中国实用神经疾病杂志
中國實用神經疾病雜誌
중국실용신경질병잡지
CHINESE JOURNAL OF PRACTICAL NERVOUS DISEASES
2014年
19期
7-9
,共3页
冯毅%蔡冰%白西民%党俊涛%杜春亮
馮毅%蔡冰%白西民%黨俊濤%杜春亮
풍의%채빙%백서민%당준도%두춘량
高血压脑出血%手术%再出血%影响因素%对照研究
高血壓腦齣血%手術%再齣血%影響因素%對照研究
고혈압뇌출혈%수술%재출혈%영향인소%대조연구
Hypertensive intracerebral hemorrhage%Surgery%Recurrent hemorrhage%Influencing factors
目的：研究高血压脑出血术后再出血的影响因素，为临床预防提供理论依据。方法回顾性分析2005-01-2013-01在渭南市中心医院神经外科住院经手术治疗的347例高血压脑出血患者的临床资料，其中术后再出血23例，采用病例对照研究对高血压脑出血术后再出血的影响因素进行非条件Logistic多元逐步回归分析。结果本组347例患者23例手术后24 h内发生再次出血，发生率6.63％（23/347）；单因素分析显示，年龄≥60岁、合并糖尿病、入院时GCS评分较低、口服阿司匹林、入院时舒张压＞90 mmHg、凝血异常、血肿量＞60 mL、中线结构移位和手术持续时间与术后再出血有相关性（P＜0.05）；多因素Logistic回归分析发现入院时舒张压＞90 mmHg（OR＝6.371）、凝血功能异常（OR＝21.832）和血肿量＞60 mL （OR＝28.548）是高血压脑出血术后再出血的危险因素（P＜0.05）。结论高血压脑出血术后再出血的发生率较高，入院时舒张压＞90 mmHg、凝血功能异常和血肿量＞60 mL是再出血的独立危险因素，积极处理以上危险因素对预防术后再出血至关重要。
目的：研究高血壓腦齣血術後再齣血的影響因素，為臨床預防提供理論依據。方法迴顧性分析2005-01-2013-01在渭南市中心醫院神經外科住院經手術治療的347例高血壓腦齣血患者的臨床資料，其中術後再齣血23例，採用病例對照研究對高血壓腦齣血術後再齣血的影響因素進行非條件Logistic多元逐步迴歸分析。結果本組347例患者23例手術後24 h內髮生再次齣血，髮生率6.63％（23/347）；單因素分析顯示，年齡≥60歲、閤併糖尿病、入院時GCS評分較低、口服阿司匹林、入院時舒張壓＞90 mmHg、凝血異常、血腫量＞60 mL、中線結構移位和手術持續時間與術後再齣血有相關性（P＜0.05）；多因素Logistic迴歸分析髮現入院時舒張壓＞90 mmHg（OR＝6.371）、凝血功能異常（OR＝21.832）和血腫量＞60 mL （OR＝28.548）是高血壓腦齣血術後再齣血的危險因素（P＜0.05）。結論高血壓腦齣血術後再齣血的髮生率較高，入院時舒張壓＞90 mmHg、凝血功能異常和血腫量＞60 mL是再齣血的獨立危險因素，積極處理以上危險因素對預防術後再齣血至關重要。
목적：연구고혈압뇌출혈술후재출혈적영향인소，위림상예방제공이론의거。방법회고성분석2005-01-2013-01재위남시중심의원신경외과주원경수술치료적347례고혈압뇌출혈환자적림상자료，기중술후재출혈23례，채용병례대조연구대고혈압뇌출혈술후재출혈적영향인소진행비조건Logistic다원축보회귀분석。결과본조347례환자23례수술후24 h내발생재차출혈，발생솔6.63％（23/347）；단인소분석현시，년령≥60세、합병당뇨병、입원시GCS평분교저、구복아사필림、입원시서장압＞90 mmHg、응혈이상、혈종량＞60 mL、중선결구이위화수술지속시간여술후재출혈유상관성（P＜0.05）；다인소Logistic회귀분석발현입원시서장압＞90 mmHg（OR＝6.371）、응혈공능이상（OR＝21.832）화혈종량＞60 mL （OR＝28.548）시고혈압뇌출혈술후재출혈적위험인소（P＜0.05）。결론고혈압뇌출혈술후재출혈적발생솔교고，입원시서장압＞90 mmHg、응혈공능이상화혈종량＞60 mL시재출혈적독립위험인소，적겁처리이상위험인소대예방술후재출혈지관중요。
Objective To investigate the influential factors of recurrent hemorrhage of postoperative hypertensive intrace-rebral hemorrhage ,and to provide basis for clinical prevention. Methods 347 cases of hypertensive intracerebral hemorrhage operated from Jan. 2005 to Jan. 2013 in department of Neurosurgery of Weinan Center Hospital were retrospectively analyzed.Among them ,there were 23 cases of postoperative recurrent hemorrhage. The data were analyzed by mono-factorial and multi-factorial non-conditional Logistic regression analysis.Results Rate of recurrent hemorrhage of postoperative hypertensive in-tracerebral hemorrhage was 6.63% (23/347) ,univariant Logistic analysis showed that age≥60 years ,diabetes ,low Glasgow Coma Scale (GCS) score ,aspirin ,diastolic blood pressure>90 mmHg ,dysfunction of blood clotting ,higher hematoma volume>60 mL ,midline shift and operation time were associated with recurrent hemorrhage (P<0.05). Multiple linear logistic re-gression analysis showed that the diastolic blood pressure > 90 mmHg (OR= 6.371) ,dysfunction of blood clotting (OR=21.832) and higher hematoma volume>60 mL (OR=28.548) were risk factors of recurrent hemorrhage (P<0.05). Conclu-sion There is higher incidence of rebleeding of postoperative hypertensive intracerebral hemorrhage patients ,diastolic blood pressure>90 mmHg ,disfunction of blood clotting and higher hematoma volume>60 mL are independent risk factors of recur-rent hemorrhage. It is important to actively deal with the risk factors to prevent recurrent hemorrhage.
