高血压脑出血保守治疗转手术治疗的危险因素分析

目的探讨高血压脑出血保守治疗后效果差需转手术治疗的相关危险因素。方法回顾性分析2014年12月至2021年12月在本院就诊的高血压脑出血病例,收集患者的一般资料、凝血功能指标、血清离子钙水平、CT影像学特征等资料。根据入院后治疗期间药物治疗效果差需转为手术的患者分为手术组,药物治疗有效继续药物治疗的患者为保守组,统计分析相关危险因素。结果总共261例纳入研究,其中手术组(63例)及保守组(198例),单因素分析结果显示年龄、CT出血征、血清离子钙水平、脑水肿程度、意识变化、首次CT血肿量、收缩压与患者保守治疗后转手术治疗有关(P<0.05),多因素Logistic回归分析显示血清离子钙水平、CT出血征、首次CT血肿量、收缩压、脑水肿程度、意识变化为高血压脑出血患者保守治疗后转手术治疗的独立危险因素(P<0.05)。结论首次CT血肿量、高收缩压、低血清离子钙水平、CT出血征、重度脑水肿、意识变化是影响高血压脑出血患者保守治疗后转手术治疗的独立危险因素,对高血压脑出血预测保守治疗效果差需转为手术治疗具有较高的临床指导价值。

Objective To analyse risk factors for poor outcomes requiring conversion from conservative treatment to surgical treatment in hypertensive intracerebral hemorrhage.Methods A retrospective analysis was conducted on hypertensive intracerebral hemorrhage cases treated at our hospital from December 2014 to December 2021.General information,coagulation function indicators,serum ionized calcium levels,CT imaging characteristics,and other data of the patients were collected.Patients who required surgical treatment due to poor response to medical treatment during hospitalization were assigned to the surgical group,while patients who showed effective response to medical treatment and continued with conservative management were assigned to the conservative group.Relevant risk factors were statistically analyzed.Results A total of 261 cases were included in the study,with 63 in the surgical group and 198 in the conservative group.Univariate analysis showed that age,CT hemorrhagic signs,serum ionized calcium levels,degree of cerebral edema,changes in consciousness,initial CT hematoma volume,and systolic blood pressure were associated with the conversion from conservative treatment to surgical treatment(P<0.05).Multivariate logistic regression analysis showed that serum ionized calcium levels,CT hemorrhagic signs,initial CT hematoma volume,systolic blood pressure,degree of cerebral edema,and changes in consciousness were independent risk factors for the conversion from conservative treatment to surgical treatment in hypertensive intracerebral hemorrhage patients(P<0.05).Conclusion High initial CT hematoma volume,high systolic blood pressure,low serum ionized calcium levels,CT hemorrhagic signs,severe cerebral edema,and changes in consciousness are independent risk factors for the conversion from conservative treatment to surgical treatment in hypertensive intracerebral hemorrhage patients.They have significant clinical value in predicting poor outcomes following conservative treatment in hypertensive intracerebral hemorrhage and the need for surgical intervention.