高血压脑出血术后再出血分析与防治(1)
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[摘要] 目的 探讨高血压脑出血术后再出血发生的原因、防治方法。 方法 回顾463例经手术治疗的高血压脑出血的临床资料，分析高血压脑出血术后再出血的原因。 结果 463例高血压脑出血患者术后发生再出血48例，占10.37%。凝血功能异常、血肿形状不规则、出血量大、血压骤然波动大、超早期手术是高血压脑出血术后再出血的重要因素(P < 0.05)。 结论 术前有凝血功能异常者严格掌握手术指征；如病情允许，高血压脑出血首次手术时间应选择在7～24 h；术中清除血肿70%～80%即可，避免对血肿壁的损伤操作；术后加强血压监控。
[关键词] 高血压脑出血；术后再出血；防治
[中图分类号] R651.1 [文献标识码] A [文章编号] 1673-7210(2012)04(a)-0053-02
Analysis and prevention of rebleeding after hypertensive intracerebral hemorrhage surgery
LU Ke ZHU Sheng XIE Hua ZHANG Yingpeng GUO Chunyu CHEN Jian YAO Jiemin
The Third Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning 530031, China
[Abstract] Objective To investigate the causes and prevention and treatment methods of rebleeding after hypertensive intracerebral hemorrhage surgery. Methods The clinical data of 463 patients receiving the surgical treatment of hypertensive intracerebral hemorrhage was reviewed and the causes of rebleeding after hypertensive intracerebral hemorrhage were analyzed. Results Of the 463 patients receiving the surgical treatment of hypertensive cerebral hemorrhage, postoperative bleeding was found in 48 patients, accounting for 10.37%. Abnormal blood coagulation function, irregular hematoma shape, large bleeding amount, large sudden fluctuation of blood pressure, super early surgery were important causes of rebleeding after hypertensive intracerebral hemorrhage (P < 0.05). Conclusion Surgical indications should be strictly controlled for people with abnormal blood coagulation function; If the patient′s conditions allows, the first surgery time of hypertensive intracerebral hemorrhage should be selected between 7-24 hours; It is enough to remove 70%-80% of the hematoma during the surgery in order to avoid the injury operations to the hematoma wall; Blood press examination and control after the surgery should be strengthened.
[Key words] Hypertensive intracerebral hemorrhage; Postoperative rebleeding; Prevention and treatment
高血压脑出血是最常见的原发性脑实质内出血，其病死率和病残率均较高，手术清除血肿对于改善预后非常重要，但术后再出血严重影响着治疗效果，预防和正确处理再出血，对提高患者预后及生存质量尤为重要 ......
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