Surgical Treatment Strategies For Patients With Intracerebral Hemorrhage Under Different Aspirin Inhibition Rates

Objective:To analyze the surgical treatment strategies of patients with cerebral hemorrhage under different aspirin inhibition rates,and to explore the influencing factors of postoperative rebleeding.Methods:A retrospective analysis was made on 120 patients with cerebral hemorrhage who underwent surgery in the Department of Neurosurgery of the Affiliated Hospital of Inner Mongolia University for the Nationalities from June 2016 to June 2019.The aspirin inhibition rate was measured by laboratory thromboelastogram before operation.The patients with aspirin inhibition rate of 50%and 100%were divided into 4 groups with aspirin inhibition rate of 75%as the center,50%?64%group(group A)and 65%?74%group(group B)and 75%?89%group(group C)and 90%?100%group(group D).There were 30 patients in each group.The basic information of each group was collected by electronic medical record information system,including age,sex,preoperative complications,bleeding site,bleeding volume,operation time,preoperative Glasgow Coma Score,blood coagulation index,platelet transfusion,operation mode,postoperative rebleeding and postoperative complications,as well as the follow-up records of Glasgow outcome scale 3 months after operation,and the data of each group were compared.IBM SPSS22.0 software was used for statistical analysis.The measurement data were expressed by mean±standard deviation and t-test,the counting data were analyzed by X~2test or rank sum test,and the two-way ordered data were analyzed by Spearman correlation analysis.single factor Logistic regression analysis was carried out for all patients with postoperative rebleeding as dependent variables and the studied factors as independent variables.According to the results of univariate analysis,multivariate Logistic regression analysis was carried out.Results:Statistical analysis of clinical data by IBM SPSS22.0 software showed that there were significant differences in blood loss,preoperative Glasgow Coma Score,platelet transfusion,operation timing,postoperative rebleeding and Glasgow outcome scale 3months after operation among the four groups.In patients with ICH with an aspirin inhibition rate of more than 75%,preoperative platelet transfusion significantly reduced postoperative rebleeding and improved Glasgow outcome scale 3 months after operation(P<0.05).Multivariate Logistic regression analysis showed that preoperative platelet transfusion was a protective factor for postoperative rebleeding(OR=0.261,95%CI:0.078?0.868,P<0.05).Early surgical treatment of ICH patients with an aspirin inhibition rate of more than 50%can improve the Glasgow outcome scale 3 months after operation compared with ultra-early and delayed treatment(P<0.05).In multivariate Logistic regression analysis,compared with early stage,subgroup analysis showed that ultra-early surgical treatment was a risk factor for postoperative rebleeding(OR=12.027,1.058?136.681,P<0.05).Compared with small bone window craniotomy and large bone flap craniotomy in patients with ICH with an aspirin inhibition rate of more than 50%,drilling and drainage can improve the 3-month GOS prognosis score(P<0.05).Multivariate Logistic regression analysis showed that abnormal coagulation indexes(OR=9.435,95%CI:1.991?44.696,P<0.05)and aspirin inhibition rate(OR=1.085,95%CI:1.031?1.143,P<0.05)were independent risk factors for postoperative rebleeding in ICH patients with an aspirin inhibition rate of more than 50%.Conclusion:(1)With the increase of aspirin inhibition rate,the amount of bleeding was larger,and the preoperative GCS coma score was lower.(2)For patients with cerebral hemorrhage with an aspirin inhibition rate of more than 75%,platelet transfusion can reduce the aspirin inhibition rate,reduce postoperative rebleeding,and improve the prognosis of the patients.(3)For patients with cerebral hemorrhage with an aspirin inhibition rate of more than 50%,early surgical treatment can reduce the risk of postoperative rebleeding more than ultra-early stage.(4)With the increase of aspirin inhibition rate,patients with cerebral hemorrhage should be treated by early operation(7 to 24 hours),mainly by drilling and drainage as far as possible.