阿司匹林相关性脑出血钻孔引流术后继发性脑梗死的危险因素分析  

Analysis of risk factors of secondary cerebral infarction in patients with aspirin-related cerebral hemorrhage after drilling and drainage surgery

作　　者：邓磊[1] 汪美平 张珑[1] 张先斌 秦荣 张有昆 龚存林 DENG Lei;WANG Meiping;ZHANG Long;ZHANG Xianbin;QIN Rong;ZHANG Youkun;GONG Cunlin(The 908th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Nanchang 330002,China;Zhangshu People's Hospital,Zhangshu 331299,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院,江西南昌3300022 [2]樟树市人民医院,江西樟树331299

出　　处：《中国实用神经疾病杂志》2021年第24期2126-2135,共10页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探究阿司匹林相关性脑出血患者钻孔引流术后继发性脑梗死的危险因素。方法选取2016-09—2019-10于中国人民解放军联勤保障部队第九〇八医院接受钻孔引流术的179例有口服阿司匹林史的脑出血患者为研究对象,根据术后是否发生脑梗死分为脑梗死组(52例)和非脑梗死组(127例)。比较2组患者一般临床资料以及实验室指标,将差异显著的因素纳入logistic多因素回归分析,以发生脑梗死的独立危险因素构建阿司匹林相关性脑出血患者术后继发性脑梗死的列线图预测模型,并对模型进行分析。结果脑梗死组患者高血压人数、口服阿司匹林时间、收缩压、舒张压、脑组织位移、手术时长、发病至手术时间、血肿大小均高于非脑梗死组,hs-CRP低于非脑梗死组(P<0.05)。多因素分析显示高血压、口服阿司匹林时间、术中出血量、血肿大小以及发病至手术时间是阿司匹林相关性脑出血患者术后继发性脑梗死的独立预测因素(P<0.05)。根据多因素分析结果构建列线图预测模型并对模型进行验证,校准曲线显示以上述因素构建的脑梗死发生风险列线图模型准确性较高,模型的C-index值为0.822(95%CI:0.691-0.878),ROC曲线下面积(area under curve,AUC)为0.892,预测准确度为85.93%。结论高血压、口服阿司匹林时间、脑组织位移、血肿大小以及发病至手术时间是阿司匹林相关性脑出血患者术后继发性脑梗死的独立危险因素。依据独立影响因素构建的列线图预测模型对患者术后继发性脑梗死发生风险预测效能较好。临床上应严格阿司匹林用药指征,动态监测凝血指标,改善患者预后。Objective To explore the risk factors of secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage after drilling and drainage surgery.Methods Totally 179 patients with cerebral hemorrhage with a history of oral aspirin who underwent drilling and drainage surgery in our hospital from September 2018 to October 2019 were selected as the research objects.According to whether cerebral infarction occurred after the operation,they were divided into cerebral infarction group(52 cases) and non-cerebral infarction group(127 cases).The general clinical data and laboratory indicators of the two groups of patients were compared,and the significant differences were included in the logistic multivariate regression analysis,and the independent risk factors of cerebral infarction were used to construct the nomogram prediction of secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage after surgery model and analyze the model.Results The number of hypertension,time of oral aspirin,systolic blood pressure,diastolic blood pressure,brain tissue displacement,length of operation,time from onset to operation,and hematoma size in the cerebral infarction group were higher than those in the non-cerebral infarction group,and hs-CRP was lower than that in the non-cerebral infarction group(P<0.05).Multivariate analysis showed that hypertension,time of oral aspirin,intraoperative blood loss,hematoma size,and time from onset to operation were independent predictors of secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage(P<0.05).According to the results of multi-factor analysis,a nomogram prediction model was constructed and the model was verified.The calibration curve showed that the accuracy of the cerebral infarction risk nomogram model constructed with the above factors was high,and the C-index value of the model was 0.822(95% CI:0.691-0.878),the area under curve(AUC) is 0.892,and the prediction accuracy is 85.93%,indicating that the model has s

关 键 词：脑出血 钻孔引流术 继发性脑梗死 危险因素 阿司匹林 凝血 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]