钻孔引流术联合阿托伐他汀治疗慢性硬膜下血肿的效果
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摘要
目的探讨钻孔引流术联合阿托伐他汀治疗慢性硬膜下血肿(CSDH)的效果。方法选取2008年11月—2017年11月于我院接受治疗的CSDH患者42例,分为联合治疗组和单纯手术组各21例,单纯手术组患者行钻孔引流术治疗,联合治疗组在钻孔引流术的基础上口服阿托伐他汀,随访3个月后对两组患者的临床症状消失时间、血肿量消失程度、复发率及并发症发生率进行比较。结果两组患者临床疗效比较差异无显著性(P>0.05)。联合治疗组治疗后日常生活能力评分明显高于单纯手术组(t=5.209,P<0.05)。两组临床症状消失时间及复发率比较差异有显著性(t=-4.096,P<0.05,P=0.048)。结论 CSDH钻孔引流术后口服阿托伐他汀能够明显提高患者临床治疗效果,改善术后神经功能的康复,有效减少复发,值得在临床推广应用。
Objective To investigate the effect of trepanation and drainage combined with atorvastatin on chronic subdural hematoma(CSDH). Methods A total of 42 patients with CSDH treated in our hospital from November 2008 to November2017 were enrolled and equally divided into combined treatment group and simple operation group.The simple operation group underwent trepanation and drainage,and the combined treatment group was given atorvastatin tablets orally in addition to the operation.The time to symptom disappearance,the change in hematoma size,recurrence rate,and the incidence of complications were compared between the two groups after 3 months of follow-up. Results There was no significant difference in clinical outcome between the two groups(P>0.05).The combined treatment group had a significantly higher Activities of Daily Living score than the simple operation group(t=5.209,P<0.05),and there were significant differences in the time to symptom disappearance and recurrence rate(t=-4.096,P<0.05,P=0.048). Conclusion Trepanation and drainage combined with atorvastatin can significantly improve the clinical outcomes and the postoperative rehabilitation of neurological function and effectively reduce recurrence in patients with CSDH,and it holds promise for clinical application.
Objective To investigate the effect of trepanation and drainage combined with atorvastatin on chronic subdural hematoma(CSDH). Methods A total of 42 patients with CSDH treated in our hospital from November 2008 to November2017 were enrolled and equally divided into combined treatment group and simple operation group.The simple operation group underwent trepanation and drainage,and the combined treatment group was given atorvastatin tablets orally in addition to the operation.The time to symptom disappearance,the change in hematoma size,recurrence rate,and the incidence of complications were compared between the two groups after 3 months of follow-up. Results There was no significant difference in clinical outcome between the two groups(P>0.05).The combined treatment group had a significantly higher Activities of Daily Living score than the simple operation group(t=5.209,P<0.05),and there were significant differences in the time to symptom disappearance and recurrence rate(t=-4.096,P<0.05,P=0.048). Conclusion Trepanation and drainage combined with atorvastatin can significantly improve the clinical outcomes and the postoperative rehabilitation of neurological function and effectively reduce recurrence in patients with CSDH,and it holds promise for clinical application.
引文
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[12]JIANG R,ZHAO S G,WANG R Z,et al.Safety and efficacy of atorvastatin for chronic subdural hematoma in Chinese patients:A randomized clinicaltrial[J].JAMA Neurol,2018,75(11):1338-1346.
[13]QIU S,ZHUO W,SUN C M,et al.Effects of atorvastatin on chronic subdural hematoma:A systematic review[J].Medicine(Baltimore),2017,96(26):e7290.
[14]XU M,CHEN P,ZHU X,et al.Effects of atorvastatin on conservative and surgical treatments of chronic subdural hematoma in patients[J].World Neurosurg,2016,91:23-28.
[15]TANG R R,SHI J T,LI X G,et al.Effects of atorvastatin on surgical treatments of chronic subdural hematoma[J].World Neurosurg,2018,117:e425-e429.
[16]SOLEMAN J,NOCERA F,MARIANI L.The conservative and pharmacological management of chronic subdural haematoma[J].Swiss Med Wkly,2017,147:w14398.
[17]CHAN D Y,CHAN D T,SUN T F,et al.The use of atorvastatin for chronic subdural haematoma:A retrospective cohort comparison Study[J].Br J Neurosurg,2017,31(1):72-77.
[18]TAO Z Q,LIN Y Y,HU M T,et al.Mechanism of subdural effusion evolves into chronic subdural hematoma:IL-8inducing neutrophil oxidative burst[J].Med Hypotheses,2016,86:43-46.
[19]JIANG R,WANG D,POON W S,et al.Effect of a torvastatin on chronic subdural hematoma(ATOCH):A study protocol for a randomized controlled trial[J].Trials,2015,16:528.
[20]WANG D,LI T,TIAN Y,et al.Effects of atorvastatin on chronic subdural hematoma:A preliminary report from three medical centers[J].J Neurol Sci,2014,336(1-2):237-242.
[21]SAHYOUNI R,GOSHTASBI K,MAHMOODI A,et al.Chronic subdural hematoma:A historical and clinical perspective[J].World Neurosurg,2017,108:948-953.
[22]YANG W Y,HUANG J.Chronic subdural hematoma:Epidemiology and natural history[J].Neurosurg Clin N Am,2017,28(2):205-210.
[23]UNO M,TOI H,HIRAI S.Chronic subdural hematoma in elderly patients:Is this disease benign[J]?Neurol Med Chir(Tokyo),2017,57(8):402-409.
[24]CECCHINI G.Chronic subdural hematoma pathophysiology:A unifying theory for a dynamic process[J].J Neurosurg Sci,2017,61(5):536-543.
