中药益气化瘀方对慢性硬膜下血肿术后颅内残余血肿影响的临床研究  

Clinical study on the effect of Yiqi Huayu Decoction on intracranial residual hematoma after chronic subdural hematoma surgery

作　　者：王永谦[1] 冯庆琪 张征达 王维平[1] 施杞[2] 顾明昌[3] WANG Yongqian;FENG Qingqi;ZHANG Zhengda;WANG Weiping;SHI Qi;GU Mingchang(Department of Neurosurgery,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200032,China;Institute of Spondylopathy,Shanghai University of Traditional Chinese Medicine,Shanghai 201210,China;Encephalopathy Department,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院神经外科,上海200032 [2]上海中医药大学脊柱病研究所,上海201210 [3]上海中医药大学附属龙华医院脑病科,上海200032

出　　处：《上海中医药杂志》2021年第1期61-65,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市卫计委中医药事业发展三年行动计划项目(LH01-26-013);上海市卫计委卫生行业临床研究专项计划(201840029)。

摘　　要：目的观察中药益气化瘀方治疗慢性硬膜下血肿钻颅引流手术术后颅内残余血肿的临床疗效。方法将56例慢性硬膜下血肿患者随机分为治疗组(33例)及对照组(23例)。两组均采用钻颅引流术,术后治疗组予中药益气化瘀方治疗,对照组予阿托伐他汀片治疗。两组连续服药直至残余血肿完全吸收或体积显著减少(体积≤10 cm^3),至少连续服药30 d。结果①试验期间共有2例病例脱落,其中治疗组1例,对照组1例。②术前与术后各时点组内比较,两组残余血肿体积差异均有统计学意义(P<0.05),术后7 d与术后14、30、60、180 d比较,残余血肿体积缩小率差异均有统计学意义(P<0.05)。组间术后60 d、180 d残余血肿体积比较,治疗组明显小于对照组(P<0.05),组间术后30 d、60 d、180 d残余血肿体积缩小率比较,治疗组明显高于对照组(P<0.05)。③随访期间,治疗组和对照组残余血肿复发率分别为3.1%(1/32)和13.6%(3/22),差异无显著性意义(P>0.05)。④经Logistic回归分析,提示高龄(>80岁)和术后较小的血肿体积缩小率(<30%)与血肿复发密切相关(P=0.008和P=0.011)。⑤术前与术后各时点组内比较,两组改良Rankin评分均明显下降(P<0.05)。组间术后相同时点比较,改良Rankin评分差异无统计学意义(P>0.05)。⑥两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论与阿托伐他汀片相比,中药益气化瘀方治疗钻颅引流手术术后慢性硬膜下血肿患者,可更好地促进术后残余血肿的吸收;同时该中药疗法不良反应少,还可改善患者术后的神经功能。Objective To observe the clinical effect of Yiqi Huayu Decoction on intracranial residual hematoma after burr hole drainage surgery of chronic subdural hematoma(CSDH).Methods A total of 56 patients with chronic subdural hematoma were randomly divided into treatment group(n=33)and control group(n=23).Both groups conducted burr hole drainage surgery.After surgery,the treatment group was treated with Yiqi Huayu Decoction,while the control group was treated with atorvastatin tablets.The two groups were administered corresponding medicine continuously for at least 4 weeks until the residual hematoma was completely absorbed or the volume significantly reduced(V≤10 cm^3).Results①During the follow-up period,there were 2 dropout cases,including 1 case in the treatment group and 1 case in the control group.②The differences in the volume of residual hematoma were significant(P<0.05)when comparing the volume before operation and that at each time point after operation in both groups.The differences in the volume reduction rate of residual hematoma were significant statistically when comparing the reduction rate on day 7 after operation and that on day 14,day 30,day 60 and day 180 respectively after operation in both groups(P<0.05).The volume of residual hematoma in the treatment group was significantly smaller than that in the control group on day 60 and day 180 after operation(P<0.05),and the volume reduction rate of residual hematoma in the treatment group was significantly higher than that in the control group on day 30,day 60 and day 180 after operation(P<0.05).③During the follow-up period,the recurrence rates of residual hematoma in the treatment group and the control group were 3.1%(1/32)and 13.6%(3/22),respectively,with no significant difference(P>0.05).④Logistic regression analysis showed that the old age(>80 years old)and the smaller hematoma volume reduction rate after operation(<30%)were closely related to hematoma recurrence(P=0.008,P=0.01).⑤The modified Rankin score of the two groups decreased signif

关 键 词：慢性硬膜下血肿 老年人 钻颅引流术 中医疗法 颅内残余血肿 术后复发 神经功能 

分 类 号：R651.1[医药卫生—外科学]