Relation between perioperative hypertension and intracranial hemorrhage after craniotomy

被引:236
作者
Basali, A
Mascha, EJ
Kalfas, I
Schubert, A
机构
[1] Cleveland Clin Fdn, Dept Gen Anesthesiol, Cleveland, OH 44195 USA
[2] Ohio State Univ, Cleveland Clin Fdn, Hlth Sci Ctr, Cleveland, OH USA
[3] Cleveland Clin Fdn, Dept Biostat & Epidemiol, Cleveland, OH 44195 USA
[4] Cleveland Clin Fdn, Dept Neurosurg, Cleveland, OH 44195 USA
关键词
anesthesia; complications; morbidity; neurosurgery;
D O I
10.1097/00000542-200007000-00012
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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.
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页码:48 / 54
页数:7
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