摘要
目的探讨小脑梗死后颅窝减压术后出血转化的相关危险因素。方法选取2010年1月至2018年1月在金华市中心医院神经外科行后颅窝减压术的91例小脑梗死患者,其中术后出血转化或出血增多组17例,无出血或出血无变化组74例。回顾性分析比较两组患者的临床指标,经单因素和非条件多因素logistic回归分析法,筛选和分析小脑梗死后颅窝减压术后出血转化的相关危险因素。结果单因素分析显示,两组在大面积小脑梗死(受累面积直径>5cm)、术前急诊溶栓治疗、术前少量出血、口服抗凝药、房颤、高血糖和术后血压波动7个危险因素差异有统计学意义(P<0.05);多因素分析显示,大面积小脑梗死(P<0.05)、术前急诊溶栓治疗(P<0.01)、术前少量出血(P<0.01)和口服抗凝药(P<0.01)是小脑梗死减压术后发生出血转化的相关独立危险因素。结论大面积小脑梗死、术前急诊溶栓治疗、术前少量出血、口服抗凝药、房颤、高血糖和术后血压波动是小脑梗死减压术后出血转化的重要危险因素,大面积小脑梗死、术前急诊溶栓治疗、术前少量出血和口服抗凝药是术后出血转化的独立危险因素,术前合理评估这些因素,同时个体化治疗术后出血转化,有助于更好把握手术风险和提高临床预后,具有重要意义。
Objective To investigate the related risk factors for hemorrhagic transformation (HT) of cerebellar infarction after posterior fossa decompression surgery. Methods A total of 91 patients with cerebellar infarction were treated by posterior fossa decompression surgery in Department of Neurosurgery of Jinhua Municipal Central Hospital from Jan 2010 to Jan 2018, were selected as study subjects. The HT group included 17 cases, while the Non-HT group included 74 cases. The clinical data of the two groups were analyzed retrospectively, the univariate and non-conditional lgistic regression analysis were performed to detect the relevant risk factors for hemorrhagic transformation of cerebellar infarction after posterior fossa decompression surgery. Results By univariate analysis, the differences of these seven risk factors, the large area cerebellar infarction (the diameter of area was larger than 5 cm), pre-op thrombolysis, pre-op mild HT, oral anticoagulants, atrial fibrillation, hyperglycemia and fluctuation of BP in post-op, between two groups were statistically significant (P<0.05). By multivariate logistic analysis, the large area cerebellar infarction (P<0.05), pre-op thrombolysis(P<0.01), pre-op mild HT (P<0.01), oral anticoagulants (P<0.01) were the independent risk factors for post-op HT. Conclusions The large area cerebellar infarction (the diameter of area was more than 5 cm), pre-op thrombolysis, pre-op mild HT, oral anticoagulants, atrial fibrillation, hyperglycemia and fluctuation of BP in post-op are important risk factors for post-op HT. The large area cerebellar infarction, pre-op thrombolysis, pre-op mild HT, oral anticoagulants are the independent risk factors for post-op HT. A proper pre-op evaluation of these risk factors and an individualized treatment for post-op HT would help a lot with balancing operational risk and improving prognosis.
作者
许志剑
余丹枫
徐虎
周格知
Xu Zhijian;Yu Danfeng;Xu Hu;Zhou Gezhi(Department of Neurosurgery,Jinhua Municipal Central Hospital,Jinhua 321000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第5期380-383,共4页
National Medical Journal of China
关键词
小脑梗死
出血转化
后颅窝减压术
危险因素
Cerebellar infarction
Hemorrhagic transformation
Posterior fossa decompression
Risk factor
