微创硬通道钻孔不冲洗、尿激酶溶解引流联合口服阿托伐他汀治疗慢性硬膜下血肿的临床研究  

Treatment of chronic subdural hematoma with minimally invasive hard channel drilling without irrigation and drainage with urokinase clot lysis combined with oral atrovastatin

作　　者：王亚飞 王国伟[1] 张轩宇 崔政[1] 郑虎林[1] 霍龙伟[1] WANG Ya-fei;WANG Guo-wei;ZHANG Xuan-yu;CUI Zheng;ZHENG Hu-lin;HUO Long-wei(Department of Neurosurgery Ward 2,the First Hospital of Yulin,Yulin 719000,Shaanxi,China)

机构地区：[1]榆林市第一医院神经外科二病区,陕西榆林719000

出　　处：《川北医学院学报》2020年第5期898-901,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨微创硬通道钻孔不冲洗、尿激酶溶解引流联合口服阿托伐他汀治疗慢性硬膜下血肿(CSDH)的临床价值。方法:将医院收治的88例CSDH患者按照治疗方式不同分为对照组与观察组每组44例,两组均采用微创硬通道钻孔不冲洗、尿激酶溶解引流术治疗,观察组术后加用阿托伐他汀口服治疗。比较两组治疗效果,测定患者术后积液、颅内积气情况,统计两组引流时间、住院时间,测定治疗前后患者血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子-α(TNF-α)水平的变化,评定治疗前后患者中国卒中量表(CSS)评分及日常生活能力(ADL)-Barthel指数(BI)表的变化。结果:观察组治疗总有效率高于对照组,比较差异有统计学意义(P<0.05);观察组引流时间、住院时间短于对照组,术后积液量、积气量均低于对照组(P<0.05);治疗前,两组NSE、TNF-α水平比较差异无统计学意义(P>0.05),治疗3个月后,两组上述指标均降低(P<0.05),且观察组NSE、TNF-α水平均低于对照组(P<0.05);治疗前,两组CSS表、BI指数表评分比较差异无统计学意义(P>0.05),治疗3个月后,两组CSS表评分降低,BI指数表评分上升(P<0.05),且观察组CSS评分低于对照组,BI指数表评分高于对照组(P<0.05)。结论:微创硬通道钻孔不冲洗、尿激酶溶解引流联合口服阿托伐他汀治疗CSDH临床价值肯定,可促进患者术后恢复,改善其神经功能,提升患者日常生活能力,下调血清NSE、TNF-α水平。Objective:To explore the clinical value of minimally invasive hard channel drilling without irrigation and drainage with urokinase clot lysis combined with oral atorvastatin in the treatment of chronic subdural hematoma(CSDH).Methods:88 patients with CSDH in the hospital were randomly divided into the control group and the observation group,44 cases in each group.The two groups were treated by minimally invasive hard channel drilling without irrigation and drainage with urokinase clot lysis.The observation group was additionally treated with oral atorvastatin after operation,and the therapeutic effect was compared between the two groups.The condition of postoperative hydrops and intracranial pneumatocele was determined.The drainage time and hospitalization time of the two groups were statistically analyzed,and changes in levels of serum neuron specific enolase(NSE)and tumor necrosis factor alpha(TNF-α)before and after treatment were determined.Changes in scores of Chinese Stroke Scale(CSS)and activities of daily living(ADL)-Barthel index(BI)before and after treatment were evaluated.Results:The total effective rate in the observation group was higher than that in the control group(P<0.05).The drainage time and hospitalization time of the observation group were shorter than those of the control group,and the volume of postoperative hydrops and pneumatocele was smaller than that of the control group(P<0.05).There was no significant difference in the level of NSE or TNF-αbetween the two groups before treatment(P>0.05).After 3 months of treatment,the above indexes in the two groups decreased(P<0.05),and the levels of NSE and TNF-αin the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference in the CSS score or BI score between the two groups(P>0.05).After 3 months of treatment,CSS scores of the two groups decreased,while BI scores increased(P<0.05),and the CSS score of the observation group was lower than that of the control group,while the BI score

关 键 词：慢性硬膜下水肿 硬通道钻孔 尿激酶溶解 阿托伐他汀 

分 类 号：R651.15[医药卫生—外科学]