微创钻孔引流术联合阿托伐他汀对慢性硬膜下血肿患者术后并发症及复发率的影响
摘要
目的探讨微创钻孔引流术联合阿托伐他汀治疗慢性硬膜下血肿(CSDH)的疗效以及对术后并发症、复发率的影响。方法回顾性分析民航总医院神经外科2014年3月至2017年6月收治的60例CSDH患者的临床资料,根据治疗方式不同分为观察组和对照组,每组各30例。对照组采用微创钻孔引流术治疗,观察组在行微创钻孔引流术基础上,联合应用阿托伐他汀钙片治疗。比较两组治疗后2个月临床疗效、中国卒中量表(CSS)评分、日常生活能力量表(ADL)评分、血清相关指标水平、术后并发症发生率及复发率情况。结果观察组治疗总有效率为90. 00%,高于对照组的73. 33%,但差异无统计学意义(P> 0. 05)。治疗后,观察组CSS评分低于对照组,ADL评分高于对照组,差异均有统计学意义(P <0. 05);治疗后,观察组血清神经元特异性烯醇化酶、脑源性神经营养因子、肿瘤坏死因子-α水平均低于对照组,差异有统计学意义(P <0. 05);上述各指标治疗前后差值差异均有统计学意义(P <0. 05)。观察组术后总体并发症发生率为36. 67%,复发率为6. 67%,均低于对照组,差异有统计学意义(P <0. 05)。结论 CSDH患者采用微创钻孔引流术联合阿托伐他汀治疗,可有效改善患者神经功能,提高日常生活能力,降低血清学相关指标,减少术后并发症的发生,降低复发风险。
引文
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[2]Jack A,O'Kelly C,Mcdougall C,et al.Predicting recurrence after chronic subdural haematoma drainage.[J].Can J Neurol Sci,2015,42(1):34-39.
[3]WANG D,LI T,TIAN Y,et al.Effects ofatorvastatin on chronic subdural hematoma:a preliminary report from three medical centers[J].J Neurol Sci,2014,336(1/2):237-242.
[4]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:223-224.
[5]WANG Y P,LI Y L,AN J Z,et al.Clinical efficacy of closed drainage via minimally invasive drilling for chronic subdural hematoma[J].J Int Neurol Neuros,2015,42(2):151-155.
[6]刘超,李明昌,王军民,等.钻孔引流术联合阿托伐他汀钙片治疗慢性硬膜下血肿疗效分析[J].中华神经医学杂志,2018,17(3):295-230.
[7]DONG W,LI T,YE T,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.
[8]KYU K J,WON K S,HOON K S.Intracerebral hemorrhage following evacuation of a chronic subdural hematoma[J].JKorean Neurosurg Soc,2013,53(2):108.
[9]曹德茂,武永康,王友伟,等.微创穿刺联合口服阿托伐他汀治疗慢性硬膜下血肿的疗效分析[J/CD].中华神经创伤外科电子杂志,2016,2(2):83-85.
[10]李学,王增光.舒血宁注射液联合阿托伐他汀治疗老年慢性硬膜下血肿的临床研究[J].现代药物与临床,2017,32(8):1433-1436.
[11]GELDERBLOM M,DAEHN T,LUDEWIG P,et al.Neuron specific enolase(NSE)as a valid marker for neuronal damage in murine models of ischemic stroke and experimental autoimmune encephalomyelitis[J].J Neuroimmunol,2012,78(2):15-16.
[12]SUDO H,ABUMI K,MENJO Y,et al.Post-traumatic lumbar subdural hematoma[J].Spine J,2012,12(8):30-36.
[13]熊学辉,瞿丹霞,魏小川,等.阿托伐他汀对慢性硬膜下血肿术后复发率的影响[J].卒中与神经疾病,2018,25(2):210-212.
[14]PRIPP A H,STANII M.The correlation between pro-and anti-inflammatory cytokines in chronic subdural hematoma patients assessed with factor analysis[J].PLo S One,2014,9(2):e90149.