CAJ | 학술논문

目的探讨口服阿司匹林脑出血手术后再出血的风险以及治疗决策的制定.方法回顾性分析2009年1月至2014年12月首都医科大学附属北京朝阳医院神经外科306例有口服阿司匹林史的脑出血手术患者,采用病例对照研究对手术后再出血的影响因素进行分析.术前血栓弹力描记术(TEG)检查花生四烯酸(AA)途径诱导的血小板抑制率,以抑制率≥75％作为暂缓急诊手术的标准,比较不同治疗方案之间、不同术式之间术后再出血的风险差异.结果抑制率≥75％组术后再出血率为26.9％,延期手术组为4.1％,OR=8.566,95％ CI=2.279 ～ 32.190,P=0.001,差异有统计学意义;抑制率＜75％组的再出血率为7.6％,OR=1.923,95％ CI=0.594 ～6.224,P=0.275;抑制率≥75％组与＜75％组比较,OR=4.455,95％ CI=1.539 ～ 12.891,P=0.006,差异有统计学意义.急诊开颅手术组与延期手术组相比,再出血率为15.9％,OR =4.399,95％ CI=1.215 ～ 15.919,P=0.024,差异有统计学意义.结论经AA途径诱导的血小板抑制率≥75％可做为口服阿司匹林脑出血患者手术后再出血高风险的预测指标,可根据术者自身经验及技术优势合理选择手术方法及治疗策略.
목적 탐토구복아사필림뇌출혈수술후재출혈적풍험이급치료결책적제정.방법 회고성분석2009년1월지2014년12월수도의과대학부속북경조양의원신경외과306례유구복아사필림사적뇌출혈수술환자,채용병례대조연구대수술후재출혈적영향인소진행분석.술전혈전탄력묘기술(TEG)검사화생사희산(AA)도경유도적혈소판억제솔,이억제솔≥75％작위잠완급진수술적표준,비교불동치료방안지간、불동술식지간술후재출혈적풍험차이.결과 억제솔≥75％조술후재출혈솔위26.9％,연기수술조위4.1％,OR=8.566,95％ CI=2.279 ～ 32.190,P=0.001,차이유통계학의의;억제솔＜75％조적재출혈솔위7.6％,OR=1.923,95％ CI=0.594 ～6.224,P=0.275;억제솔≥75％조여＜75％조비교,OR=4.455,95％ CI=1.539 ～ 12.891,P=0.006,차이유통계학의의.급진개로수술조여연기수술조상비,재출혈솔위15.9％,OR =4.399,95％ CI=1.215 ～ 15.919,P=0.024,차이유통계학의의.결론 경AA도경유도적혈소판억제솔≥75％가주위구복아사필림뇌출혈환자수술후재출혈고풍험적예측지표,가근거술자자신경험급기술우세합리선택수술방법급치료책략.
Objective To investigate the rebleeding risk after cerebral hemorrhage surgery for oral administration of aspirin and the development of treatment decision.Methods A total of 306 patients with intracerebral hemorrhage surgery with a history of oral administration of aspirin at the Department of Neurosurgery,Beijing Chaoyang Hospital,Capital Medical University from January 2009 to December 2014 were analyzed retrospectively.The influencing factors of postoperative rebleeding were analyzed by using a case-control study.Preoperative thrombelastography (TEG) was used to examine the arachidonic acid (AA) pathway induced platelet inhibition rate,and the inhibition rate ≥ 75％ was used as the criterion of postponing emergency surgery.The postoperative rebleeding risk differences between the different treatment regimens and between the different surgical procedures were compared.Results The postoperative rebleeding rate of the inhibition rate ≥75％ group was 26.9％,the delayed surgery group was 4.1％ (OR,8.566,95％ CI 2.279-32.190;P =0.001).The rebleeding rate of the inhibition rate ＜ 75％ group was 7.6％ (OR,1.923,95％ CI 0.594-6.224;P =0.275);the inhibition rate ≥75％ group compared with the inhibition rate ＜75％ group (OR,4.455,95％ CI 1.539-12.891;P =0.006).The emergency craniotomy group compared with the delayed surgery group,the rebleeding rate was 15.9％ (OR,4.399,95％ CI 1.215-15.919;P=0.024).Conclusions The platelet inhibition rate ≥75％ induced by AA pathway can be used as a predictor for the high risk of postoperative rebleeding in patients with cerebral hemorrhage for oral administration of aspirin.The surgical methods and treatment choice can be chosen reasonably according to the own experiences and technological advantages of surgeons