Objective To analyze the sedative treatment outcome and influencing factors of prognosis in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma.Methods From April 2012 to March 2016,a total of 78 hypertensive cerebral hemorrhage patients undergoing craniotomy for evacuation of hematoma were selected in General Hospital of Fengfeng Mining District,Handan,and they were divided into sedation group and non-sedation group according to random number table,each of 39 cases. Patients in non-sedation group received routine intensive care,while patients in sedation group received intravenous pumping of midazolam for 3 days based on routine intensive care. Blood pressure and incidence of restlessness 1 hour,12 hours,24 hours and 48 hours after operation,incidence of re-hemorrhage and prognosis during the 3-month follow-up were compared between the two groups. Influencing factors of prognosis in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma were analyzed by multivariate Logistic regression analysis.Results There was significant interaction between time and method in SBP and DBP(P<0.05);main effects of time and method were significant in SBP and DBP(P<0.05);SBP and DBP in sedation group were statistically significantly lower than those in non-sedation group 12 hours,24 hours and 48 hours after operation(P<0.05).(2)Incidence of restlessness in sedation group was statistically significantly lower than that in non-sedation group 1 hour and 12 hours after operation,respectively(P<0.05),while no statistically significant differences of incidence of restlessness was found between the two groups 24 hours or 48 h after operation(P>0.05).(3)Incidence of re-hemorrhage in sedation group was statistically significantly lower than that in non-sedation group during follow-up,while proportion of patients with good prognosis in sedation group was statistically significantly higher than that in non-sedation group(P<0.05). No statistically significant differences of gender,hematoma volume,hematoma locations,age,GCS score at admission,duration of operation,SBP or DBP was found in patients with different prognosis(P>0.05);proportion of patients with hematoma broken into cerebral ventricle,24 h SBP-SD,24 h DBP-SD,24 h SBP-ARV and 24 h DBP-ARV in patients with good prognosis were statistically significantly lower than those in patients with poor prognosis,while proportion of patients received sedative treatment in patients with good prognosis was statistically significantly higher than that in patients with poor prognosis(P<0.05).(5)Multivariate Logistic regression analysis results showed that,24 h SBP-SD〔OR=10.381,95％CI(1.468,72.984)〕,24 h DBP-SD〔OR=12.984,95％CI(2.598,58.447)〕,24 h SBP-ARV〔OR=13.466,95％CI(1.768,102.687)〕,24 h DBP-ARV〔OR=13.416,95％CI(2.607,69.012)〕and sedative treatment〔OR=0.127,95％CI(0.027,0.595)〕were independent influencing factors of prognosis in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma(P<0.05).Conclusion Sedative treatment has certain effect in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma,can effectively stabilize the blood pressure,reduce the risk of postoperative restlessness and re-hemorrhage,improve the prognosis;blood pressure variability and sedative treatment are independent influencing factors of prognosis in postoperative hypertensive cerebral hemorrhage patients treated by craniotomy for evacuation of hematoma.%目的 分析高血压脑出血患者开颅血肿清除术后镇静治疗效果,并探讨其预后影响因素.方法 选取2012年4月—2016年3月在邯郸市冀中能源峰峰集团总医院行开颅血肿清除术的高血压脑出血患者78例,采用随机数字表法分为镇静组和非镇静组,每组39例.非镇静组患者于开颅血肿清除术后给予常规重症监护,镇静组患者在非镇静组基础上静脉泵注咪达唑仑,持续治疗3 d.比较两组患者术后1 h、12 h、24 h、48 h血压、躁动发生率,随访3个月再出血发生率及预后.高血压脑出血患者开颅血肿清除术后预后影响因素分析采用多因素Logistic回归分析.结果 (1)时间与方法在收缩压(SBP)、舒张压(DBP)上存在交互作用(P<0.05);时间与方法在SBP、DBP上主效应显著(P<0.05);术后12 h、24 h、48 h镇静组患者SBP、DBP低于非镇静组(P<0.05).(2)镇静组患者术后1 h、12 h躁动发生率低于非镇静组(P<0.05);两组患者术后24 h、48 h躁动发生率比较,差异无统计学意义(P>0.05).(3)镇静组患者随访期间再出血发生率低于非镇静组,预后良好者所占比例高于非镇静组(P<0.05).(4)不同预后患者性别、血肿量、血肿位置、年龄、入院时格拉斯哥昏迷量表(GCS)评分、手术时间、SBP、DBP比较,差异无统计学意义(P>0.05);预后良好者中血肿破入脑室者所占比例、24 h收缩压标准差(24 h SBP-SD)、24 h舒张压标准差(24 h DBP-SD)、24 h收缩压平均真实变异性(24 h SBP-ARV)、24 h舒张压平均真实变异性(24 h DBP-ARV)低于预后不良者,镇静治疗者所占比例高于预后不良者(P<0.05).(5)多因素Logistic回归分析结果显示,24 h SBP-SD〔OR=10.381,95％CI(1.468,72.984)〕、24 h DBP-SD〔OR=12.984,95％CI(2.598,58.447)〕、24 h SBP-ARV〔OR=13.466,95％CI(1.768,102.687)〕、24 h DBP-ARV〔OR=13.416,95％CI(2.607,69.012)〕及镇静治疗〔OR=0.127,95％CI(0.027,0.595)〕是高血压脑出血患者开颅血肿清除术后预后的独立影响因素(P<0.05).结论 高血压脑出血患者开颅血肿清除术后镇静治疗效果确切,能有效稳定患者血压,降低术后躁动、再出血发生率,改善患者预后;血压变异性和镇静治疗是高血压脑出血患者开颅血肿清除术后预后的独立影响因素.
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