脑出血微创术后再出血的危险因素分析  

Postoperative Rehemorrhage of Minimally Invasive Hematoma Aspiration: Etiological Analysis

作　　者：梁奇明[1] 许峰[1] 连立飞[1] 王刚[1] 张逸驰[1] 薛铮[1] 王芙蓉[1] 唐洲平[1] 朱遂强[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《神经损伤与功能重建》2015年第5期394-398,470,共6页Neural Injury and Functional Reconstruction

基　　金：卫生部部属(管)医院临床学科重点项目;同济医院引领未来临床诊疗新技术新业务基金项目

摘　　要：目的:探讨自发性脑出血(ICH)经微创术联合重组组织型纤溶酶原激活剂(rt-PA)治疗后再出血的危险因素。方法:回顾性分析接受微创术联合rt-PA治疗的自发性ICH患者,观察其临床特点、再出血危险因素及再出血对预后的影响。结果:共纳入183例患者,再出血率9.29%,症状性再出血率1.64%,穿刺损伤(穿刺道出血及术后蛛网膜下腔出血)率19.67%,30 d死亡率4.37%。穿刺损伤率与再出血率显著相关(P=0.001)。原发性高血压病史(P=0.042)、液化前调整穿刺针(P=0.030)增加再出血风险,术中是否抽吸、rt-PA剂量及用药次数与再出血均缺乏显著相关性。再出血后继续液化治疗者血肿清除率为(57.32±21.20)%,二次再出血率为23.07%。再出血患者30 d死亡率为5.88%。结论:微创术联合rt-PA治疗的自发性ICH的再出血率低,安全性较高。穿刺损伤及液化前调整穿刺针再出血风险较高。再出血后应用小剂量rt-PA治疗仍可有效减少血肿量,但仍需警惕二次出血。Objective： To explore the etiology of rehemorrhage after minimally invasive surgery （MIS） combined with recombinant issue plasminogen activator （rt-PA） for hematoma evacuation. Methods： The clinical data of pa-tients with intracerebral hemorrhage treated by MIS plus rt-PA were analyzed retrospectively. Results： One hundred and eighty-three patients were enrolled. The incidence of rehemorrhage was 9.29% and symptomatic rehemorrhage was 1.64%. The rates of puncture injury （include catheter-tract hemorrhage and subarachnoid hemorrhage） was 19.67%, and the 30-d mortality was 4.37%. There was a significantly positive correlation between puncture injury and rehemorrhage （P=0.001）. Hypertension（P=0.042） and reposition of catheter （P=0.030） were also significantly associated with rehemorrhage. But aspiration, dosage of rt-PA were not significantly associated with rehemorrhage. The hematoma clearance rate of the patients with liquefaction treatment after rebleeding was （57.32 ± 21.20）%. 23.07% rehemorrhage patients who received sequential thrombolytics had another rehemorrhage. Thirty-day mor-tality of the rehemorrhage patients was 5.88%. Conclusion： MIS plus rt-PA for hemorrhage evacuation is relatively safe with low rehemorrhage rate. Puncture injury and reposition of catheter will increase the risk of rehemorrhage. Low dose of rt-PA can be cautiously used to treat hematoma postoperation. However, the risk of secondary rehem-orrhage need more attention.

关 键 词：自发性脑出血 微创术 重组组织型纤溶酶原激活剂 再出血 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]