华法令对慢性硬膜下血肿的影响及治疗探讨  

Study on the influence of warfarin on chronic subdural hematoma

作　　者：施立海[1] 

机构地区：[1]首都医科大学附属北京安贞医院神经外科,北京市100029

出　　处：《中国基层医药》2013年第14期2099-2101,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨抗凝药物华法令的使用与慢性硬膜下血肿（CSDH）发生的相关性以及其在术后复发中所起的作用。方法选择136例CSDH行钻孔引流手术患者，分析患者临床资料并对其进行随访观察，比较单独使用维生素K（VK）与VK联合人凝血酶原复合物（PCC）患者治疗前后抗凝状态国际标准化比值（INR）水平及其纠正时间，比较应用华法令抗凝治疗与未应用患者外伤史情况、术后复发率、复发时间等。结果VK联合PCC患者INR降至正常值所用时间为（6．4±4．9）h，显著短于使用VK患者的（14．5±7．6）h（P〈0．05）。术前未使用华法令抗凝患者中52例（57％）有颅脑外伤史，使用华法令抗凝患者中12例（27％）术前有颅脑外伤史，未使用华法令患者有颅脑外伤史比例显著多于用华法令抗凝治疗患者（P〈0．05）。所有患者中共有18例（13％）术后复发，均再次行CSDH钻孔引流术。使用华法令抗凝（18％）与未抗凝（11％）患者复发率差异无统计学意义（P〉0．05）。术前使用华法令抗凝治疗的患者复发时间为（20．5±8．1）d，未抗凝治疗患者的复发时间为（24．4±13．2）d（P〉0．05）。结论华法令抗凝提高了非外伤性CSDH发生的可能性，PCC联合VK缩短了纠正华法令抗凝所需时间。Objective To investigate the influence of anticoagulant drug warfarin on chronic subdural hema- toma （CSDH） and the role in CSDF recurrence. Methods 136 patients with CSDH hole drainage surgery were se- lected. The clinical data were analyzed and the patients were followed up, INR level and the correct time in patients only used VK or used VK ＋ PCC were compared between the two groups before and after treatment. The history of trauma, the recurrence rate, time to recurrence in patients received warfarin therapy or not were compared. Results The time of anticoagulated indicators INR dropped to normal was （6.4±4.9） h in VK ＋ PCC group,which was significantly shorter than in the VK group（ 14.5 ±7.6）h （P 〈 0.05 ）. In patients not received warfarin preopera- tively,52 cases（57% ） had a history of traumatic brain injury. 12 patients （27%） had the history of traumatic brain injury in patients received warfarin preoperatively. The proportion of patients with a history of traumatic brain injury in without warfarin therapy group was significantly higer than the anticoagulant therapy group（ P 〈0, 05 ）. A total of 18 cases （13%） had postoperative recurrence, they were given the CSDH drilling drainage again. The recurrence rate be tween the warfarin anticoagulant group （ 18 % ） and non - anticoagulant group （ 1 1% ） had no significant difference （ P 〉0.05）. Time to relapse in patients with preoperative use of warfarin therapy and without anticoagulant therapy was （20.5 ±8.1）d,（24.4 ±13.2）d （P〉0.05）. Conclusion Warfarin increased the possibility of non-traumatic CS- DH, VK ＋ PCC shortened the corrective warfarin anticoagulation time required.

关 键 词：血肿 硬膜下 慢性 抗凝药 华法令 

分 类 号：R651.1[医药卫生—外科学]