[25]SAHYOUNI R,GOSHTASBI K,MAHMOODI A,et al.Chronic subdural hematoma:A perspective on subdural membranes and dementia[J].World Neurosurg,2017,108:954-958.
[26]BAN S P,HWANG G,BYOUN H S,et al.Middle meningeal artery embolization for chronic subdural hematoma[J].Radiology,2018,286(3):992-999.
[27]ABECASSIS I J,KIM L J.Craniotomy for treatment of chro-nic subdural hematoma[J].Neurosurg Clin N Am,2017,28(2):229-237.
[28]LIU W M,BAKKER N A,GROEN R J.Chronic subdural hematoma:A systematic review and meta-analysis of surgical procedures[J].J Neurosurg,2014,121(3):665-673.
[2]何兵孝,程小玉,张毅飞,等.慢性硬膜下血肿钻孔引流术后并发症临床分析[J].中华神经外科疾病研究杂志,2009,8(4):366-367.
[3]姚鹏飞,石鹏飞,荔志云.慢性硬膜下血肿发病机制及治疗研究的进展[J].临床神经外科杂志,2007,14(6):478-480.
[4]杨云娜,张茜,顾征,等.阿托伐他汀辅助钻孔引流术治疗慢性硬膜下血肿患者的临床效果及对血清NSE的影响[J].中国生化药物杂志,2016,36(8):58-60.
[5]肖德琨.50例慢性硬膜下血肿硬通道微创引流治疗体会[J].中国实用医药,2015,10(1):86-87.
[6]许奕聪,林运全,郑泽洲.老年慢性硬膜下血肿引流不畅的临床研究[J].中外医疗,2014,33(22):73-75.
[7]冯镜吾.老年慢性硬膜下血肿手术治疗35例临床分析[J].交通医学,2013,27(3):252-253.
[8]GELABERT-GONZLEZ M,SERRAMITO-GARCIA R.Letter to the editor:Chronic subdural hematoma[J].J Neurosurg,2011,114(3):887-888.
[9]FU S L,LI F B,BIE L.Drug therapy for chronic subdural hematoma:Bench to bedside[J].J Clin Neurosci,2018,56:16-20.
[10]LI T,WANG D,TIAN Y,et al.Effects of atorvastatin on the inflammation regulation and elimination of subdural hematoma in rats[J].J Neurol Sci,2014,341(1-2):88-96.
[11]葛元鸿,徐学君,张新宇,等.他汀类药物对慢性硬膜下血肿术后复发的影响[J].四川医学,2016,37(1):93-95.
[12]JIANG R,ZHAO S G,WANG R Z,et al.Safety and efficacy of atorvastatin for chronic subdural hematoma in Chinese patients:A randomized clinicaltrial[J].JAMA Neurol,2018,75(11):1338-1346.
[13]QIU S,ZHUO W,SUN C M,et al.Effects of atorvastatin on chronic subdural hematoma:A systematic review[J].Medicine(Baltimore),2017,96(26):e7290.
[14]XU M,CHEN P,ZHU X,et al.Effects of atorvastatin on conservative and surgical treatments of chronic subdural hematoma in patients[J].World Neurosurg,2016,91:23-28.
[15]TANG R R,SHI J T,LI X G,et al.Effects of atorvastatin on surgical treatments of chronic subdural hematoma[J].World Neurosurg,2018,117:e425-e429.
[16]SOLEMAN J,NOCERA F,MARIANI L.The conservative and pharmacological management of chronic subdural haematoma[J].Swiss Med Wkly,2017,147:w14398.
[17]CHAN D Y,CHAN D T,SUN T F,et al.The use of atorvastatin for chronic subdural haematoma:A retrospective cohort comparison Study[J].Br J Neurosurg,2017,31(1):72-77.
[18]TAO Z Q,LIN Y Y,HU M T,et al.Mechanism of subdural effusion evolves into chronic subdural hematoma:IL-8inducing neutrophil oxidative burst[J].Med Hypotheses,2016,86:43-46.
[19]JIANG R,WANG D,POON W S,et al.Effect of a torvastatin on chronic subdural hematoma(ATOCH):A study protocol for a randomized controlled trial[J].Trials,2015,16:528.
[20]WANG D,LI T,TIAN Y,et al.Effects of atorvastatin on chronic subdural hematoma:A preliminary report from three medical centers[J].J Neurol Sci,2014,336(1-2):237-242.
[21]SAHYOUNI R,GOSHTASBI K,MAHMOODI A,et al.Chronic subdural hematoma:A historical and clinical perspective[J].World Neurosurg,2017,108:948-953.
[22]YANG W Y,HUANG J.Chronic subdural hematoma:Epidemiology and natural history[J].Neurosurg Clin N Am,2017,28(2):205-210.
[23]UNO M,TOI H,HIRAI S.Chronic subdural hematoma in elderly patients:Is this disease benign[J]?Neurol Med Chir(Tokyo),2017,57(8):402-409.
[24]CECCHINI G.Chronic subdural hematoma pathophysiology:A unifying theory for a dynamic process[J].J Neurosurg Sci,2017,61(5):536-543.
[25]SAHYOUNI R,GOSHTASBI K,MAHMOODI A,et al.Chronic subdural hematoma:A perspective on subdural membranes and dementia[J].World Neurosurg,2017,108:954-958.
[26]BAN S P,HWANG G,BYOUN H S,et al.Middle meningeal artery embolization for chronic subdural hematoma[J].Radiology,2018,286(3):992-999.
[27]ABECASSIS I J,KIM L J.Craniotomy for treatment of chro-nic subdural hematoma[J].Neurosurg Clin N Am,2017,28(2):229-237.
[28]LIU W M,BAKKER N A,GROEN R J.Chronic subdural hematoma:A systematic review and meta-analysis of surgical procedures[J].J Neurosurg,2014,121(3):665-673.
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