively analyzed, and the patients were divided into control group with 31 cases and monitoring group with 39 cases according to whether had intracranial pressure monitoring. The perioperative operation indexes of the control group and the monitoring group were compared, and the postoperative complications of the control group and the monitoring group were compared. The influencing factors of postoperative rebleeding of patients were analyzed by univariate and multivariate Logistic regression. Results: The dosage of mannitol in the monitoring group was less than that in the control group, and the length of stay in intensive care unit(ICU) and the days of mannitol use in the monitoring group were shorter than those in the control group(P<0.05). The total incidence rate of postoperative complications in the monitoring group was lower than that in the control group(P<0.05). Among the 70 patients with hypertensive intracerebral hemorrhage included in this study, 13 patients with postoperative rebleeding were included in the rebleeding group, and the incidence of rebleeding was 18.57%(13/70). The remaining 57 patients without bleeding were included in the non bleeding group. Univariate analysis showed that postoperative rebleeding was related to the time from onset to operation, coagulation mechanism, preoperative hematoma volume and systolic blood pressure(SBP) at admission(P<0.05). Multivariate Logistic regression analysis showed that the time from onset to operation ≤ 6 h, abnormal coagulation mechanism, preoperative hematoma volume > 60 mL, SBP at admission ≥200 mmHg were independent risk factors for postoperative rebleeding of hypertensive intracerebral hemorrhage(P<0.05). Conclusion: Intracranial pressure monitoring in the treatment of patients with hypertensive intracerebral hemorrhage has a high guiding value. Postoperative rebleeding in patients with hypertensive intracerebral hemorrhage is closely related to the time from onset to operation, coagulation mechanism, preoperative hematoma volume and SBP at admission. We should attach great importance to it and actively treat it in order to reduce the incidence rate of postoperative rebleeding.