【摘要】 目的 :探讨高血压脑出血早期手术后再出血的发生率、发生时间、发生部位、防治及其危险因素。方法 :回顾我院 1996-2 0 0 2年脑出血早期手术患者 3 2 2例 ,并对其中 69例手术后再出血 (再出血组 )的临床资料进行比较 ,分析各种可能因素对术后再出血的影响。结果 :早期手术后再出血发生率为 2 1.4% ,其中出血 <6h手术组再出血率为 43 .1% ,6～ 12h手术组再出血率为 2 0 .9% ,13～ 2 4h手术组再出血率降为 3 .6%。再出血发生时间分析 ,手术后 <12h发生率为 3 .1% ,12～ 2 4h为 15.5% ,而 >2 4h仅为 2 .8%。再出血位于基底节区占 92 .6%。高舒张压状态、术后血压控制不稳、长期服用抗凝药物、出血部位、术中止血困难或不彻底均与再出血的发生率呈显著相关性 (P <0 .0 1) ,其中高舒张压状态 ,术后血压控制不稳是再出血的危险因素。结论 :高血压脑出血早期术后再出血不容忽视 ,术后 <2 4h是再出血高危阶段。舒张压控制在 85mmHg以下 ,对预防再出血有重要意义更多还原

【Abstract】 Objective: To investigate the incidence, tim e, locus, prevention, cure and risk factor of recurrent hemorrhage in earlier pe riod of cerebral hemorrhage after operation. Methods: 322 patients on whom opera tions have been done in earlier period of cerebral hemorrhage were analyzed retr ospectively. The clinical data were compared and analyzed statistically between hemorrhage and recurrent cerebral hemorrhage groups. Logistic regression analysi s was applied to analyze the function of various possible factors to recurrent h emorrhage after operation. Results: The incidence of recurrent hemorrhage was 21 .4 % in earlier period of cerebral hemorrhage after operation. When the operatio n was performed after cerebral hemorrhage within 6 h, 6～12 h and 12～24 h, the in cidence of recurrent hemorrhage after operation was 43.1 %, 20.9 % and 3.6 % res pectively. As to time of recurrent hemorrhage, the incidence was 3.1 % within 12 h after operation, 15.5 % between 12～24 h and just 2.8 % after 24 h. The incid e nce of recurrent hemorrhage in basipodite was 92.6 %. Mono-agent logistic analy sis revealed that there was significant correlation between high diastolic blood pressure, labilization of blood pressure after operation, taking anti-coagulan t drug for a long time, bleeding site, difficulty or un-thorough of hemostasis in operation and recurrent hemorrhage ( P <0.01). Multiple linear logistic reg ression analysis showed that a remarkable diastolic blood pressure, labilization of blood pressure after operation were risk factors of recurrent hemorrhage. Co nclusion: The incidence of recurrent cerebral hemorrhage after the operation in earlier period is 21.4 %, which can never be ignored. The period within 24 h aft er operation is a highly risky stage. Controlling diastolic blood pressure under 85 mmHg and steadily controlling the pressure after operation have a great impo rtance in preventing recurrent cerebral hemorrhage.更多还原