高血压脑出血患者术后再出血危险因素分析

目的探讨高血压脑出血患者术后再出血的危险因素。方法选择2009年1月—2015年2月收治的高血压脑出血患者712例,根据术后是否再出血进行分组,术后再出血的116例为出血组,术后未出血的596例为未出血组,采用多因素Logistic回归模型分析术后再出血的危险因素,P0.05为差异有统计学意义。结果多因素非条件Logistic回归分析结果显示,高血压脑出血术后再出血的危险因素包括术后血压波动(OR=9.864)、出血至手术时间(OR=7.186)、术中止血困难或止血不彻底(OR=6.127)。结论在外科手术治疗高血压脑出血中,应尽快手术、做好术中止血、术后确保血压稳定是预防术后再出血的关键措施。     

Management of intracerebral hemorrhage

Currently, intracerebral hemorrhage (ICH) has the highest mortality rate of all stroke subtypes (Counsell et al 1995; Qureshi et al 2005). Hematoma growth is a principal cause of early neurological deterioration. Prospective and retrospective studies indicate that up to 38% hematoma expansion is noted within three hours of ICH onset and that hematoma volume is an important predictor of 30-day mortality (Brott et al 1997; Qureshi et al 2005). This article will review current standard of care measures for ICH patients and new research directed at early hemostatic therapy and minimally invasive surgery.     

Neonatal adrenal gland hemorrhage

During a six-month period the authors have been diagnosing 25 neonatal adrenal haemorrhage by 870 ultrasound screening examinations. This frequency (28.7%) is surprisingly high in comparison with earlier postmortem estimated literature data (1.7-6.0%). In 24 survived neonates the adrenal haemorrhage was absorbed between 6 weeks and 4 months, no disturbances in the electrolyte levels were found, and the haemorrhage did not require any treatment. However, the authors observed pathological neurological symptoms or intracranial haemorrhage as more than 30% of the newborn infants suffering from adrenal haemorrhage. On the basis of ultrasound signs of adrenal haemorrhages the authors distinguish three groups, namely, cortical, medullar and apoplectiform haemorrhages. By analysing the history, clinical symptoms and follow up study of adrenal haemorrhages in the newborn period the authors conclude that infants born as "large for date babies", suffered from intrauterine asphyxia, forceps or vacuum extractions can be taken the risk of adrenal haemorrhage.