Relation between perioperative hypertension and intracranial hemorrhage after craniotomy
Relation between perioperative hypertension and intracranial hemorrhage after craniotomy
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DOI：
10.1097/00000542-200007000-00012
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发表时间：
2000-07-01
期刊：
影响因子：
8.8
通讯作者：
Schubert, A
中科院分区：
文献类型：
--
作者：
Basali, A;Mascha, EJ;Schubert, A
背景：既往资料提示全身性高血压（HTN）是开颅术后颅内出血（ICH）的危险因素。作者采用回顾性病例对照设计研究了围手术期血压升高与术后ICH之间的关系。方法：对1976年至1992年接受开颅手术的所有患者的医院数据库进行筛选，排除凝血功能障碍和不匹配的患者。有69例可评价患者术后发生ICH（n = 69）。一个2：1匹配（年龄，手术日期，病理诊断，手术方式和外科医生）的对照组，没有术后rca（n = 138）。检查术前、术中和术后（最多12小时）的血压记录。围手术期HTN（血压大于或等于160/90 mmHg）的发病率和ICH.Results的比值比：11,214例开颅手术患者中，86例（0.77%）患有ICH，69例符合纳入标准。ICH组（34%）和对照组（24%）的术前HTN发生率相似。术后21小时（中位数）发生ICH，四分位数间距为4-52小时。62%的ICH患者术中有HTN，而对照组只有34%（P < 0.001）。62%的ICH患者在术后最初12小时内有出血前Hm，而对照组为25%（P < 0.001），术后ICH的比值比为4.6（P < 0.001）。住院时间（中位数，24.5与11.0天），死亡率（18.2与1.6%）是显着更大的ICE比在对照groups.Conclusions：颅内出血开颅术后严重延长住院时间和死亡率。急性血压升高经常发生在开颅术后ICH之前。发生开颅术后ICH的患者更可能在术中和术后早期出现高血压。
Background: Previous data suggest that systemic hypertension (HTN) is a risk factor for postcraniotomy intracranial hemorrhage (ICH). The authors examined the relation between perioperative blood pressure elevation and postoperative ICH using a retrospective case control design.Methods: The hospital's database of all patients undergoing craniotomy from 1976 to 1992 was screened, Coagulopathic and unmatchable patients were excluded. There were 69 evaluable patients who developed ICH postoperatively (n = 69). A 2-to-1 matched (by age, date of surgery, pathologic diagnosis, surgical procedure, and surgeon) control group without postoperative rca was assembled (n = 138). Preoperative, intraoperative, and postoperative blood pressure records (up to 12 h) were examined. Incidence of perioperative HTN (blood pressure greater than or equal to 160/90 mmHg) and odds ratios for ICH were determined.Results: Of the 11,214 craniotomy patients, 86 (0.77%) suffered ICH, and 69 fulfilled inclusion criteria. The incidence of preoperative HTN was similar in the ICH (34%) and the control (24%) groups. ICH occurred 21 h (median) postoperatively, with an interquartile range of 4-52 h. Sixty-two percent of ICH patients had intraoperative HTN, compared with only 34% of controls (P < 0.001). Sixty-two percent of the ICH patients had prehemorrhage Hm in the initial 12 postoperative hours versus 25% of controls (P < 0.001), with an odds ratio of 4.6 (P < 0.001) for postoperative ICH. Hospital stay (median, 24.5 vs. 11.0 days), and mortality (18.2 vs. 1.6%) were significantly greater in the ICE than in the control groups.Conclusions: ICH after craniotomy is associated with severely prolonged hospital stay and mortality. Acute blood pressure elevations occur frequently prior to postcraniotomy ICH. Patients who develop postcraniotomy ICH are more likely to be hypertensive in the intraoperative and early postoperative periods.