阿司匹林对脑出血患者手术术后再出血率响分析

发布时间：2018-05-27 06:18

  本文选题：脑出血 + 血小板抑制剂类药物　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的分析阿司匹林对高血压脑出血患者急诊开颅手术血肿清除术术后再出血率的影响,并探讨此类患者手术时机的选择。方法回顾性分析2013年01月01日至2016年06月31日沈阳军区总医院神经外科我科共收治脑出血患者3341例,除外明确颅内动脉瘤、血管畸形等造成的脑出血及未手术脑出血患者,剩余共有1712例高血压脑出血手术治疗患者,再选取其中采用骨瓣开窗颅内血肿清除术的脑出血患者775例,排除本科室其他手术组手术患者,本研究共纳入153例病例。其中25例(A组)有血小板抑制类药物(阿司匹林)应用史,出血前近期仍在使用该药物,且术前行TEG(thromboela-stogram,血栓弹力图)检查花生四烯酸(AA)途径诱导的血小板抑制率,且根据产品说明中AA抑制率大于50%者,手术术后再出血有增加趋势,本实验选取的脑出血患者抑制率均大于50%,另外128例(B组)无血小板抑制药物应用史的高血压脑出血手术患者。两组数据采用病例对照研究方式比较两组脑出血患者术后再出血率的差异。数据分析采用统计学软件SPSS19.0对数据进行分析,具体统计学方法为:计量资料符合正态分布用均数±标准差表示,组间比较采用两组独立样本的t检验:计数资料以百分率表示,组间比较采用χ2检验;探讨口服阿司匹林是否与术后再出血有无相关性,使用二分类logistic回归分析。P0.05表示差异具有统计学意义。结果A组患者有阿司匹林服用史,出血时仍在使用且术前行TEG检查花生四烯酸(AA)途径诱导的血小板抑制率,且抑制率均大于50%脑出血手术患者中再出血者2例,再出血率为8.00%,B组无阿司匹林及其他血小板抑制药物应用史的高血压脑出血手术患者术后再出血者8例,再出血率为6.25%,综合再出血率为6.54%,χ~2=0.014,P0.25,区别没有统计学意义。结论本结果表明有使用血小板抑制类药物(阿司匹林)的高血压脑出血患者急诊开颅血肿清除术后再出血率较未使用血小板抑制类药物的高血压脑出血患者没有明显增加,因此对于此类有手术指征的脑出血患者如积极手术,可能降低不良后果的发生概率。
[Abstract]:Objective to analyze the effect of aspirin on the rate of rebleeding in patients with hypertensive intracerebral hemorrhage after emergency craniotomy. Methods 3341 patients with intracerebral hemorrhage were retrospectively analyzed from January 01, 2013 to June 31, 2016, Department of Neurosurgery, Shenyang military region General Hospital, with the exception of intracerebral hemorrhage and unoperated intracerebral hemorrhage caused by intracranial aneurysm and vascular malformation. There were 1712 patients with hypertensive intracerebral hemorrhage. Among them, 775 patients were treated with craniocerebral hematoma clearance with bone flap, excluding other surgical patients in our department. 153 cases were included in this study. In group A, 25 patients had a history of use of platelet suppressor (aspirin), which was still used recently before bleeding, and the platelet inhibition rate induced by the arachidonic acid (AAA) pathway was examined by TEGG thrombo-boela-stograms (thromboelastogram) before bleeding. According to the product description, the rate of AA inhibition was more than 50%, and there was an increasing trend of rebleeding after operation. The inhibitory rates of patients with cerebral hemorrhage were more than 50 and 128 patients in group B were treated with hypertensive intracerebral hemorrhage with no history of platelet suppressive drugs. Case-control study was used to compare the rate of postoperative rebleeding between the two groups of patients with intracerebral hemorrhage. The statistical software SPSS19.0 was used to analyze the data. The specific statistical methods were as follows: the measurement data were expressed by mean 卤standard deviation according to normal distribution, and the comparison between groups was expressed by t-test of two independent samples: counting data was expressed as percentage. 蠂 2 test was used to study the correlation between oral aspirin and postoperative rebleeding. The difference was statistically significant by using two classification logistic regression analysis. P0.05. Results the patients in group A had a history of aspirin taking and were still in use at the time of hemorrhage. The platelet inhibition rate induced by arachidonic acid (AA) pathway was examined by TEG before operation, and the inhibition rate was higher than that in 2 patients with recurrent hemorrhage in 50% intracerebral hemorrhage operation. The rebleeding rate of group B was 8.00%. In group B, 8 patients with hypertensive intracerebral hemorrhage who had no history of aspirin and other platelet suppressive drugs were re-bleeding after operation, the rate of rebleeding was 6.25, and the rate of comprehensive rebleeding was 6.54g, 蠂 ~ (20.014) P _ (0.25). The difference was not statistically significant. Conclusion the results suggest that the rate of rebleeding after emergency craniotomy in patients with hypertensive intracerebral hemorrhage using platelet-suppressive drugs (aspirin) is not significantly higher than that in patients with hypertensive intracerebral hemorrhage without platelet inhibitors. Therefore, active surgery may reduce the probability of adverse consequences in patients with intracerebral hemorrhage.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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