高血压脑出血患者开颅血肿清除术后镇静治疗效果及其预后影响因素研究

摘要

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(P0.05).(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(P0.05);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(P0.05).(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(P0.05);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.