行立体定向颅内血肿穿刺引流术后再出血与术中血肿清除率的关系  

Relationship between postoperative rebleeding and intraoperative hematoma evacuation rates in patients undergoing stereotactic intracranial hematoma aspiration and drainage for intracerebral hemorrhage

作　　者：罗胜 王丽琨 任思颖 叶飞 黎辰 伍国锋 LUO Sheng;WANG Likun;REN Siying;YE Fei;LI Chen;WU Guofeng(School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Emergency Neurology,the Affiliated Hospital of Guizhou Medical University Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550004 [2]贵州医科大学附属医院急诊神经科,贵州贵阳550004

出　　处：《贵州医科大学学报》2023年第12期1501-1506,共6页Journal of Guizhou Medical University

基　　金：国家自然科学基金(81971126);贵州省高层次留学人才创新创业择优资助启动项目(〔2020〕5);贵州省卫生健康委科学技术基金项目(gzwjk2020-1-016)。

摘　　要：目的探究自发性脑出血(ICH)患者行立体定向颅内血肿穿刺引流术后再出血与术中血肿清除率的关系。方法选取ICH患者320例,根据术中血肿清除率与术后再出血间的关系经受试者工作特征曲线(receiver operating characteristic curve,ROC)分析,分为低术中血肿清除率组(术中血肿清除率≥42.037%,n=180)和高术中血肿清除率组(术中血肿清除率<42.037%,n=140);比较两组患者一般人口学资料(性别、年龄),临床资料[发病至入院时间、既往史、个人史、用药史、入院血压、入院格拉斯哥昏迷评分(GCS)、入院时国立健康研究院卒中评分(NIHSS),入院时mRS评分],入院时、手术前、手术后及出院时影像学资料(各次头颅CT片及其所示颅内血肿量及形态)及术中血肿清除率等手术相关资料;将有差异的指标纳入二元logistics回归,分析患者术后再出血的影响因素。结果与高术中清除率组相比,低术中清除率组发病到入院时间短、入院GCS评分高、入院NIHSS评分低,入院肌力差、入院具有糖尿病史患者比例升高,差异有统计学意义(P<0.05);其余指标比较,差异无统计学意义(P>0.05);logistic回归分析结果显示,仅术中血肿清除率是术后再出血的发生的独立预测因素。结论行立体定向颅内血肿穿刺引流术的自发性脑出血患者中,术中血肿清除率≥42.037是患者发生术后再出血的独立预测因子,且术中血肿清除率越高患者发生术后再出血的可能性越高。Objective To investigate the relationship between postoperative rebleeding and intraoperative hematoma evacuation rates in patients with intracerebral hemorrhage(ICH)who underwent stereotactic intracranial hematoma aspiration and drainage.Methods A total of 320 patients with ICH were selected and divided into low intraoperative hematoma evacuation group(intraoperative hematoma evacuation≥42.037%,n=180)and high intraoperative hematoma evacuation group(intraoperative hematoma evacuation<42.037%,n=140)according to the relationship between intraoperative hematoma evacuation and postoperative rebleeding subject to receiver operating characteristic curve(ROC)analysis.The general demographic data(gender,age),clinical data onset to admission time,previous medical history,personal history,medication history,admission blood pressure,admission Glasgow Coma Scale(GCS),National Institutes of Health Stroke Scale(NIHSS),admission modified Rankin score(mRS)score,medical imaging data of admission to hospital,before surgery,after surgery and after discharge(cranial CT results,intracranial hematoma volume and morphology),and relevant surgery data(intraoperative hematoma evacuation rate).The indicators of differences were included into binary logistics regression to analyze the influencing factors of patients'postoperative rebleeding.Results Compared with the group with high intraoperative evacuation,the group with low intraoperative evacuation had following features:a shorter onset to admission time,higher admission GCS score,lower admission NIHSS score,worse admission muscle strength,and higher proportion of patients with admission history of diabetes,those differences were statistically significant(P<0.05).The remaining indicators were statistically analyzed,and the differences were not significant(P>0.05).The results of logistic regression analysis showed that only intraoperative hematoma evacuation was an independent predictor for the occurrence of postoperative rebleeding.Conclusions Intraoperative hematoma evacuation rate�

关 键 词：脑出血 立体定向颅内血肿穿刺引流术 血肿清除率 术后再出血 预后 

分 类 号：R741[医药卫生—神经病学与精神病学]