高血压性脑出血患者行开颅血肿清除术治疗后并发脑梗死相关危险因素的logistic回归分析

Logistic Regression Analysis of Risk Factors Related to Cerebral Infarction in Patients with Hypertensive Intracerebral Hemorrhage Treated with Craniotomy Hematoma Clearance Surgery

目的:探讨高血压性脑出血(HICH)患者行开颅血肿清除术治疗后并发脑梗死的相关危险因素。方法:回顾性分析2020年1月—2022年12月安阳地区医院收治的101例HICH患者临床资料,患者均行开颅血肿清除术治疗,术后依据脑梗死发生情况分为发生组与未发生组,收集两组患者年龄、性别、发病至就诊时间、文化程度、高血压病程、糖尿病史、高脂血症病史、吸烟史、饮酒史、术前格拉斯哥评分(GCS)、术前血肿量、脑水肿体积、降颅压药物使用时间、术中操作不规范等多方面基础资料,分别开展单因素分析、logistic回归分析,获得影响HICH患者术后并发脑梗死的独立危险因素。结果:101例患者术后共22例发生脑梗死,发生率为21.57%;两组患者高血压病程、糖尿病史、高脂血症病史、术前GCS评分<8分、术前血肿量≥40 mL、脑水肿体积≥70 cm^(3)、降颅压药物使用时间≥24 h、术中操作不规范比较,差异有统计学意义(P<0.05);logistic回归分析结果显示,高血压病程≥10年(OR=5.108)、有糖尿病史(OR=3.567)、有高脂血症病史(OR=3.903)、术前GCS评分<8分(OR=3.315)、术前血肿量≥40 mL(OR=7.350)、脑水肿体积≥70 cm^(3)(OR=6.193)、降颅压药物使用时间≥24 h(OR=29.500)、术中操作不规范(OR=19.200)为影响HICH患者术后并发脑梗死的高危因素,差异有统计学意义(P<0.05且OR>1)。结论:HICH患者术后并发脑梗死风险较高,受高血压病程≥10年、有糖尿病史、有高脂血症病史、术前GCS评分<8分、术前血肿量≥40 mL、脑水肿体积≥70 cm^(3)、降颅压药物使用时间≥24 h、术中操作不规范影响较大,需加以重视,早期做好高危因素的干预。

Objective:To explore the relevant risk factors of cerebral infarction in patients with hypertensive intracerebral hemorrhage(HICH)after undergoing craniotomy hematoma removal surgery.Methods:The clinical data of 101 patients with HICH admitted to the hospital from January 2020 to December 2022 were retrospectively analyzed.All patients were treated with craniotomy hematoma removal.The patients were divided into the occurrence group and the non occurrence group according to the occurrence of cerebral infarction after surgery.The age,gender,time from onset to treatment,education level,course of hypertension,history of diabetes,history of hyperlipidemia,smoking and drinking history,preoperative Glasgow Scale(GCS),preoperative hematoma volume,brain edema volume,duration of intracranial pressure lowering medication use,and non-standard intraoperative procedures,were compared.Results:A total of 22 out of 101 patients developed cerebral infarction after surgery,with an incidence rate of 21.57%.There were statistically significant differences between the two groups in the course of hypertension,history of diabetes,history of hyperlipidemia,preoperative GCS score<8 points,preoperative hematoma volume≥40 mL,brain edema volume≥70 cm^(3),use time of intracranial pressure lowering drugs≥24 h,and non-standard operation(P<0.05).Logistic regression analysis showed that the duration of hypertension≥10 years(OR=5.108),history of diabetes(OR=3.567),history of hyperlipidemia(OR=3.903),preoperative GCS score<8 points(OR=3.315),preoperative hematoma volume≥40 mL(OR=7.350),brain edema volume≥70 cm^(3)(OR=6.193),use time of intracranial pressure lowering drugs≥24 h(OR=29.500),and improper intraoperative procedures(OR=19.200)were high-risk factors for postoperative cerebral infarction in HICH patients(P<0.05,OR>1).Conclusion:The risk of postoperative cerebral infarction in patients with HICH is high,which is greatly influenced by the duration of hypertension≥10 years,history of diabetes,history of hyperlipidemia,preoperative GCS score<8 points,preoperative hematoma volume≥40 mL,brain edema volume≥70 cm^(3),use time of intracranial pressure lowering drugs≥24 h,and irregular operation during operation.Attention should be paid to early intervention of high-risk factors.