CAJ | 학술논문

目的：探讨神经内镜治疗高血压脑出血术后早期（24 h内）再出血的原因和预防措施。方法应用神经内镜手术治疗高血压性壳核脑出血术后患者69例，于术后6、24 h复查头颅CT。术后病情恶化的患者立即复查。分为术后再出血组和无再出血组，对比分析两组在年龄、长期饮酒、服用抗血小板和抗凝药物、术中止血情况、术后血压波动情况等5个方面的差异，结合手术经过分析预防措施。结果本组患者术中血肿清除程度均＞90％。术后24 h内发生再出血9例，再出血率为13.0％。超早期手术者在再出血组中占77.8％，在无再出血组中占23.3％，两组比较差异有统计学意义（ P＝0.003）；术后血压波动在再出血组中占66.7％，在无再出血组中占13.3％，两组比较差异有统计学意义（ P＝0.001）；被认定术中止血欠确切者在再出血组中占55.6％，在无再出血组中占11.7％，两组比较差异有统计学意义（ P＝0.003）。入院前GCS评分11～13分者在再出血组中占88.9％，在无出血组中占43.3％，两组比较差异有统计学意义（ P＝0.003）。结论虽然神经内镜治疗高血压脑出血术后早期再出血可能与多种因素有关，但是其中超早期手术、止血欠确切、术后血压波动与术后再出血密切相关。选择正确的手术时机、术中确切止血、加强术后血压管理是防止术后早期再出血的最重要措施。
목적：탐토신경내경치료고혈압뇌출혈술후조기（24 h내）재출혈적원인화예방조시。방법응용신경내경수술치료고혈압성각핵뇌출혈술후환자69례，우술후6、24 h복사두로CT。술후병정악화적환자립즉복사。분위술후재출혈조화무재출혈조，대비분석량조재년령、장기음주、복용항혈소판화항응약물、술중지혈정황、술후혈압파동정황등5개방면적차이，결합수술경과분석예방조시。결과본조환자술중혈종청제정도균＞90％。술후24 h내발생재출혈9례，재출혈솔위13.0％。초조기수술자재재출혈조중점77.8％，재무재출혈조중점23.3％，량조비교차이유통계학의의（ P＝0.003）；술후혈압파동재재출혈조중점66.7％，재무재출혈조중점13.3％，량조비교차이유통계학의의（ P＝0.001）；피인정술중지혈흠학절자재재출혈조중점55.6％，재무재출혈조중점11.7％，량조비교차이유통계학의의（ P＝0.003）。입원전GCS평분11～13분자재재출혈조중점88.9％，재무출혈조중점43.3％，량조비교차이유통계학의의（ P＝0.003）。결론수연신경내경치료고혈압뇌출혈술후조기재출혈가능여다충인소유관，단시기중초조기수술、지혈흠학절、술후혈압파동여술후재출혈밀절상관。선택정학적수술시궤、술중학절지혈、가강술후혈압관리시방지술후조기재출혈적최중요조시。
Objective To investigate the causes and preventive management of postoperative early rehaemorrhagia ( during the first 24 hours after operation ) after neuroendoscopic treatment for hypertensive cerebral hemorrhage .Methods The five known contributing factors for postoperative rehaemorrhagia such as age , alcoholism , antiplatelet or anticoagu-lant therapy , intraoperative hemostasis , fluctuation of postoperative blood pressure were analyzed retrospectively on 69 pa-tients with hypertensive putamen hemorrhage who underwent neuroendoscopic evacuation .Head CT scans were performed at 6 h and 24 h after operation in all patients .A CT scan was also performed immediately whenever the patients′conditions were getting worse after surgery .Sixty-nine patients were divided into the rehaemorrhagia group and the non -rehaemor-rhagia group.Results Intraoperative removal of more than 90%of hematomas was achieved in all of the 69 patients.Nine patients developed rehaemorrhagia within the first 24 hours after operation .The postoperative rehaemorrhagia rate was 13.0%.Ultra-early surgery was done in 77.8%of the rehaemorrhagia group while only in 23.3%of the non-rehaem-orrhagia group (P=0.003).Postoperative fluctuation of blood pressure occurred in 66.7% of patients in the rehaemor-rhagia group, whereas it only occurred in 13.3%of patients in the non -rehaemorrhagia group (P=0.001).Unreliable intraoperative hemostasis occurred in 55.6%of patients in the rehaemorrhagia group , whereas it only occurred in 11.7%of the non-rehaemorrhagia group (P=0.003).GCS scores before admission in 88.7%of patients in the rehaemorrhagia group were between 11 to 13, whereas only 43.3%in the non-rehaemorrhagia group had a GCS score between 11 to 13 (P=0.033).Conclusions Although many factors may be associated with postoperative rehaemorrhagia after neuroendo-scopic treatment for hypertensive cerebral hemorrhage , ultra-early surgery, unreliable intraoperative hemostasis and poor control of postoperative blood pressure may be the closely related factors .Therefore , proper timing of surgery , reliable in-traoperative hemostasis and strict postoperative management of blood pressure are the most important strategies to prevent postoperative rehaemorrhagia .