高血压脑出血术后再出血的危险因素分析及对策

高血压脑出血术后再出血的危险因素

分析及对策

罗武锋　洪映标　蔡洁波　陈泽鑫　蔡跃豪　黄广俊　陈秋宏

揭阳市人民医院　522000

通信作者：罗武锋，Email：luowufeng@

【摘要】　目的　探讨自发性血管源性高血压脑出血首次手术后再出血的相干风险指标，并对相关危险因素作出相应对策以降低再出血风险。方法　来源于本院神经外科的自发性血管源性高血压脑出血患者中，随机选取其中进行手术干预的130例作为研究对象，对被选患者（分为再次出血组和比照组）临床资料进行数据比对，分析首次手术后在原有的手术区域再出血的风险因素。结果　自发性血管源性高血压脑出血首次手术后，因多种因素诱导原有区域再出血发生率为9.23%，经实施头颅CT平扫复查发现再出血部位均位于原有手术区域，而再出血患者病死率达到惊人的59.68%。自发性血管源性高血压脑出血患者，术后原有区域再出血和下述围手术期数据密切相关：包括患者出血后首次手术时间、凝血因子丢失或不良所致的凝血功能障碍、术后NICU或ICU检测的收缩压均值及术后躁动程度呈正相关性（均P＜0.05），而与患者的年龄阶层、性别、GCS评分、外科手术干预方法、责任血管位置无正相关性（均P＞0.05）。采用Logistic回归方程将各个可能的相关风险要素进行统计分析，剖析得出急性发病到首次手术干预时间、凝血因子丢失或不良所致的凝血功能障碍，NICU所检测得到的术后收缩压均值、术后烦躁是手术部位区域术后再出血的独立风险因素（均P＜0.05）。结论　掌握好脑出血后初次手术的时间、对术后血压的良好管理、纠正可能的凝血功能障碍、避免术后患者烦躁，能够明显降低自发性高血压性脑出血初次手术后再次出血的发生率

【关键词】　高血压脑出血；再出血；风险因素；对策

DOI：10.3760/cma.j.issn.1007-1245.2019.11.033

Risk factors of rebleeding after surgery for hypertensive intracerebral hemorrhage and its countermeasures Luo Wufeng, Hong Yingbiao, Cai Jiebo, Chen Zexin, Cai Yuehao, Huang Guangjun, Chen Qiuhong

Jieyang People's Hospital, Jieyang 522000, China

Corresponding author: Luo Wufeng, Email: luowufeng@

【Abstract】Objective To discuss the coherent risk indicators of re-bleeding after the first operation for cerebral hemorrhage caused by spontaneous vascular hypertension, and to reduce the risk of rebleeding taking some countermeasures corresponding to the relevant risk factors. Methods 130 patients with cerebral hemorrhage caused by spontaneous vascular hypertension treated at the department of neurology of our hospital were randomly selected as study objects, and were surgically treated and divided into a rebleeding group and a control group. The clinical data of the two groups were compared. The risk factors of rebleeding on the first operation sites were analyzed. Results The incidence of rebleeding on surgical sites after the first operation due to various factors was 9.23%. The head CT scan showed that the rebleeding sites were located in the original surgical area, and the mortality of rebleeding patients reached 59.68%. In patients with spontaneous angiogenic hypertensive intracerebral hemorrhage, postoperative local rebleeding positively correlated with the first operation time after hemorrhage, coagulation factor loss or poor coagulopathy, postoperative mean value of systolic blood pressure detected by NICU or ICU, and the degree of postoperative agitation (all P＜0.05), but not with the patients' age, gender, GCS score, surgical intervention, and position of responsible vessel (all P＞0.05). Logistic regression equation was used to analyze all possible related risk factors, and the results showed that the coagulation dysfunction caused by acute onset to first surgery intervention, clotting factor loss or poor, and the mean postoperative systolic blood pressure detected by NICU were the independent risk factors for postoperative rebleeding on the surgical sites (all P＜0.05). Conclusion Mastering the time of initial surgery after cerebral hemorrhage, good management of postoperative blood pressure, correcting possible coagulopathy, and avoiding postoperative irritability can significantly reduce the chance of recurrent bleeding after initial surgery for 1788