Abstract:

Objective To investigate the risk factors for rehaemorrhagia after hypertension cerebral hemorrhage treatment by the frontal drainage cone, so as to provide clinical reference. Methods Retrospective analysis was used based on data of patients who had rehaemorrhagia after the frontal drainage cone treatment of hypertension cerebral hemorrhage from January 2013 to February 2015 in People′s Hospital of Qinglong. Patients' gender, age, preoperative blood pressure, blood glucose, blood lipid level, body mass index, preoperative hematoma volume, blood coagulation function, preoperative Glasgow Coma Scale (GCS) score, Montreal Cognitive Assessment (MoCA) scores, the United States National Institutes of Health Stroke Scale (NIHSS) scores, time between onset and operation, intraoperative bleeding were recorded. The multifactor and single factor Logistic regression analysis were used to analyze risk factors for rehaemorrhagia after frontal cone hole drainage treatment of hypertensive cerebral hemorrhage. Results A total of 100 cases were collected, including 15 cases of postoperative bleeding. The occurrence rate was 15.0%. The single factor analysis results showed that systolic blood pressure [(125±12) mmHg vs (146±17) mmHg, P <0.001], preoperative hematoma volume [(58.7±4.5) ml vs (63.4±6.2) ml, P <0.001], the time between onset to operation [5.1 (6.0) h vs 6.9 (6.2) h, P <0.001],

intraoperative with active bleeding [11 (12.9%) vs 9 (60.0%), P <0.001], and postoperative blood pressure control rate [60 (70.6%) vs 3 (20.0%), P <0.001] between non-rehaemorrhagia group and rehaemorrhagia group had significant differences. Multifactor Logistic regression analysis showed that large preoperative hematoma volume [OR 1.035, 95%CI (1.008, 2.359)], long duration between onset and operation [OR 1.289, 95%CI (1.027, 6.325)], intraoperative active bleeding [OR 2.154, 95%CI (1.067, 3.245)] were risk factors for rehaemorrhagia after the frontal cone hole drainage treatment of hypertensive cerebral hemorrhage, and the postoperative blood pressure control [OR 0.147, 95%CI (0.004, 0.358)] was the protective factor. Conclusion Large hematoma volume, long duration between onset and operation, intraoperative with active bleeding, uncontrolled postoperative blood pressure are risk factors for patients underwent frontal drainage cone treatment of hypertension cerebral hemorrhage after the high incidence of bleeding.

Key words: Hypertension; Cerebral hemorrhage; Frontal drainage cone; Rehaemorrhagia; Riskfactor

摘要：

目的 探讨经额部锥孔引流治疗高血压脑出血后再出血危险因素，为临床提供依据。 方法 采用回顾性分析方法，收集2013年1月-2015年2月河北省秦皇岛市青龙满族自治县医院收治 的采用经额部锥孔引流治疗的高血压脑出血患者的资料。记录患者性别、年龄、术前血压、血糖、血 脂水平、体质指数、术前血肿量、术前格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分、蒙特利尔 认知评估量表（Montreal Cognitive Assessment，MoCA）评分、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分、发病至手术时间、术中有无活动性出血、术后血压控 制情况。采用单因素和多因素分析经额部锥孔引流治疗高血压脑出血后再出血危险因素。 结果 共收集100例患者的资料，其中术后发生再出血15例，发生率为15.0%。单因素分析结果显 示，未再出血组与再出血组术前收缩压（[ 125±12）mmHg vs（146±17）mmHg，P＜0.001]、术前血肿量 （[ 58.7±4.5）ml vs（63.4±6.2）ml，P＜0.001]、发病至手术时间[5.1（3.2，9.2）h vs 6.9（5.3，11.5）h， P＜0.001]、术中有活动性出血[11（12.9%）vs 9（60.0%），P＜0.001]、术后血压控制率[60（70.6%）vs 3（20.0%），P＜0.001]等因素有显著差异。多因素Logistic回归分析显示，术前血肿量大[比值比（odds ratio，OR）1.035，95%可信区间（confidence interval，CI）（1.008，2.359）]、发病至手术时间长[OR 1.289， 95%CI（1.027，6.325）]、术中有活动性出血[OR 2.154，95%CI（1.067，3.245）]为经额部锥孔引流治疗 高血压脑出血后再出血的危险因素；术后血压控制为保护因素[OR 0.147，95%CI（0.004，0.358）]。 结论 经额部锥孔引流治疗高血压脑出血，术前血肿量大、发病至手术时间长、术中有活动性出血、 术后血压未控制的患者术后再出血的风险更高。

关键词: 高血压; 脑出血; 经额部锥孔引流; 再出血; 危险因素