高血压基底节区出血术后再出血原因及处理

目的 分析高血压基底节区脑出血术后再出血的原因及防治措施.方法 回顾性研究我院2008年～2012年190例高血压基底节区血肿清除术后患者,对其中术后再出血的30例患者进行分析,探讨其出血原因及治疗措施.结果 30例术后再出血患者中有15例患者有再次手术指针,其中8例再次行血肿清除术,复查头CT血肿基本清除,5例好转出院,3例死于肺部并发症;另外7例术后再出血有手术指针但放弃手术治疗予保守治疗,仅1例好转出院,其余6例后死亡.15例经保守治疗好转出院.本组高血压基底节区出血术后再出血发生率为15.7%,再出血原因与手术时机、手术技巧、术前CT显示血肿形态、出血量大小、术后患者的血压控制不佳有关.结论选择手术时机、良好的手术技巧及术后管理等是降低高血压基底节区出血术后再出血的有效方法.

Causes and treatment of postoperative rebleeding of hypertensive basal ganglia hemorrhage

Objective To analyze the causes and preventive measures of postoperative rebleeding of hypertensive basal ganglia hemorrhage. Methods A retrospective study of 190 patients included 30 postoperative rebleeding patients with hyperten- sive basal ganglia hematoma in our hospital between 2008 and 2012. To explore the causes of rebleeding and treatment measures. Results Among 30 cases of postoperative rebleeding patients, 15 patients had indications for surgery again, of which 8 had hema- toma evacuations, their postoperative head CT review were clear, 5 cases improved and discharged, 3 patients died of pulmonary complications. Another 7 patients gived up surgery to conservative treatment, only 1 patient improved and was discharged, the re- maining 6 cases died. 15 cases who were treated conservatively improved and were discharged. The rate of hypertensive basal gan- glia hemorrhage postoperative rebleeding in this group was 15.7%, and the causes of rebleeding were related with the timing of surgery, surgical techniques, preoperative CT showed hematoma shape, the amount of bleeding, postoperative poorly controlled hypertension. Conclusion The timing of surgery, surgical techniques, and postoperative management might effective methods to reduce the incidences of hypertensive basal ganglia hemorrhage postoperative rebleeding.