急性大面积脑梗死去骨瓣减压术后脑出血的原因分析  

Analysis on causes of cerebral hemorrhage after decompressive craniectomy for acute massive cerebral infarction

作　　者：赵重庆 ZHAO Chong-qing(Zhengzhou Central Hospital Affiliated to Zhengzhou University,zhengzhou 450007,China)

机构地区：[1]郑州大学附属郑州中心医院神经外科,郑州450007

出　　处：《医药论坛杂志》2021年第4期40-42,46,共4页Journal of Medical Forum

摘　　要：目的研究急性大面积脑梗死行去骨瓣减压术后脑出血的原因。方法对郑州大学附属郑州中心医院2016年5月—2019年10月38例急性大面积脑梗死行去骨瓣减压术患者的临床资料复习,采用Fisher确切概率法分析发病至手术时长、是否行静脉溶栓、机械取栓、术前脑疝情况、凝血功能对去骨瓣减压术后脑出血的影响。结果 38例患者中术后未出血的有30例,新发出血或出血增加的有8例;发病至手术时长≥48 h组术后出血率41.18%,与发病至手术时长<48 h组术后出血率4.76%相比,P=0.013,差异有统计学意义;行静脉溶栓和/或机械取栓组出血率25%,与未行静脉溶栓和/或机械取栓组出血率14.29%相比,P=0.684,差异无统计学意义;术前凝血功能异常组出血率33.33%,与凝血功能正常组出血率12%相比,P=0.003,差异有统计学意义;中线移位>1 cm组出血率35%,与中线移位≤1 cm组出血率5.56%相比,P=0.045,差异有统计学意义。结论发病至手术时长≥48 h、中线移位>1 cm、术前凝血功能异常、行静脉溶栓和/或机械取栓是导致急性大面积脑梗死行去骨瓣减压术后脑出血原因。Objective To study the causes of cerebral hemorrhage after decompression of bone flap in acute massive cerebral infarction.Methods Of Zhengzhou Central Hospital Affiliated to Zhengzhou University from May 2016 to October 2019, totally 38 cases of acute massive cerebral infarction to bone disc decompression in patients with clinical data review and analysis by Fisher’s exact probability method to the surgery time, whether intravenous thrombolysis, mechanical bolt, preoperative cerebral hernia, blood coagulation function on postoperative bleeding in the brain to bone disc decompression and the effect ofP<0.05, there is statistical significance.Results Among the 38 patients, 30 had no bleeding after operation, and 8 had new bleeding or increased bleeding.The postoperative bleeding rate was 41.18% in the group with ≥48 h from onset to operation, compared with 4.76% in the group with <48 h from onset to operation, P=0.013, and the difference was statistically significant.The bleeding rate of the group receiving intravenous thrombolysis and/or mechanical thrombolysis was 25%, compared with 14.29% of the group not receiving intravenous thrombolysis and/or mechanical thrombolysis, P=0.684, and the difference was not statistically significant.The bleeding rate of the preoperative group with abnormal coagulation function was 33.33%, compared with 12% of the group with normal coagulation function, P=0.003, and the difference was statistically significant.The bleeding rate of the midline shift > 1 cm group was 35%, compared with 5.56% of the midline shift ≤1 cm group, P=0.045, the difference was statistically significant.Conclusion The causes of cerebral hemorrhage after bone flap decompression in acute massive cerebral infarction were as follows: the duration of onset to operation ≥48 h, midline displacement > 1 cm, abnormal preoperative coagulation function, intravenous thrombolysis and/or mechanical thrombectomy.

关 键 词：急性大面积脑梗死 去骨瓣减压术 术后脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]