高血压脑出血开颅术中发生动脉高流量出血的影响因素分析

Risk factors of high-flow-bleeding during craniotomy for hypertensive cerebral hemorrhage

目的探讨高血压脑出血(HICH)开颅术中发生动脉高流量出血(术中视野下有活动性出血)的影响因素。方法选取2018年1月至2020年12月在浙江大学医学院附属金华医院行开颅手术的HICH患者113例,术中发生高流量出血48例,未发生高流量出血65例;比较两组患者出血速度、CT血管造影(CTA)活动性出血征象(点征、漩涡征、黑洞征等)、血肿CT值、发病至手术时间、术前止血药物使用、术中收缩压及血压波动率等临床资料,采用多因素logistic回归分析术中发生高流量出血的影响因素。结果高流量出血组与非高流量出血组患者发病至手术时间、出血速度、CTA活动性出血征像、血肿CT值、术前使用止血药物比例比较,差异均有统计学意义(均P<0.05)。发病至手术时间、出血速度、血肿CT值是HICH开颅术中发生高流量出血的影响因素,其OR值分别为0.940、1.188、1.486。结论发病至手术时间、出血速度、血肿CT值是HICH开颅术中发生高流量出血的影响因素;对于此类患者,应在围术期采取有效的针对性措施。

Objective To analyzed the risk factors of high-flow-bleeding during craniotomy for hypertensive intracerebral hemorrhage(HICH).Methods A total of 113 patients who underwent craniotomy for HICH in Jinhua Hospital from January 2018 to December 2020 were enrolled in the study.There were 48 patients with high-flow-bleeding(HFB group)and 65 patients without high-flow-bleeding(non-HFB group).The clinical data of hemorrhage speed,active bleeding signs on CTA(spot sign,whirlpool sign,black hole sign,etc.),CT value of hematoma,time from onset to operation,use of hemostatic drugs before operation were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of high-flow-bleeding during HICH craniotomy.Results There were significant differences in the time from onset to operation,hemorrhage speed,CTA active bleeding signs,hematoma CT value and preoperative use of hemostatic drugs between HFB group and the non-HFB group(all P<0.05).The time from onset to operation,hemorrhage speed and CT value of hematoma were the independent risk factors of high-flow-bleeding during HICH craniotomy,and their OR values were 0.940,1.188 and 1.486,respectively.Conclusion The time from onset to operation,hemorrhage speed and CT value of hematoma are the influencing factors of high-flow-bleeding during HICH craniotomy,and effective measures should be taken perioperatively for patients with risk factors.