神经内镜下血肿清除术联合云南红药治疗慢性硬膜下血肿的疗效观察
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摘要
目的:观察神经内镜下血肿清除术联合云南红药治疗慢性硬膜下血肿(CSDH)的临床疗效。方法:96例CSDH患者随机分为观察组和对照组,每组48例。对照组入院后行神经内镜下血肿清除术,术后常规治疗,观察组在对照组的基础上联合云南红药胶囊治疗。对比两组手术情况、临床疗效、术前及术后7d血清神经生长因子(NGF)、硫化氢(H_2S)水平,并观察患者术前及术后3个月认知功能(MoCA评分)、日常生活活动能力(ADL评分)及生活质量(SF-36评分)。结果:两组手术时间及术中出血量比较,差异无统计学意义(P>0.05)。观察组治疗总有效率高于对照组(P<0.05)。两组术后7d血清NGF、H_2S水平较术前改善,且观察组血清NGF水平高于对照组,H_2S水平低于对照组(均P<0.05)。两组术后3个月MoCA评分、ADL评分及SF-36评分均高于术前,且观察组高于对照组(均P<0.05)。结论:神经内镜下血肿清除术联合云南红药治疗CSDH疗效确切,可改善患者的认知功能、日常生活活动能力及生活质量。
Objective:To investigate the effect of neural endoscopic removal of hematoma combined with Yunnan Hongyao on chronic subdural hematoma(CSDH).Methods:Ninety-six patients with CSDH were randomly divided into an observation group and a control group,with 48 cases in each group.The patients in the control group received endoscopic neuroendoscopic hematoma clearance and conventional treatment after operation.The patients in the observation group were treated as the control group with addition of Yunnan Hongyao.The surgery conditions,clinical efficacy and serum levels of nerve growth factor(NGF)and hydrogen sulfide(H_2S)as well as the cognitive function(MoCA score),activities of daily living(ADL score)and the quality of life(SF-36 score)were compared.Results:There were no statistical differences in the operation time and intraoperative blood loss volume between the two groups(P>0.05).The response rate of the observation group was higher than that of the control group(P<0.05).The serum levels of NGF and H_2S after 7 days of operation were improved in both groups.The serum NGF level of the observation group was higher than that of the control group,and the H_2S level was lower(P<0.05).The MoCA score,ADL score and SF-36 score were increased after 3 months of operation,and the increase was more significant in the observation group(P <0.05).Conclusion:Neural endoscopic removal of hematoma combined with Yunnan Hongyao was effective in the treatment of CSDH.It could reduce the serum NGF and H_2S levels,and promote cognitive function,daily living ability and life quality of patients.
Objective:To investigate the effect of neural endoscopic removal of hematoma combined with Yunnan Hongyao on chronic subdural hematoma(CSDH).Methods:Ninety-six patients with CSDH were randomly divided into an observation group and a control group,with 48 cases in each group.The patients in the control group received endoscopic neuroendoscopic hematoma clearance and conventional treatment after operation.The patients in the observation group were treated as the control group with addition of Yunnan Hongyao.The surgery conditions,clinical efficacy and serum levels of nerve growth factor(NGF)and hydrogen sulfide(H_2S)as well as the cognitive function(MoCA score),activities of daily living(ADL score)and the quality of life(SF-36 score)were compared.Results:There were no statistical differences in the operation time and intraoperative blood loss volume between the two groups(P>0.05).The response rate of the observation group was higher than that of the control group(P<0.05).The serum levels of NGF and H_2S after 7 days of operation were improved in both groups.The serum NGF level of the observation group was higher than that of the control group,and the H_2S level was lower(P<0.05).The MoCA score,ADL score and SF-36 score were increased after 3 months of operation,and the increase was more significant in the observation group(P <0.05).Conclusion:Neural endoscopic removal of hematoma combined with Yunnan Hongyao was effective in the treatment of CSDH.It could reduce the serum NGF and H_2S levels,and promote cognitive function,daily living ability and life quality of patients.
引文
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[12]周晋,黄春刚,郑建辉,等.基底核区高血压脑出血患者术后生活质量的影响因素分析[J].医学临床研究,2017,34(7):1348-1350.
[13]刘大雪,王旭聪,张金承,等.微创穿刺引流术与神经内镜下血肿清除术治疗慢性硬膜下血肿临床效果的对比研究[J].实用心脑肺血管病杂志,2017,25(7):70-73.
[14]李乾锋,吴京雷,杨国平.神经内镜手术治疗慢性硬膜下血肿50例[J].中国临床神经外科杂志,2015,20(9):557-558.
[15]张征达,王永谦.益气活血法治疗老年慢性硬膜下血肿钻孔术后疗效观察[J].内蒙古中医药,2016,35(7):20-21.
