CAJ | 학술논문

目的探讨阿司匹林与脑出血术后再出血的相关性和预防措施.方法前瞻性对照研究2001年1月至2007年5月河北医科大学附属哈励逊国际和平医院神经外科收治并开颅手术治疗的高血压基底节区脑出血患者725例,符合1995年全国第四届脑血管病会议修订的诊断标准.出血量＞50 mL.排除标准:(1)呼吸循环衰竭;(2)发病前有神经功能障碍;(3)重要脏器功能障碍;(4)有出血性疾病和出血倾向;(5)应用除阿司匹林以外影响凝血功能药物.另以患病前未应用阿司匹林的患者389例作为对照组(A组),应用阿司匹林的患者随机(随机数字法)分为B,C两组,每组168例,C组应用冰冻血小板.比较三组再出血量、死亡率及随访6个月ADL评分.数据用SPSS 13.0软件分析.计量资料用均数±标准差表示,做x2检验、t检验及秩和检验.以P＜0.05为差异具有统计学意义.结果再出血量三组分别为 (40.59±20.061)mL,(53.21±21.260)mL,(40.68±19.517)mL.A组与B组比较有统计学意义(P＜0.01),B组与C组比较有统计学意义(P＜0.05),A组与C组比较无统计学意义(P＞0.05).随访6个月ADL评分三组分别为(67.04±26.176),(54.47±29.403),(68.21±25.254).ADL评分及死亡率:A组与B组、B组与C组分别比较均有统计学意义(P＜0.01),A组与C组比较无统计学意义(P＞0.05).结论阿司匹林可增加脑出血术后再出血的机会,增加致残率及死亡率;应用冰冻血小板可减少术后再出血的机会,降低致残率及死亡率.
목적 탐토아사필림여뇌출혈술후재출혈적상관성화예방조시.방법 전첨성대조연구2001년1월지2007년5월하북의과대학부속합려손국제화평의원신경외과수치병개로수술치료적고혈압기저절구뇌출혈환자725례,부합1995년전국제사계뇌혈관병회의수정적진단표준.출혈량＞50 mL.배제표준:(1)호흡순배쇠갈;(2)발병전유신경공능장애;(3)중요장기공능장애;(4)유출혈성질병화출혈경향;(5)응용제아사필림이외영향응혈공능약물.령이환병전미응용아사필림적환자389례작위대조조(A조),응용아사필림적환자수궤(수궤수자법)분위B,C량조,매조168례,C조응용빙동혈소판.비교삼조재출혈량、사망솔급수방6개월ADL평분.수거용SPSS 13.0연건분석.계량자료용균수±표준차표시,주x2검험、t검험급질화검험.이P＜0.05위차이구유통계학의의.결과 재출혈량삼조분별위 (40.59±20.061)mL,(53.21±21.260)mL,(40.68±19.517)mL.A조여B조비교유통계학의의(P＜0.01),B조여C조비교유통계학의의(P＜0.05),A조여C조비교무통계학의의(P＞0.05).수방6개월ADL평분삼조분별위(67.04±26.176),(54.47±29.403),(68.21±25.254).ADL평분급사망솔:A조여B조、B조여C조분별비교균유통계학의의(P＜0.01),A조여C조비교무통계학의의(P＞0.05).결론 아사필림가증가뇌출혈술후재출혈적궤회,증가치잔솔급사망솔;응용빙동혈소판가감소술후재출혈적궤회,강저치잔솔급사망솔.
Objective To explore the relation and measures prevention between aspirin and relapsing haemorrhage after operation in cerebral haemorrhage patients. Method It' s a prospective control study. A total of 725 patients with hypertensive basal ganglia cerebral haemorrhage admitted to department of neurosurgery from January 2001 to May 2007 were enrolled. They were diagnosed according to the diagnostic criteria set by the fourth national cerebrovascular disease conference in 1995. Haematoma volume was ＞ 50 mL. All patients were treated with craniotomy. And those with respiration and circulation failure, neurologic function deficit before the onset of the disease,major organ dysfunction, haemorrhagic disease and bleeding tendency or applied medicines affecting coagulation function excepted aspirin were excluded. The patients without use of aspirin before the onset of the disease were operated as the control group(group A), and there were 389 patients in group A.The patients with use of aspirin before the onset of the disease were randomly assigned to group B and C group,and there were 168 patients in group B or group C.The patients in group C received the frozen apheresis platelets. We counted different haematoma volume of relapsing haemorrhage after operation,death rate,ADL scores grades by 6 months follow-up survey in three groups. Quantitative data were expressed as mean ± standard deviation (-x ± s). The data were analyzed by using Chi-square test and Student's t test and rank sum test with SPSS 13.0 statistical package. A P value less than 0.05 indicated statisticals significance. Results Haematoma volume of relapsing haemorrhage was (40.59 + 20. 061 )mL, (53.21 ± 21.260) mL, (40.68 ± 19.517) mL in groups A, B, C,respectively. There was significant difference between group A and group B ( P ＜ 0.01 ), between group B and group C ( P ＜ 0.05), but there was no significant difference between group A and group C(P ＞ 0.05). ADL scores grades at 6-month follow-up was (67.04 ± 26. 176), (54.47 ± 29.403 ), (68.21 ± 25.254) in groups A, B, C, respectively. There was more significant difference between group A and group B, in ADL scores grades and the death rate between group B and group C (P ＜ 0.01), but there was no significant difference between group A and group C (P ＞ 0.05). Conclusions Aspirin can increase the occurrence rate of haemorrhage after operation, disablement and death in cerebral haemorrhage patients, but frozen apheresis platelets can reduce the occurrence rate.