高血压大脑半球出血术后再出血的多因素分析

发布时间：2018-10-05 19:48

【摘要】：目的分析高血压大脑半球出血术后再出血的常见可能原因,针对相关可能原因采取相应的预防措施。方法本组资料是对安徽医科大学第一附属医院神经外科2010年1月~2014年11月近5年间行手术治疗的高血压大脑半球出血患者进行回顾性分析,回顾性分析124例高血压大脑半球出血手术病例,其中再出血20例,未再出血104例;其中男性72例,女性52例;年龄32~76岁,平均(57.2±10.3)岁;出血部位:脑叶出血33例,基底节区出血37例,丘脑出血54例;手术时机(发病至手术时间):出血6小时内25例,6~12小时内81例,12~18小时内10例,18~24小时内8例;手术方法:行骨瓣开颅脑血肿清除+去骨瓣减压术82例,行小骨窗开颅血肿清除术42例。术中止血困难27例,止血满意97例。术后血压控制良好(收缩压160mmHg)48例,控制较好(收缩压180mmHg)47例,控制不佳(收缩压≥180mmHg)29例。选取124例高血压脑出血手术病例的23项变量包括(性别,年龄,高血压病程,术前高血压分级,术前高血压分组,术前意识状况,手术时机,既往冠心病病史,既往糖尿病病史,既往脑出血病史,既往脑梗塞病史,止凝血功能异常,出血部位,手术方式,术中血肿清除彻底与否,术中止血困难与否,术后血压控制情况,术后躁动,术后癫痫发作,术后便秘,术后肺部感染,术后脑积水与否,术后脑梗塞与否),并进行与术后再出血的相关性分析。采用logistic回归模型分析各种可能因素对高血压大脑半球出血开颅手术后再次出血的影响。结果本研究中开颅行手术治疗的高血压大脑半球出血患者共有124例,高血压大脑半球出血患者手术以后再次发生脑出血的发生率为16.1%。单因素Logistic分析显示:发病至手术时间(手术时机)、出血部位、有无凝血功能异常、术中止血彻底与否、术后血压波动情况等与术后再出血发生显著相关(P0.05);多元逐步Logistic分析显示:发病至手术时间、术中止血彻底与否、术后血压波动情况是术后再出血的危险因素(P0.05)。结论结合客观实际情况,对得出数据结果的临床意义进行分析和总结。单因素Logistic分析显示:发病至手术时间(手术时机)、出血部位、有无凝血功能异常、术中止血彻底与否、术后血压波动情况等与术后再出血发生显著相关;多元逐步Logistic分析显示:发病至手术时间、术中止血彻底与否、术后血压波动情况是术后再出血的危险因素。因此,发病至手术时间、术中止血彻底与否、术后血压波动情况是术后再出血的高危因素,通过最佳的手术时机、争取术中彻底确切止血和术后控制血压在合理范围对预防再出血有重要意义。
[Abstract]:Objective to analyze the common causes of recurrent hemorrhage after hemispheric hemorrhage in hypertensive patients and to take preventive measures. Methods the data of patients with hypertensive hemispheric hemorrhage treated in neurosurgery department of the first affiliated Hospital of Anhui Medical University from January 2010 to November 2014 were retrospectively analyzed. 124 cases of hypertensive hemispheric hemorrhage were retrospectively analyzed, including 20 cases of recurrent hemorrhage, 104 cases of no rebleeding, 72 cases of male and 52 cases of female, the mean age was (57.2 卤10.3) years old, the location of hemorrhage was lobar hemorrhage in 33 cases, the mean age was (57.2 卤10.3) years old, the mean age was (57.2 卤10.3) years. There were 37 cases of basal ganglia hemorrhage and 54 cases of thalamic hemorrhage, and the time of operation (from onset to operation) was 25 cases within 6 hours, 81 cases within 1218 hours, 10 cases within 18 hours and 8 cases within 24 hours. Operative methods: craniocerebral hematoma removal and decompression were performed in 82 cases and small bone window craniotomy in 42 cases. There were 27 cases of difficulty in hemostasis and 97 cases of satisfactory hemostasis. Postoperative blood pressure was well controlled (systolic blood pressure 160mmHg) in 48 cases, better control in 47 cases (systolic pressure 180mmHg) in 47 cases, and poor control (systolic pressure 鈮，

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