Risk factors and treatment strategies of hypertensive intracerebral hemorrhage and rebleeding

doi:10.3877/cma.j.issn.2095-123X.2018.01.002

Abstract

Abstract:

Objective

To explore the risk factors and treatment strategies of rebleeding in hypertensive intracerebral hemorrhage.

Methods

Three hundred and twenty patients with hypertensive intracerebral hemorrhage who underwent surgical treatment, admitted to Department of Neurosurgery of General Hospital of Ji’nan Military Area from February 2010 to December 2017, were selected as clinical research cases. Their clinical data were retrospectively analyzed to explore the risk factors of hypertensive intracerebral hemorrhage.

Results

The incidence of recurrent hemorrhage in hypertensive intracerebral hemorrhage was 11.25% (36 cases). The original hemorrhage site and other hemorrhage sites were detected by CT, and the mortality rate was 61.11%. Rehemorrhage in patients with hypertensive intracerebral hemorrhage was correlated with bleeding volume, blood pressure control, patient agitation, long-term anticoagulant use, coagulation mechanism, INR value and timing of operation (P<0.05); and with age, sex, GCS score at admission, family history of hypertension, whether to take antihypertensive drugs regularly for a long time, and whether to take antihypertensive drugs regularly, location of cerebral hemorrhage, the use of dehydrating agents, and surgical methods were not related (P>0.05). Logistic regression equation was used to analyze the statistical significance of single factor analysis. It was concluded that bleeding volume (>60 mL), systolic blood pressure (≤140 mmHg), long-term oral anticoagulant, abnormal coagulation mechanism, INR value (≥1.4) and time from onset to operation (≤2.5 h) were independent risk factors for recurrent hemorrhage after hypertensive intracerebral hemorrhage (P<0.05).

Conclusion

Rehaemorrhage of hypertensive intracerebral hemorrhage is significantly correlated with the amount of bleeding, blood pressure control, agitation, coagulation function, long-term oral anticoagulant, INR value, timing of operation and other factors. Appropriate clinical treatment of appeal factors can reduce the rebleeding rate of cerebral hemorrhage.

Key words: Hypertensive cerebral hemorrhage, Rebleeding, Risk factors

Xueming Lyu, Yiran Duan, Zhenyu Zhao, Tianzhu Wang, Chenyu Chu, Peigang Lu, Shaoji Yuan. Risk factors and treatment strategies of hypertensive intracerebral hemorrhage and rebleeding[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2018, 08(01): 5-10.

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References 26

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指标		未再出血组（n=284）	再出血组（n=36）	t/χ²值	P值
年龄（Mean±SD，岁）		58.43±19.19	78.68±4.13	0.152	0.135
男性		172（60.56)	22（12.80)	0.889	0.110
出血部位		?	?	0.023	0.140
?	深部（基底节、丘脑、脑室）	185（65.14)	22（11.06)	?	?
?	浅表（脑叶）	99（34.86)	14（11.57)	?	?
出血量		?	?	5.248	0.010
?	≤60 mL	103（36.27)	19（8.30)	?	?
?	>60 mL	81（28.53)	17（16.83)	?	?
入院时GCS评分		?	?	0.010	0.140
?	≤8分	149（52.46)	18（11.11)	?	?
?	>8分	135（47.54)	18（11.39)	?	?
术后收缩压		?	?	25.401	0.001
?	≤140 mmHg	184（64.79)	8（3.98)	?	?
?	>140 mmHg	100（35.21)	28（21.71)	?	?
家族高血压病史		?	?	0.512	0.140
?	有	56（19.72)	6（8.82)	?	?
?	无	228（80.28)	30（11.90)	?	?
长期规律口服降压药物		?	?	0.778	0.100
?	有	99（34.86)	10（9.09)	?	?
?	无	185（65.14)	26（12.38)	?	?
凝血机制异常		?	?	96.014	0.001
?	有	65（22.89)	31（14.08)	?	?
?	无	219（77.11)	5（2.00)	?	?
长期服用抗凝药物		?	?	143.187	0.001
?	有	50（17.61)	32（57.14)	?	?
?	无	234（82.39)	4（1.51)	?	?
术前2 h内INR值		?	?	4.385	0.032
?	≤1.4	250（88.03)	26（44.83)	?	?
?	>1.4	34（11.97)	10（76.92)	?	?
是否使用甘露醇降颅压		?	?	0.819	0.111
?	是	197（69.37)	27（12.33)	?	?
?	否	87（30.63)	9（8.91)	?	?
发病后是否使用镇静处理		?	?	8.301	0.001
?	是	150（52.82)	11（6.47)	?	?
?	否	134（47.18)	25（16.67)	?	?
发病至手术时间		?	?	7.433	0.010
?	≤2.5 h(超早期手术)	35（12.32)	12（21.81)	?	?
?	>2.5 h	249（87.68)	24（9.06)	?	?
手术方式		?	?	2.146	0.051
?	常规（开颅）	84（29.58)	7（7.29)	?	?
?	微创（钻孔穿刺引流+尿激酶溶解术）	200（70.42)	29（12.95)	?	?

