【摘要】 目的探讨神经内镜治疗高血压脑出血术后早期(24 h内)再出血的原因和预防措施。方法应用神经内镜手术治疗高血压性壳核脑出血术后患者69例,于术后6、24 h复查头颅CT。术后病情恶化的患者立即复查。分为术后再出血组和无再出血组,对比分析两组在年龄、长期饮酒、服用抗血小板和抗凝药物、术中止血情况、术后血压波动情况等5个方面的差异,结合手术经过分析预防措施。结果本组患者术中血肿清除程度均>90%。术后24 h内发生再出血9例,再出血率为13.0%。超早期手术者在再出血组中占77.8%,在无再出血组中占23.3%,两组比较差异有统计学意义(P=0.003);术后血压波动在再出血组中占66.7%,在无再出血组中占13.3%,两组比较差异有统计学意义(P=0.001);被认定术中止血欠确切者在再出血组中占55.6%,在无再出血组中占11.7%,两组比较差异有统计学意义(P=0.003)。入院前GCS评分11~13分者在再出血组中占88.9%,在无出血组中占43.3%,两组比较差异有统计学意义(P=0.003)。结论虽然神经内镜治疗高血压脑出血术后早期再出血可能与多种因素有关,但是其中超早期手术、止血欠确切、术后血压波动与术后再出血密切相关。选择正确的手术时机、术中确切止血、加强术后血压管理是防止术后早期再出血的最重要措施。更多还原

【Abstract】 Objective To investigate the causes and preventive management of postoperative early rehaemorrhagia( during the first 24 hours after operation) after neuroendoscopic treatment for hypertensive cerebral hemorrhage.Methods The five known contributing factors for postoperative rehaemorrhagia such as age,alcoholism,antiplatelet or anticoagulant therapy,intraoperative hemostasis,fluctuation of postoperative blood pressure were analyzed retrospectively on 69 patients with hypertensive putamen hemorrhage who underwent neuroendoscopic evacuation.Head CT scans were performed at 6 h and 24 h after operation in all patients.A CT scan was also performed immediately whenever the patients’ conditions were getting worse after surgery.Sixty-nine patients were divided into the rehaemorrhagia group and the non-rehaemorrhagia group.Results Intraoperative removal of more than 90% of hematomas was achieved in all of the 69 patients.Nine patients developed rehaemorrhagia within the first 24 hours after operation.The postoperative rehaemorrhagia rate was13.0%.Ultra-early surgery was done in 77.8% of the rehaemorrhagia group while only in 23.3% of the non-rehaemorrhagia group( P = 0.003).Postoperative fluctuation of blood pressure occurred in 66.7% of patients in the rehaemorrhagia group,whereas it only occurred in 13.3% of patients in the non-rehaemorrhagia group( P = 0.001).Unreliable intraoperative hemostasis occurred in 55.6% of patients in the rehaemorrhagia group,whereas it only occurred in 11.7%of the non-rehaemorrhagia group( P = 0.003).GCS scores before admission in 88.7% of patients in the rehaemorrhagia group were between 11 to 13,whereas only 43.3% in the non-rehaemorrhagia group had a GCS score between 11 to 13( P = 0.033).Conclusions Although many factors may be associated with postoperative rehaemorrhagia after neuroendoscopic treatment for hypertensive cerebral hemorrhage,ultra-early surgery,unreliable intraoperative hemostasis and poor control of postoperative blood pressure may be the closely related factors.Therefore,proper timing of surgery,reliable intraoperative hemostasis and strict postoperative management of blood pressure are the most important strategies to prevent postoperative rehaemorrhagia.更多还原