影响高血压脑出血患者微创置管引流术后血肿未完全清除的相关因素

Related Factors Affecting Hematoma Clearance after Minimally Invasive Catheterization and Drainage in Patients with Hypertensive Intracerebral Hemorrhage

【目的】探讨影响高血压脑出血患者微创置管引流术后血肿未完全清除的相关因素。【方法】回顾性分析2016年1月至2022年1月本院收治的100例行微创置管引流术治疗的高血压脑出血患者的临床资料,根据患者术后血肿清除情况将其分为完全清除组(n=38)和未完全清除组(n=62)。收集入组患者的性别、年龄、血肿部位、血肿形态、原发出血量、手术穿刺定位、术前格拉斯哥昏迷评分标准(GCS)评分、受伤机制、入院至手术时间、血压、血小板计数(PLT)及凝血功能指标。通过受试者工作特征(ROC)曲线分析凝血指标预测血肿未完全清除的价值,采用Logistic多因素回归分析血肿未完全清除的危险因素。【结果】完全清除组年龄>60岁、血肿形态不规则、入院至手术时间<6 h占比低于未完全清除组,凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)水平均高于未完全清除组,差异有统计学意义(P<0.05)。ROC曲线分析显示,血清TT、PT、APTT水平均可用于血肿未完全清除的预测,曲线下面积分别为0.738、0.699、0.652(P<0.05)。Logistic多因素回归分析显示,年龄>60岁、血肿形态不规则、入院至手术时间<6 h、TT<15.881 s、PT<9.789 s、APTT<38.477 s是血肿未完全清除的危险因素(P<0.05)。【结论】年龄、血肿形态、入院至手术时间及TT、PT、APTT水平变化与高血压脑出血患者微创置管引流术后血肿清除情况有关,是血肿未完全清除的危险因素。

To explore the relevant factors affecting hematoma clearance after minimally invasive catheterization and drainage surgery in patients with hypertensive cerebral hemorrhage.【Methods】A retrospective analysis was conducted on the clinical data of 100 patients with hypertensive cerebral hemorrhage treated with minimally invasive catheterization and drainage in our hospital from January 2016 to January 2022.They were divided into a complete clearance group(n=38)and an incomplete clearance group(n=62)based on their postoperative hematoma clearance.We collected the gender,age,hematoma location,hematoma morphology,original blood volume,surgical puncture location,preoperative Glasgow Coma Scale(GCS)score,injury mechanism,admission to surgery time,blood pressure,platelet count(PLT),and coagulation function indicators of the enrolled patients.ROC analysis of coagulation indicators is used to predict the value of incomplete clearance of hematoma.Logistic multivariate regression analysis was used to identify the risk factors for incomplete clearance of hematoma.【Results】In the complete clearance group,the proportion of patients over 60 years old,with irregular hematoma morphology,and a hospital to surgery time of<6 hours were lower than those in the incomplete clearance group.The levels of TT,PT,and APTT were all higher than those in the incomplete clearance group,with statistically significant differences(P<0.05).ROC curve analysis showed that serum TT,PT,and APTT levels can be used for predicting incomplete clearance of hematoma,with areas under the curve of 0.738,0.699,and 0.652,respectively(P<0.05).Logistic multiple factor regression analysis showed that age>60 years old,irregular hematoma morphology,time from admission to surgery<6 hours,TT<15.881 s,PT<9.789 s,APTT<38.477 s were risk factors for hematoma failure(P<0.05).【Conclusion】Age,hematoma morphology,time from admission to surgery,and changes in TT,PT,and APTT levels are related to the clearance of hematoma after minimally invasive catheter drainage surgery in patients with hypertensive cerebral hemorrhage,and are risk factors for incomplete clearance of hematoma.