高血压性脑出血术后出血162例临床分析

目的分析高血压性脑出血(hypertensivc cerebral hemorrhage,HCH)患者开颅术后再出血的危险因素。方法回顾性分析162例全身麻醉下施行手术治疗的HCH患者的临床资料,着重分析HCH的手术方法、治疗结果、随访结果及对HCH开颅术后再出血的危险因素(性别、年龄、高血压患病年限、糖尿病史、高胆固醇病史、出血部位、出血量、术后收缩压、术后舒张压)进行多元回归分析。结果 l9例术后出现高血压,24例术后出现再出血,再出血率14.8%(24/162),16例死亡,病死率9.8%(16/162)。治愈出院的患者随访6个月,1例出现再出血需手术治疗。多元回归分析结果显示,高血压病程(P=0.036,OR=1.086),糖尿病史(P=0.026,OR=1.100)和术后收缩压(P=0.039,OR=1.218)与HCH开颅术后再出血呈正相关。结论 HCH术后再出血的危险因素为糖尿病史、高血压病程和术后高收缩压。

Clinical analysis of recurrent hemorrhage after craniotomy in 162 patients with hypertensive cerebral hemorrhage

Objectives To analyze the risk factors for recurrent hemorrhage after craniotomy in patients with hypertensive cerebral hemorrhage（HCH）. Methods Clinical data of 162 HCH patients undergone surgery were retrospectively analyzed. We focused on the surgcry methods,results, follow-up and muhiple regression analyses were earried out on risk factors （gender,age, duration of hypertension,history of diabetes mellitus and hypercholesterolemia, site and volume of hemorrhage and post-surgical systolic and diastolic pressure） for recurrent hemorrhage after craniotomy in patients with HCH. Results Hypertension appeared on nineteen 19 after surgery, recurrent hemorrhage appeared on 24 patients and the rate of recurrent hemorrhage was 14.8% （24/162）, 16 died and the case fatality was 9.8% （16/162）. After followed up for 6 months, recurrent hemorrhage appeared on 1 patient and he needed surgery again. Multiple regression analysis indicated that duration of hypertension （P=0.036, 0R=1.086）, history of diabetes mellitus （P=0.026,OR= 1.100） and post-surgical systolic pressure （P=0.039,OR=1.218） had positive correlation with recurrent hemorrhage after craniotomy in patients with HCH. Conclusions Risk factors for recurrent hemorrhage after craniotomy in patients with HCH are diabetes,long-term hypertension and higher post-surgical systolic pressure.