脑脊液/脑内室体积与高血压性脑出血患者立体定向微创穿刺引流术后再出血的关系分析

刘宇

【摘要】 目的：研究腦脊液/脑内室体积（CSF/ICV）与高血压性脑出血（HIH）患者立体定向微创穿刺引流（SMIPD）术后再出血的关系。方法：选择2019年2月-2020年12月在本院接受SMIPD手术治疗的200例HIH患者。21例患者发生术后再出血为观察组，179例患者未发生再出血为对照组。比较两组CSF/ICV及颅内压（ICP）水平，分析患者术后再出血情况的影响因素。结果：观察组的CSF/ICV及ICP水平均高于对照组，差异均有统计学意义（P<0.05）。根据Pearson法分析相关性显示，患者的CSF/ICV与ICP呈正相关（r=0.649，P<0.05）。两组性别、年龄、术前收缩压、出血量、出血区域、GCS评分及是否合并糖尿病、冠心病、高脂血症和高血压病程比较，差异均无统计学意义（P>0.05）。两组手术时机、术后收缩压比较，差异均有统计学意义（P<0.05）。根据logistic回归分析法统计发现，CSF/ICV、术后收缩压及手术时机均为患者术后再出血的影响因素（P<0.05）。结论：CSF/ICV术后收缩压及手术时机均为HIH患者SMIPD术后再出血的影响因素。

【关键词】 脑脊液 脑内室体积 高血压性脑出血 立体定向微创穿刺引流

Relationship between Cerebrospinal Fluid/Intracerebral Ventricular Volume and Rebleeding after Stereotactic Minimally Invasive Puncture and Drainage in the Treatment of Patients with Hypertensive Intracerebral Hemorrhage/LIU Yu. //Medical Innovation of China， 2021， 18（31）： -147

[Abstract] Objective： To investigate the relationship between cerebrospinal fluid/intracerebral ventricular volume （CSF/ICV） and rebleeding after stereotactic minimally invasive puncture and drainage （SMIPD） in the treatment of patients with hypertensive intracerebral hemorrhage （HIH）. Method： A total of 200 HIH patients who underwent SMIPD surgery in our hospital from February 2019 to December 2020 were selected. 21 patients with postoperative rebleeding were in the observation group， and 179 patients without rebleeding were in the control group. CSF/ICV and intracranial pressure （ICP） levels were compared between two groups， and the influencing factors of postoperative rebleeding were analyzed. Result： The levels of CSF/ICV and ICP in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. Pearson correlation analysis showed that CSF/ICV was positively correlated with ICP （r=0.649， P<0.05）. There were no statistically significant differences in gender， age， preoperative systolic blood pressure， bleeding volume， bleeding area， GCS score and the diabetes， coronary heart disease， hyperlipidemia and course of hypertension between two groups （P>0.05）. There were statistically significant differences in surgical timing and postoperative systolic blood pressure between two groups （P<0.05）. logistic regression analysis showed that CSF/ICV， postoperative systolic blood pressure and surgical time were all influential factors of postoperative rebleeding （P<0.05）. Conclusion： CSF/ICV， postoperative systolic blood pressure and the surgical timing are the influencing factors of rebleeding after SMIPD in HIH patients.

[Key words] Cerebrospinal fluid Intracerebral ventricle volume Hypertensive cerebral hemorrhage Stereotactic minimally invasive puncture and drainage

First-author’s address： Chaoyang City Central Hospital of Liaoning Province， Chaoyang 122000， China

doi：10.3969/j.issn.1674-4985.2021.31.034

高血压性脑出血（hypertensive intracerebral hemorrhage，HIH）是临床十分多见的一类脑血管类疾病，此病对患者脑部的危害较大，且预后较差，若不及时为患者采取科学的治疗措施，则可能会导致较高的致残率及死亡率[1]。目前，手术治疗能够较好地降低患者的死亡率，并提升其生存质量，临床应用较为广泛的立体定向微创穿刺引流（stereotactic minimally invasive puncture and drainage，SMIPD）即能获得较好的预后效果[2]。然而，无论选择何种手术方案，患者在术后均可能会出现再出血的情况，这将进一步加剧患者的病情，增大治療难度，同时危及其生命安全，因此，探寻何种因素与HIH患者的术后再出血具有紧密联系，将对患者的预后生存产生指导作用。……