术前血肿形态与高血压脑出血患者血肿清除效果及术后再出血的关联  

Association of preoperative hematoma morphology with hematoma removal effect and postoperative rebleeding in patients with hypertensive cerebral hemorrhage

作　　者：张国庆 何玲 周兴民 郑丹 何立建 ZHANG Guoqing;HE Ling;ZHOU Xingmin;ZHENG Dan;HE Lijian(Department of Neurosurgery,Qiannan Prefecture People's Hospital,Duyun 558000,China;不详)

机构地区：[1]黔南州人民医院神经外科,都匀558000 [2]黔南州人民医院医务科,都匀558000 [3]黔南州人民医院运管办,都匀558000 [4]贵州省荔波县人民医院神经外科

出　　处：《临床神经外科杂志》2025年第1期82-87,共6页Journal of Clinical Neurosurgery

基　　金：贵州省科技计划项目任务书[黔科合基础-ZK(2024)一般483];黔南州科技计划项目任务书[黔南科合社字(2022)2号]。

摘　　要：目的探讨术前血肿形态与高血压脑出血(HICH)患者血肿清除效果及术后再出血的关联。方法选取2021年5月—2024年1月在黔南州人民医院接受微创穿刺引流术治疗的80例HICH患者,依据血肿状态分为规则组、不规则组,并比较两组术后即刻、术后1 d、术后3 d血肿清除率及术前、术后3 d改良Rankin量表(mRS)、美国国立卫生研究院卒中量表(NIHSS)评分。术后6~12 h常规复查入组患者头颅CT,依据术后是否再出血分为出血组、未出血组,收集患者临床资料,单因素、多因素回归分析法筛选影响HICH患者术后再出血的危险因素。结果规则组术后即刻、术后1 d、术后3 d血肿清除率分别为(45.50±0.20)%、(68.50±5.15)%、(88.65±0.20)%,均高于不规则组的(20.25±1.15)%、(4.50±0.05)%、(70.80±5.25)%,组间差异具有统计学意义(P<0.05)。规则组与不规则组组间、时间点mRS评分、NIHSS评分存在交互作用(P<0.05),且规则组术后3 d mRS评分、NIHSS评分均低于不规则组(P<0.05)。出血组、未出血组年龄≥60岁比例、术前血压分级、发病至手术时间、术前血肿形态、术前血肿量、术后压差>80 mmHg比例差异有统计学意义(P<0.05),性别比、体质量指数(BMI)、基础疾病、出血部位、手术时长等临床资料差异无统计学意义(P>0.05)。Logistic多因素回归分析结果显示,年龄≥60岁、术前血压分级(重度)、发病至手术时间>6 h、术前血肿形态(不规则)、术前血肿量多、术后压差>80 mmHg是影响HICH患者术后再出血的危险因素(P<0.05),即与上述指标与HICH患者术后再出血密切相关。结论术前规则血肿的HICH患者术后不同时间点血肿清除效果、神经功能恢复情况均优于术前不规则血肿的HICH患者,且术前血肿形态与HICH患者术后再出血密切相关。Objective To investigate the relationship between the morphology of hematoma before operation and the effect of hematoma removal and postoperative rebleeding in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 80 patients with HICH who received minimally invasive puncture and drainage treatment in Qiannan Prefecture People's Hospital from May 2021 to January 2024 were selected.According to the status of hematoma,they were divided into regular group and irregular group,the hematoma clearance rate immediately after surgery,1 day and 3 days after surgery,and the scores of modified Rankin scale(mRS)and National Institute of Health stroke scale(NIHSS)before surgery and 3 days after surgery were compared.Head CT of enrolled patients was routinely reviewed 6-12 h after surgery,and they were divided into bleeding group and non-bleeding group according to whether postoperative bleeding occurred again,clinical data of patients were collected,single factor and multiple factor regression analysis were used to screen the risk factors of postoperative rebleeding in patients with HICH.Results The hematoma clearance rates of the regular group were(45.50±0.20)%,(68.50±5.15)%and(88.65±0.20)%immediately,1 day and 3 days after surgery respectively,which were higher than those of the irregular group(20.25±1.15)%,(4.50±0.05)%and(70.80±5.25)%,the difference between groups was statistically significant(P<0.05).There was interaction between the regular group and the irregular group,and between the time point mRS score and NIHSS score(P<0.05),and the mRS score and NIHSS score at 3 days after operation in the regular group were lower than those in the irregular group(P<0.05).The proportion of age≥60 years old,preoperative blood pressure grade,time from onset to operation,preoperative hematoma shape,preoperative hematoma amount and postoperative pressure difference>80 mmHg were statistically significant differences between bleeding group and non-bleeding group(P<0.05).There were no significant differences

关 键 词：高血压脑出血 微创穿刺引流术 血肿形态 术后再出血 

分 类 号：R651.1[医药卫生—外科学]