老年高血压脑出血血肿清除术后患者并发脑梗死的影响因素分析  

Influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance

作　　者：彭越[1] 刘慧勤[1] 王冰[1] Peng Yue;Liu Huiqin;Wang Bing(Department of Internal Neurology,Henan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院神经内科,郑州450000

出　　处：《中华行为医学与脑科学杂志》2019年第1期24-27,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：河南省科技计划项目(162102310295).

摘　　要：目的探讨老年高血压脑出血血肿清除术后患者并发脑梗死的影响因素。方法选取老年高血压脑出血血肿患者197例,行开颅血肿清除术+去骨瓣减压术治疗,术后复查颅脑CT观察并发脑梗死情况。采用Logistic回归分析影响并发脑梗死独立危险因素。结果高血压脑出血血肿清除后并发脑梗死发生率为26.90%(53/197)。经单因素分析,高血压脑出血血肿清除后并发脑梗死患者脑梗死发生率在性别、年龄方面差异无统计学意义(P>0.05);在糖尿病史(χ^2=7.986)、高血压病史(χ^2=10.399)、血肿量(χ^2=10.396)、脑水肿面积(χ2=12.436)、收缩压(χ^2=12.128)、舒张压(χ^2=13.040)和GCS评分(χ^2=3.940)方面比较差异有统计学意义(均P<0.05)。Logistic回归分析显示,有糖尿病史(β=1.472,OR=2.174,95%CI=1.092~2.981)、高血压病史(β=1.894,OR=2.819,95%CI=1.309~3.973)、血肿量>35ml(β=2.361,OR=3.890,95%CI=1.792~5.132)、脑水肿面积≥65cm3(β=2.471,OR=4.321,95%CI=1.879~5.487)、收缩压≥150mmHg(1mmHg=0.133kPa)(β=2.073,OR=3.172,95%CI=1.428~4.768)、舒张压≥90mmHg(β=1.715,OR=2.498,95%CI=1.276~3.451)和GCS评分<8分(β=2.592,OR=4.871,95%CI=1.974~5.798)是影响高血压脑出血血肿并发脑梗死的独立危险因素。结论老年高血压脑出血血肿清除术后并发脑梗死受糖尿病史、高血压病史、血肿量、水肿、收缩压、舒张压等因素影响,早期针对性给予干预可能有效降低脑梗死的发生率。Objective To investigate the influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance. Methods A total of 197 elderly patients with hypertensive intracerebral hemorrhage were selected and treated with craniotomy hematoma removal and decompression of bone flap. Cerebral infarction was checked by craniocerebral CT after operation.Univariate and multivariate Logistic regression analysis was used to identify the independent risk factors for cerebral infarction. Results The incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage was 26.90%(53/197). There was no significant difference in the incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage on gender and age (P>0.05), while the differences were statistically significant in diabetes(χ^2=7.986), hypertension history(χ^2=10.399), hematoma volume(χ^2=10.396), edema(χ^2=12.436), systolic blood pressure(χ^2=12.128), diastolic blood pressure(χ^2=13.040) and GCS score(χ^2=3.940) (all P<0.05). Logistic regression analysis showed that history of diabetes mellitus(β=1.472, OR=2.174, 95%CI=1.092-2.981), history of hypertension(β=1.894, OR=2.819, 95%CI=1.309-3.973), volume of hematoma > 35 ml(β=2.361, OR=3.890, 95%CI=1.792-5.132), area of brain edema (> 65 cm3) (β=2.471, OR=4.321, 95%CI=1.879-5.487), systolic pressure (> 150 mm Hg, 1 mmHg=0.133 kPa) (β=2.073, OR=3.172, 95%CI=1.428-4.768), diastolic pressure (> 90 mm Hg) (β=1.715, OR=2.498, 95%CI=1.276-3.451)and GCS score < 8(β=2.592, OR=4.871, 95%CI=1.974-5.798)were independent risk factors for cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage. Conclusion Elderly patients with cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage is affected by diabetes mellitus, hypertension, hematoma volume, edema, systolic blood pressure, diastolic blood pressure and other factors. Early intervention o

关 键 词：高血压脑出血 血肿 脑梗死 老年人 影响因素 

分 类 号：R651.1[医药卫生—外科学]