阿司匹林相关性高血压性脑出血病人开颅术后再出血的危险因素分析  

Analysis of risk factors for postoperative rebleeding after craniotomy for aspirin-related hypertensive intracerebral hemorrhage

作　　者：刘双 刘学友[1] 何霞[2] 周国胜[1] 王正锋[1] Liu Shuang;Liu Xueyou;He Xia;Zhou Guosheng;Wang Zhengfeng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,He'nan 450052,China;Neuro-Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,He'nan 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,450052 [2]郑州大学第一附属医院神经重症监护病房,450052

出　　处：《中国微侵袭神经外科杂志》2020年第7期299-302,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨阿司匹林相关性高血压性脑出血病人开颅清除血肿术后再出血的危险因素。方法回顾性分析172例有口服阿司匹林史的高血压性脑出血病人的临床资料,均行脑内血肿开颅清除术,并对可能引起术后再出血的危险因素进行单因素分析和多因素Logistics回归分析。结果术后发生再出血29例(16.9%)。单因素分析结果提示:发病至手术时间、血肿形态、术中出血量、手术时长、血栓弹力图(thrombelastogram,TEG)中花生四烯酸途径的血小板抑制率是影响病人开颅术后再出血的危险因素(P<0.05)。多因素Logistic回归分析显示:发病至手术时间(OR=1.037,95%CI:1.011-1.065,P<0.01)、术中出血量(OR=1.004,95%CI:1.002-1.007,P<0.01)和血小板抑制率≥75%(OR=10.520,95%CI:3.159-35.034,P<0.01)为开颅术后再出血的独立危险因素。结论TEG检查可以指导阿司匹林相关性脑出血病人的手术治疗,发病后早期手术、减少术中出血量可减少病人开颅清除血肿术后再出血率。Objective To analyze the risk factors for postoperative rebleeding after craniotomy in patients with aspirin-related hypertensive intracerebral hemorrhage(HICH).Methods Clinical data of 172 HICH patients with a history of oral aspirin were analyzed retrospectively,and all the patients received craniotomy to remove intracerebral hematoma.Univariate analysis and multivariate logistic regression analysis were used to find the risk factors resulting in postoperative rebleeding.Results Postoperative rebleeding occurred in 29 patients(16.9%).Univariate analysis showed that the time from onset to surgery,hematoma morphology,intraoperative blood loss,surgical duration and the arachidonic acid(AA)pathway-induced platelet inhibition rate in the thromboelastogram(TEG)were the risk factors related to rebleeding after craniotomy(P<0.05).Multivariate logistic regression analysis showed that the time from onset to onset(OR=1.037,95%CI:1.011-1.065,P<0.01),intraoperative blood loss(OR=1.004,95%CI:1.002-1.007,P<0.01)and the platelet inhibition rate≥75%(OR=10.520,95%CI:3.159-35.034,P<0.01)were the independent risk factors for postoperative rebleeding.Conclusions TEG examination can guide the surgical treatment of aspirin-related HICH patients.Early operation and reducing the amount of intraoperative blood loss can reduce the rate of postoperative rebleeding after craniotomy.

关 键 词：颅内出血 高血压性 阿司匹林 颅骨切开术 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]