[16]肖耀广,夏侃,夏仁云.云南红药对创伤患者血液流变学的影响[J].中国医院药学杂志,2004,24(9):553-554.
[17]BERGHAUSER PONT L M,DAMMERS R,SCHOU-TEN J W,et al.Clinical factors associated with outcome in chronic subdural hematoma:a retrospective cohort study of patients on preoperative corticosteroid therapy[J].Neurosurgery,2012,70(4):873-880.
[18]马成鑫,秦尚振.慢性硬膜下血肿的研究进展[J].中国临床神经外科杂志,2014,19(8):507-509.
[19]牛彦彦,鲍春龄,岳亚琳,等.头穴透刺对脑出血大鼠血肿周围脑组织神经生长因子表达的影响[J].中国中西医结合杂志,2016,36(9):1107-1111.
[20]赵倩,孙蜀宁,张淑艳,等.尤瑞克林对脑梗死患者血清H2S、神经元特异性烯醇化酶与S100β浓度的影响[J].中国医师杂志,2015,17(7):974-977.
[21]STANISIC M,AASEN A O,PRIPP A H,et al.Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma:aprospective study[J].Inflamm Res,2012,61(8):845-852.
[2]徐伟光,殷利明,钟德泉,等.改良钻孔引流术治疗老年慢性硬膜下血肿38例[J].中国老年学杂志,2014,34(17):4974-4975.
[3]ALCALACERRA G,YOUNG A M,MOSCOTESAL-AZAR L R,et al.Efficacy and safety of subdural drains after burr-hole evacuation of chronic subdural hematomas:systematic review and meta-analysis of randomized controlled trials[J].World Neurosurg,2014,82(6):1148-1157.
[4]刘国栋,王守利,李会华,等.三种手术方法治疗慢性硬膜下血肿的临床分析[J].中华神经外科疾病研究杂志,2017,16(1):58-60.
[5]王景广,李海军.慢性硬膜下血肿患者钻孔引流术后并发症[J].中国老年学杂志,2014,34(23):6781-6782.
[6]阮航,杨国平,闵强,等.神经内镜手术治疗慢性硬膜下血肿的体会[J].临床外科杂志,2015,23(1):78-79.
[7]罗明,闵强,杨国平,等.神经内镜辅助手术治疗慢性硬膜下血肿103例分析[J].中国临床神经外科杂志,2015,20(2):111-112.
[8]刘树亭,王春红.慢性硬膜下血肿术后复发原因分析[J].中国药物与临床,2014,14(1):113-114.
[9]任杰红,陈林芳.云南红药的药效学研究[J].云南中医中药杂志,2000,21(4):43.
[10]吕传真.实用神经病学[M].上海:上海科学技术出版社,2014:155-156.
[11]孙俊启,毕彩琴.奥拉西坦对慢性硬膜下血肿患者认知功能和日常生活活动能力的影响[J].安徽医学,2014,35(5):616-618.
[12]周晋,黄春刚,郑建辉,等.基底核区高血压脑出血患者术后生活质量的影响因素分析[J].医学临床研究,2017,34(7):1348-1350.
[13]刘大雪,王旭聪,张金承,等.微创穿刺引流术与神经内镜下血肿清除术治疗慢性硬膜下血肿临床效果的对比研究[J].实用心脑肺血管病杂志,2017,25(7):70-73.
[14]李乾锋,吴京雷,杨国平.神经内镜手术治疗慢性硬膜下血肿50例[J].中国临床神经外科杂志,2015,20(9):557-558.
[15]张征达,王永谦.益气活血法治疗老年慢性硬膜下血肿钻孔术后疗效观察[J].内蒙古中医药,2016,35(7):20-21.
[16]肖耀广,夏侃,夏仁云.云南红药对创伤患者血液流变学的影响[J].中国医院药学杂志,2004,24(9):553-554.
[17]BERGHAUSER PONT L M,DAMMERS R,SCHOU-TEN J W,et al.Clinical factors associated with outcome in chronic subdural hematoma:a retrospective cohort study of patients on preoperative corticosteroid therapy[J].Neurosurgery,2012,70(4):873-880.
[18]马成鑫,秦尚振.慢性硬膜下血肿的研究进展[J].中国临床神经外科杂志,2014,19(8):507-509.
[19]牛彦彦,鲍春龄,岳亚琳,等.头穴透刺对脑出血大鼠血肿周围脑组织神经生长因子表达的影响[J].中国中西医结合杂志,2016,36(9):1107-1111.
[20]赵倩,孙蜀宁,张淑艳,等.尤瑞克林对脑梗死患者血清H2S、神经元特异性烯醇化酶与S100β浓度的影响[J].中国医师杂志,2015,17(7):974-977.
[21]STANISIC M,AASEN A O,PRIPP A H,et al.Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma:aprospective study[J].Inflamm Res,2012,61(8):845-852.