指标		未再出血组（n=284）	再出血组（n=36）	t/χ²值	P值
年龄（Mean±SD，岁）		58.43±19.19	78.68±4.13	0.152	0.135
男性		172（60.56)	22（12.80)	0.889	0.110
出血部位		?	?	0.023	0.140
?	深部（基底节、丘脑、脑室）	185（65.14)	22（11.06)	?	?
?	浅表（脑叶）	99（34.86)	14（11.57)	?	?
出血量		?	?	5.248	0.010
?	≤60 mL	103（36.27)	19（8.30)	?	?
?	>60 mL	81（28.53)	17（16.83)	?	?
入院时GCS评分		?	?	0.010	0.140
?	≤8分	149（52.46)	18（11.11)	?	?
?	>8分	135（47.54)	18（11.39)	?	?
术后收缩压		?	?	25.401	0.001
?	≤140 mmHg	184（64.79)	8（3.98)	?	?
?	>140 mmHg	100（35.21)	28（21.71)	?	?
家族高血压病史		?	?	0.512	0.140
?	有	56（19.72)	6（8.82)	?	?
?	无	228（80.28)	30（11.90)	?	?
长期规律口服降压药物		?	?	0.778	0.100
?	有	99（34.86)	10（9.09)	?	?
?	无	185（65.14)	26（12.38)	?	?
凝血机制异常		?	?	96.014	0.001
?	有	65（22.89)	31（14.08)	?	?
?	无	219（77.11)	5（2.00)	?	?
长期服用抗凝药物		?	?	143.187	0.001
?	有	50（17.61)	32（57.14)	?	?
?	无	234（82.39)	4（1.51)	?	?
术前2 h内INR值		?	?	4.385	0.032
?	≤1.4	250（88.03)	26（44.83)	?	?
?	>1.4	34（11.97)	10（76.92)	?	?
是否使用甘露醇降颅压		?	?	0.819	0.111
?	是	197（69.37)	27（12.33)	?	?
?	否	87（30.63)	9（8.91)	?	?
发病后是否使用镇静处理		?	?	8.301	0.001
?	是	150（52.82)	11（6.47)	?	?
?	否	134（47.18)	25（16.67)	?	?
发病至手术时间		?	?	7.433	0.010
?	≤2.5 h(超早期手术)	35（12.32)	12（21.81)	?	?
?	>2.5 h	249（87.68)	24（9.06)	?	?
手术方式		?	?	2.146	0.051
?	常规（开颅）	84（29.58)	7（7.29)	?	?
?	微创（钻孔穿刺引流+尿激酶溶解术）	200（70.42)	29（12.95)	?	?

指标		标准误	偏回归系数	Wald值	OR（95%CI）	P值
出血量		?	?	?	?	?
?	≤60 mL	0.489	0.237	0.235	2.266(0.694~8.101)	0.577
?	>60 mL	0.592	1.168	3.892	3.822(1.125~13.092)	0.024
收缩压		?	?	?	?	?
?	≤140 mmHg	0.365	0.284	0.606	1.176(0.606~2.592)	0.545
?	>140 mmHg	0.665	1.324	3.964	26.369(7.486~79.316)	0.001
凝血机制异常		?	?	?	?	?
?	无	0.367	?0.644	3.079	0.623(0.336~1.062)	0.089
?	有	0.650	0.889	1.871	13.042(3.682~50.002)	0.001
长期服用抗凝药		?	?	?	?	?
?	无	0.426	?0.457	1.151	0.637(0.262~1.394)	0.208
?	有	0.618	1.014	2.692	3.926(1.678~15.013)	0.001
术前2 h内INR值		?	?	?	?	?
?	≤1.4	0.333	?0.149	0.200	0.856(0.467~1.556)	0.621
?	>1.4	0.632	0.969	2.351	3.642(1.435~12.895)	0.001
发病后是否使用镇静处理		?	?	?	?	?
?	是	0.597	0.967	3.105	4.020(1.308~14.012)	0.019
?	否	0.422	0.643	2.322	1.900(0.817~4.818)	0.127
发病至手术时间		?	?	?	?	?
?	>2.5 h	0.391	?0.652	2.781	0.497（0.245~1.582）	0.085
?	≤2.5 h	0.611	1.184	3.755	3.482(1.095~11.016)	0.043

指标		标准误	偏回归系数	Wald值	OR（95%CI）	P值
出血量		?	?	?	?	?
?	≤60 mL	0.489	0.237	0.235	2.266(0.694~8.101)	0.577
?	>60 mL	0.592	1.168	3.892	3.822(1.125~13.092)	0.024
收缩压		?	?	?	?	?
?	≤140 mmHg	0.365	0.284	0.606	1.176(0.606~2.592)	0.545
?	>140 mmHg	0.665	1.324	3.964	26.369(7.486~79.316)	0.001
凝血机制异常		?	?	?	?	?
?	无	0.367	?0.644	3.079	0.623(0.336~1.062)	0.089
?	有	0.650	0.889	1.871	13.042(3.682~50.002)	0.001
长期服用抗凝药		?	?	?	?	?
?	无	0.426	?0.457	1.151	0.637(0.262~1.394)	0.208
?	有	0.618	1.014	2.692	3.926(1.678~15.013)	0.001
术前2 h内INR值		?	?	?	?	?
?	≤1.4	0.333	?0.149	0.200	0.856(0.467~1.556)	0.621
?	>1.4	0.632	0.969	2.351	3.642(1.435~12.895)	0.001
发病后是否使用镇静处理		?	?	?	?	?
?	是	0.597	0.967	3.105	4.020(1.308~14.012)	0.019
?	否	0.422	0.643	2.322	1.900(0.817~4.818)	0.127
发病至手术时间		?	?	?	?	?
?	>2.5 h	0.391	?0.652	2.781	0.497（0.245~1.582）	0.085
?	≤2.5 h	0.611	1.184	3.755	3.482(1.095~11.016)	0.043

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