阿司匹林相关性脑出血钻孔引流术后继发性脑梗死的危险因素分析

邓 磊1） 汪美平2）△ 张 珑1） 张先斌1） 秦 荣1） 张有昆1） 龚存林1）

1. 中国人民解放军联勤保障部队第九〇八医院，江西 南昌 330002 2）樟树市人民医院，江西 樟树 331299

作者简介：邓磊，Email：shalei71115@163.com

△通信作者：汪美平，Email：53026803@qq.com

【摘要】 目的 探究阿司匹林相关性脑出血患者钻孔引流术后继发性脑梗死的危险因素。方法 选取 2016-09—2019-10 于中国人民解放军联勤保障部队第九〇八医院接受钻孔引流术的 179 例有口服阿司匹林史的脑出血患者为研究对象，根据术后是否发生脑梗死分为脑梗死组（52 例）和非脑梗死组（127 例）。比较 2 组患者一般临床资料以及实验室指标，将差异显著的因素纳入 logistic 多因素回归分析，以发生脑梗死的独立危险因素构建阿司匹林相关性脑出血患者术后继发性脑梗死的列线图预测模型，并对模型进行分析。结果 脑梗死组患者高血压人数、口服阿司匹林时间、收缩压、舒张压、脑组织位移、手术时长、发病至手术时间、血肿大小均高于非脑梗死组，hs-CRP 低于非脑梗死组（P<0.05）。多因素分析显示高血压、口服阿司匹林时间、术中出血量、血肿大小以及发病至手术时间是阿司匹林相关性脑出血患者术后继发性脑梗死的独立预测因素（P<0.05）。根据多因素分析结果构建列线图预测模型并对模型进行验证， 校准曲线显示以上述因素构建的脑梗死发生风险列线图模型准确性较高，模型的 C-index 值为 0.822（95% CI：0.691~0.878），ROC 曲线下面积（area under curve，AUC）为0.892，预测准确度为85.93%。结论 高血压、口服阿司匹林时间、脑组织位移、血肿大小以及发病至手术时间是阿司匹林相关性脑出血患者术后继发性脑梗死的独立危险因素。依据独立影响因素构建的列线图预测模型对患者术后继发性脑梗死发生风险预测效能较好。临床上应严格阿司匹林用药指征，动态监测凝血指标，改善患者预后。

【关键词】 脑出血；钻孔引流术；继发性脑梗死；危险因素；阿司匹林；凝血；预后

【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1673-5110 （2021） 24-2126-10

DOI：10.12083/SYSJ.2021.24.005

Analysis of risk factors of secondary cerebral infarction in patients with aspirin-related cerebral hemorrhage after drilling and drainage surgery

DENG Lei1），WANG Meiping2），ZHANG Long1），ZHANG Xianbin1），QIN Rong1），ZHANG Youkun1），GONG Cunlin1）

1. The 908th Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army，Nanchang 330002，

China；2）Zhangshu People’s Hospital，Zhangshu 331299，China

【Abstract】 Objective To explore the risk factors of secondary cerebral infarction in patients with aspi⁃ rin-related intracerebral hemorrhage after drilling and drainage surgery. Methods Totally 179 patients with cerebral hemorrhage with a history of oral aspirin who underwent drilling and drainage surgery in our hospital from Sep⁃ tember 2018 to October 2019 were selected as the research objects. According to whether cerebral infarction occurred after the operation，they were divided into cerebral infarction group（52 cases）and non-cerebral infarction group（127 cases）. The general clinical data and laboratory indicators of the two groups of patients were compared，and the significant differences were included in the logistic multivariate regression analysis，and the independent risk factors of cerebral infarction were used to construct the nomogram prediction of secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage after surgery model and analyze the model. Results The number of hypertension，time of oral aspirin，systolic blood pressure，diastolic blood pressure，brain tissue displacement，length of operation，time from onset to operation，and hematoma size in the cerebral infarction group were higher than those in the non-cerebral infarction group，and hs-CRP was lower than that in the non-cerebral infarction group（P<0.05）. Multivariate analysis showed that hypertension，time of oral aspirin，intraoperative blood loss， hematoma size，and time from onset to operation were independent predictors of secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage （P<0.05）. According to the results of multi-factor analysis，a nomogram prediction model was constructed and the model was verified. The calibration curve showed that the accuracy of the cerebral infarction risk nomogram model constructed with the above factors was high，and the C-index value of the model was 0.822（95% CI：0.691-0.878），the area under curve（AUC）is 0.892，and the predic⁃ tion accuracy is 85.93%，indicating that the model has strong predictive ability. Conclusion Hypertension，time of oral aspirin，brain tissue displacement，hematoma size，and time from onset to operation are independent risk factors for secondary cerebral infarction in patients with aspirin-related intracerebral hemorrhage after surgery. The nomogram prediction model constructed based on the above factors has a better performance in predicting the risk of postoperative secondary cerebral infarction. In clinical practice，aspirin medication should be strictly indicated，and coagulation indicators should be monitored dynamically to improve the prognosis of patients.

【Key words】 Cerebral hemorrhage；Drilling and drainage surgery；Secondary cerebral infarction；Risk fac⁃ tors；Aspirin；Coagulation；Prognosis