脑出血去骨瓣减压术后患者短期内血肿扩大或再出血的危险因素分析  

Analysis of risk factors for hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage

作　　者：王迪[1] 朱周乐 陈荣 单钢明 马伟军 Wang Di;Zhu Zhoule;Chen Rong;Shan Gangming;Ma Weijun(Graduate School,Zhejiang University of Traditional Chinese Medicine,Shaoxing 310053,China;Department of Neurosurgery,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310003,China;Department of Neurosurgery,Keqiao District Traditional Chinese Medicine Hospital of Shaoxing City,Shaoxing 312030,China)

机构地区：[1]浙江中医药大学研究生院,绍兴310053 [2]浙江大学附属第二医院神经外科,杭州310003 [3]绍兴市柯桥区中医医院神经外科,绍兴312030

出　　处：《中国医师进修杂志》2022年第9期818-823,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨脑出血去骨瓣减压术后患者短期内血肿扩大或再出血的危险因素。方法回顾性分析2019年1月至2021年10月浙江大学附属第二医院和绍兴市柯桥区中医医院行去骨瓣减压术治疗的209例脑出血患者的临床资料。根据患者就诊时和短期(发病24 h)头颅CT结果进行分组,其中短期内血肿扩大和再出血28例(A组),短期内单纯血肿扩大47例(B组),短期内单纯再出血13例(C组),短期内无血肿扩大和再出血121例(D组)。收集四组患者的性别、年龄、体质量指数、首次CT检查时间、首次出血量、入院格拉斯哥昏迷评分(GCS)、入院收缩压、入院舒张压、入院活化部分凝血活酶时间(APTT)、入院丙氨酸氨基转移酶(ALT)、入院白细胞计数、血肿部位、破入脑室、不规则血肿、手术时机、入院24 h最高体温、术中止血困难、术后血压控制不理想等临床资料。采用多因素Logistic回归分析影响脑出血去骨瓣减压术后患者短期内血肿扩大或再出血的独立危险因素。结果四组性别构成、年龄和体质量指数比较差异无统计学意义(P>0.05)。A组入院收缩压≥140 mmHg(1 mmHg = 0.133 kPa)、入院舒张压≥90 mmHg、入院APTT≥37 s、入院ALT≥40 U/L、入院白细胞计数≥10×109/L、入院GCS、入院24 h最高体温≥37 ℃、首次出血量≥60 ml、首次CT检查时间≥3 h、发病至手术时间≥12 h、血肿形态不规则、丘脑部位出血、破入脑室、术中止血困难、术后血压控制不理想发生率均明显高于B组、C组和D组[92.86%(26/28)比55.32%(26/47)、7/13和23.97%(29/121),89.29%(25/28)比51.06%(24/47)、6/13和17.36%(21/121),92.86%(26/28)比48.94%(23/47)、6/13和14.88%(18/121),78.57%(22/28)比42.55%(20/47)、5/13和16.53%(20/121),89.29%(25/28)比53.19%(25/47)、7/13和18.18% (22/121),89.29%(25/28)比57.45%(27/47)、7/13和23.14%(28/121),92.86%(26/28)比55.32% (26/47)、7/13和23.97%(29/121),85.71%(24/28)比48.94%(23/47)、6/13和16.53Objective To investigate the risk factors of hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage.Methods The clinical data of 209 cerebral hemorrhage patients underwent decompressive craniectomy from January 2019 to October 2021 in the Second Affiliated Hospital of Zhejiang University and Keqiao District Traditional Chinese Medicine Hospital of Shaoxing City were retrospectively analyzed.According to the head CT result at the time of consultation and 24 h after the onset,the patients were divided into hematoma enlargement and rebleeding group(group A,28 cases),hematoma enlargement group(group B,47 cases),rebleeding groups(group C,13 cases),non-hematoma enlargement and non-rebleeding group(group D,121 cases).The gender,age,body mass index,time of first CT examination,first bleeding volume,admission Glasgow coma score(GCS),admission systolic pressures,admission diastolic pressure,admission activated partial thromboplastin time(APTT),admission alanine aminotransferase(ALT),admission white blood cell count,hematoma site,broken into the ventricle,irregular hematoma,timing of operation,maximum body temperature of 24 h after admission,intraoperative hemostasis and unsatisfactory on postoperative blood pressure control were collected.Multifactor Logistic regression analysis was used to analyze the independent risk factors of hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage.Results There were no statistical difference in sex composition,age and body mass index among 4 groups(P>0.05).The incidences of admission systolic pressures≥140 mmHg(1 mmHg=0.133 kPa),admission diastolic pressure≥90 mmHg,admission APTT≥37 s,admission ALT≥40 U/L,admission white blood cell count≥10×109/L,admission GCS,maximum body temperature of 24 h after admission≥37℃,first bleeding volume≥60 ml,time of first CT examination≥3 h,time from onset to operation≥12 h,irregular hematoma,hematoma i

关 键 词：脑出血 减压术 外科 危险因素 血肿扩大 再出血 

分 类 号：R651.12[医药卫生—外科学]