混合密度征不增加微创术治疗脑出血的再出血风险  

CT blend sign do not increase the risk of postoperative rebleeding in minimally invasive surgery for intracerebral hemorrhage

作　　者：梁奇明[1] 连立飞[1] 许峰[1] 潘超[1] 朱遂强[1] 王芙蓉 Liang Qiming;Lian Lifei;Xu Feng;Pan Chao;Zhu Suiqiang;Wang Furong(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

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：《中华脑血管病杂志（电子版）》2021年第6期361-366,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(81974218);国家重点研发计划(2020YFC2006001);湖北省科技厅重点研发计划项目(2020BCA089)。

摘　　要：目的本研究旨在探讨基线CT的混合密度征对自发性幕上脑出血患者微创术后再出血的预测价值。方法回顾性分析2013年7月至2016年6月于华中科技大学同济医学院附属同济医院接受立体定向微创术联合重组组织型纤溶酶原激活剂治疗的自发性幕上脑出血患者。将术后复查CT较基线或前一次CT的血肿体积增加≥5ml定义为术后再出血。比较再出血组与非再出血组的影像学特征、临床特点及对预后的影响。应用Logistic回归模型分析混合密度征的出现与术后再出血之间的关系。结果共294例患者纳入研究,再出血率为7.1%(21/294)。再出血组穿刺损伤比例高于非再出血组(47.6%vs 16.8%),差异具有统计学意义(χ^(2)=10.061,P=0.002)。混合密度征阳性组100例,有7例(7.0%,7/100)发生再出血,混合密度征阴性组194例,有14例(7.2%,14/194)发生再出血,2组差异无统计学意义(χ^(2)=0.005,P=0.946)。多因素Logistic回归分析表明,术后再出血的独立预测指标仅有穿刺损伤(OR=4.168,95%可信区间:1.649~10.537,P=0.003),混合密度征不增加再出血风险(OR=0.951,95%可信区间:0.357~2.533,P=0.920)。结论基线CT上发现的混合密度征不增加微创术治疗脑出血术后再出血风险,而穿刺损伤与术后再出血关系密切。Objective To determine the value of the CT blend sign in predicting rebleeding after minimally invasive surgery(MIS)in patients with intracerebral hemorrhage(ICH).Methods The clinical data of patients with intracerebral hemorrhage,who were treated with MIS plus recombinant tissue plasminogen activator at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2013 to June 2016,were analyzed retrospectively.Postoperative rebleeding was defined as an increase in hematoma volume of≥5 ml assessed by CT compared with that on baseline or previous CT.The imaging features,clinical features and prognosis of rebleeding group and non-rebleeding group were compared.Logistic model was used to analyze the relationship between the appearance of blend sign and postoperative rebleeding.Results A total of 294 patients were included and the rebleeding rate was 7.1%(21/294).The proportion of puncture damage was significantly higher in the rebleeding group than in the non-rebleeding group(47.6%vs 16.8%,χ^(2)=10.061,P=0.002).Rebleeding occurred in 7 cases(7.0%)in the blend sign-positive group(n=100)and 14 cases(7.2%)in the blend sign-negative group(n=194),and there was no statistically significant(χ^(2)=0.005,P=0.946).Multivariate logistic regression analysis demonstrated that the only independent predictor of postoperative rebleeding was puncture injury(OR=4.168,95%CI:1.649~10.537,P=0.003).CT blend sign did not predict the risk of rebleeding(OR=0.951,95%CI:0.357~2.533,P=0.920).Conclusion The CT blend sign on baseline CT did not imply the risk of rebleeding afterMIS for ICH.Puncture injury is closely associated with postoperative rebleeding.

关 键 词：脑出血 微创术 重组组织型纤溶酶原激活剂 混合密度征 再出血 术后 

分 类 号：R651.1[医药卫生—外科学]