本文選題：腦出血 + 血小板抑制劑類藥物��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的分析阿司匹林對高血壓腦出血患者急診開顱手術血腫清除術術后再出血率的影響,并探討此類患者手術時機的選擇。方法回顧性分析2013年01月01日至2016年06月31日沈陽軍區(qū)總醫(yī)院神經(jīng)外科我科共收治腦出血患者3341例,除外明確顱內動脈瘤、血管畸形等造成的腦出血及未手術腦出血患者,剩余共有1712例高血壓腦出血手術治療患者,再選取其中采用骨瓣開窗顱內血腫清除術的腦出血患者775例,排除本科室其他手術組手術患者,本研究共納入153例病例。其中25例(A組)有血小板抑制類藥物(阿司匹林)應用史,出血前近期仍在使用該藥物,且術前行TEG(thromboela-stogram,血栓彈力圖)檢查花生四烯酸(AA)途徑誘導的血小板抑制率,且根據(jù)產(chǎn)品說明中AA抑制率大于50%者,手術術后再出血有增加趨勢,本實驗選取的腦出血患者抑制率均大于50%,另外128例(B組)無血小板抑制藥物應用史的高血壓腦出血手術患者。兩組數(shù)據(jù)采用病例對照研究方式比較兩組腦出血患者術后再出血率的差異。數(shù)據(jù)分析采用統(tǒng)計學軟件SPSS19.0對數(shù)據(jù)進行分析,具體統(tǒng)計學方法為:計量資料符合正態(tài)分布用均數(shù)±標準差表示,組間比較采用兩組獨立樣本的t檢驗:計數(shù)資料以百分率表示,組間比較采用χ2檢驗;探討口服阿司匹林是否與術后再出血有無相關性,使用二分類logistic回歸分析。P0.05表示差異具有統(tǒng)計學意義。結果A組患者有阿司匹林服用史,出血時仍在使用且術前行TEG檢查花生四烯酸(AA)途徑誘導的血小板抑制率,且抑制率均大于50%腦出血手術患者中再出血者2例,再出血率為8.00%,B組無阿司匹林及其他血小板抑制藥物應用史的高血壓腦出血手術患者術后再出血者8例,再出血率為6.25%,綜合再出血率為6.54%,χ~2=0.014,P0.25,區(qū)別沒有統(tǒng)計學意義。結論本結果表明有使用血小板抑制類藥物(阿司匹林)的高血壓腦出血患者急診開顱血腫清除術后再出血率較未使用血小板抑制類藥物的高血壓腦出血患者沒有明顯增加,因此對于此類有手術指征的腦出血患者如積極手術,可能降低不良后果的發(fā)生概率。
[Abstract]:Objective to analyze the effect of aspirin on the rate of rebleeding in patients with hypertensive intracerebral hemorrhage after emergency craniotomy. Methods 3341 patients with intracerebral hemorrhage were retrospectively analyzed from January 01, 2013 to June 31, 2016, Department of Neurosurgery, Shenyang military region General Hospital, with the exception of intracerebral hemorrhage and unoperated intracerebral hemorrhage caused by intracranial aneurysm and vascular malformation. There were 1712 patients with hypertensive intracerebral hemorrhage. Among them, 775 patients were treated with craniocerebral hematoma clearance with bone flap, excluding other surgical patients in our department. 153 cases were included in this study. In group A, 25 patients had a history of use of platelet suppressor (aspirin), which was still used recently before bleeding, and the platelet inhibition rate induced by the arachidonic acid (AAA) pathway was examined by TEGG thrombo-boela-stograms (thromboelastogram) before bleeding. According to the product description, the rate of AA inhibition was more than 50%, and there was an increasing trend of rebleeding after operation. The inhibitory rates of patients with cerebral hemorrhage were more than 50 and 128 patients in group B were treated with hypertensive intracerebral hemorrhage with no history of platelet suppressive drugs. Case-control study was used to compare the rate of postoperative rebleeding between the two groups of patients with intracerebral hemorrhage. The statistical software SPSS19.0 was used to analyze the data. The specific statistical methods were as follows: the measurement data were expressed by mean 鹵standard deviation according to normal distribution, and the comparison between groups was expressed by t-test of two independent samples: counting data was expressed as percentage. 蠂 2 test was used to study the correlation between oral aspirin and postoperative rebleeding. The difference was statistically significant by using two classification logistic regression analysis. P0.05. Results the patients in group A had a history of aspirin taking and were still in use at the time of hemorrhage. The platelet inhibition rate induced by arachidonic acid (AA) pathway was examined by TEG before operation, and the inhibition rate was higher than that in 2 patients with recurrent hemorrhage in 50% intracerebral hemorrhage operation. The rebleeding rate of group B was 8.00%. In group B, 8 patients with hypertensive intracerebral hemorrhage who had no history of aspirin and other platelet suppressive drugs were re-bleeding after operation, the rate of rebleeding was 6.25, and the rate of comprehensive rebleeding was 6.54g, 蠂 ~ (20.014) P _ (0.25). The difference was not statistically significant. Conclusion the results suggest that the rate of rebleeding after emergency craniotomy in patients with hypertensive intracerebral hemorrhage using platelet-suppressive drugs (aspirin) is not significantly higher than that in patients with hypertensive intracerebral hemorrhage without platelet inhibitors. Therefore, active surgery may reduce the probability of adverse consequences in patients with intracerebral hemorrhage.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.1

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本文編號：1940798