早期微创治疗高血压脑出血术后继续出血的因素分析

目的探讨影响高血压脑出血早期微创治疗后继续出血的相关因素,预防术后继续出血。方法 230例高血压脑出血患者均采用YL-Ⅰ型颅内血肿粉碎穿刺针行微创治疗,对其中68例发生微创术后继续出血（继续出血组）与162例未发生微创术后继续出血（无继续出血组）患者发病时间、血压、首次血肿抽吸量、出血部位及血肿形状以及手术前后躁动情况进行比较,分析术后继续出血的因素。结果微创术后继续出血组患者发病时间多在6 h内（61.76%）,24 h后继续出血较少（8.82%）,与无继续出血组比较差异有统计学意义（χ^2=3.78,P〈0.05）;术前收缩压及舒张压均显著高于无继续出血组（t=2.73、3.20,P〈0.05）;首次血肿抽吸量显著多于无继续出血组（t=2.91,P〈0.05）;继续出血组患者出血部位多在基底节区（42.65%）、丘脑（29.41%）和壳核（27.94%）,不规则血肿更易发生继续出血（χ^2=11.83,P〈0.01）;手术前后躁动者易发生继续出血（χ^2=24.37,P〈0.01）。结论微创血肿穿刺引流术后继续出血与6 h内发病,高血压,首次血肿抽吸量过大,基底节区、丘脑和壳核出血,不规则血肿,以及患者躁动有关,应给予相应应对措施,降低术后继续出血的发生率,提高患者预后。

Relevant factors of recurrent bleeding in hypertensive cerebral hemorrhage after treated by microinvasive drain and aspiration

Objective To explore the relevant factors of recurrent bleeding in hypertensive cerebral hemorrhage(HCH) after treated by microinvasive drain and aspiration,and prevent postoperative recurrent bleeding.Methods A total of 230 patients with HCH were received microinvasive drain and aspiration with YL-Ⅰ transfixion pin,68 patients among them occurred recurrent bleeding(recurrent bleeding group) and 162 did not have recurrent bleeding(non-recurrent bleeding group),the onset time,blood pressure,amount of first time haematoma aspiration,bleeding part and shape and restlessness before and after surgery were compared to analyze the factors of recurrent bleeding.Results The onset time of most patients in recurrent bleeding group was within 6 hours(61.76%),and less occurred after 24 hours(8.82%),there was a statistical difference compared with non-recurrent bleeding group(χ2 = 3.78,P < 0.05);both preoperative systolic pressure and diastolic pressure were significantly higher than those of non-recurrent bleeding group(t = 2.73、3.20,P < 0.05);the amount of first time haematoma aspiration was more than that of non-recurrent bleeding group(t = 2.91,P < 0.05);the bleeding parts were mostly in basal ganglia(42.65%),colliculus nervi optici(29.41%) and dorsal caudate putamen(27.94%);irregular haematoma was more prone to recurrent bleeding(χ2 = 11.83,P < 0.01);restlessness of patients was more prone to recurrent bleeding(χ2 = 24.37,P < 0.01).Conclusion Recurrent bleeding after microinvasive drain and aspiration is relevant to onset within 6 hours,hypertension,large amount of first time haematoma aspiration,basal ganglia,colliculus nervi optici and dorsal caudate putamen bleeding,irregular haematoma and restlessness,and corresponding measures should be applied to decrease the incidence of recurrent bleeding and improve the prognosis of patients.