發(fā)布時間：2018-10-05 19:48

【摘要】：目的分析高血壓大腦半球出血術(shù)后再出血的常見可能原因,針對相關(guān)可能原因采取相應(yīng)的預(yù)防措施。方法本組資料是對安徽醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)外科2010年1月~2014年11月近5年間行手術(shù)治療的高血壓大腦半球出血患者進行回顧性分析,回顧性分析124例高血壓大腦半球出血手術(shù)病例,其中再出血20例,未再出血104例;其中男性72例,女性52例;年齡32~76歲,平均(57.2±10.3)歲;出血部位:腦葉出血33例,基底節(jié)區(qū)出血37例,丘腦出血54例;手術(shù)時機(發(fā)病至手術(shù)時間):出血6小時內(nèi)25例,6~12小時內(nèi)81例,12~18小時內(nèi)10例,18~24小時內(nèi)8例;手術(shù)方法:行骨瓣開顱腦血腫清除+去骨瓣減壓術(shù)82例,行小骨窗開顱血腫清除術(shù)42例。術(shù)中止血困難27例,止血滿意97例。術(shù)后血壓控制良好(收縮壓160mmHg)48例,控制較好(收縮壓180mmHg)47例,控制不佳(收縮壓≥180mmHg)29例。選取124例高血壓腦出血手術(shù)病例的23項變量包括(性別,年齡,高血壓病程,術(shù)前高血壓分級,術(shù)前高血壓分組,術(shù)前意識狀況,手術(shù)時機,既往冠心病病史,既往糖尿病病史,既往腦出血病史,既往腦梗塞病史,止凝血功能異常,出血部位,手術(shù)方式,術(shù)中血腫清除徹底與否,術(shù)中止血困難與否,術(shù)后血壓控制情況,術(shù)后躁動,術(shù)后癲癇發(fā)作,術(shù)后便秘,術(shù)后肺部感染,術(shù)后腦積水與否,術(shù)后腦梗塞與否),并進行與術(shù)后再出血的相關(guān)性分析。采用logistic回歸模型分析各種可能因素對高血壓大腦半球出血開顱手術(shù)后再次出血的影響。結(jié)果本研究中開顱行手術(shù)治療的高血壓大腦半球出血患者共有124例,高血壓大腦半球出血患者手術(shù)以后再次發(fā)生腦出血的發(fā)生率為16.1%。單因素Logistic分析顯示:發(fā)病至手術(shù)時間(手術(shù)時機)、出血部位、有無凝血功能異常、術(shù)中止血徹底與否、術(shù)后血壓波動情況等與術(shù)后再出血發(fā)生顯著相關(guān)(P0.05);多元逐步Logistic分析顯示:發(fā)病至手術(shù)時間、術(shù)中止血徹底與否、術(shù)后血壓波動情況是術(shù)后再出血的危險因素(P0.05)。結(jié)論結(jié)合客觀實際情況,對得出數(shù)據(jù)結(jié)果的臨床意義進行分析和總結(jié)。單因素Logistic分析顯示:發(fā)病至手術(shù)時間(手術(shù)時機)、出血部位、有無凝血功能異常、術(shù)中止血徹底與否、術(shù)后血壓波動情況等與術(shù)后再出血發(fā)生顯著相關(guān);多元逐步Logistic分析顯示:發(fā)病至手術(shù)時間、術(shù)中止血徹底與否、術(shù)后血壓波動情況是術(shù)后再出血的危險因素。因此,發(fā)病至手術(shù)時間、術(shù)中止血徹底與否、術(shù)后血壓波動情況是術(shù)后再出血的高危因素,通過最佳的手術(shù)時機、爭取術(shù)中徹底確切止血和術(shù)后控制血壓在合理范圍對預(yù)防再出血有重要意義。
[Abstract]:Objective to analyze the common causes of recurrent hemorrhage after hemispheric hemorrhage in hypertensive patients and to take preventive measures. Methods the data of patients with hypertensive hemispheric hemorrhage treated in neurosurgery department of the first affiliated Hospital of Anhui Medical University from January 2010 to November 2014 were retrospectively analyzed. 124 cases of hypertensive hemispheric hemorrhage were retrospectively analyzed, including 20 cases of recurrent hemorrhage, 104 cases of no rebleeding, 72 cases of male and 52 cases of female, the mean age was (57.2 鹵10.3) years old, the location of hemorrhage was lobar hemorrhage in 33 cases, the mean age was (57.2 鹵10.3) years old, the mean age was (57.2 鹵10.3) years. There were 37 cases of basal ganglia hemorrhage and 54 cases of thalamic hemorrhage, and the time of operation (from onset to operation) was 25 cases within 6 hours, 81 cases within 1218 hours, 10 cases within 18 hours and 8 cases within 24 hours. Operative methods: craniocerebral hematoma removal and decompression were performed in 82 cases and small bone window craniotomy in 42 cases. There were 27 cases of difficulty in hemostasis and 97 cases of satisfactory hemostasis. Postoperative blood pressure was well controlled (systolic blood pressure 160mmHg) in 48 cases, better control in 47 cases (systolic pressure 180mmHg) in 47 cases, and poor control (systolic pressure 鈮，

本文編號：2254648