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

Effecacy of drilling and drainage combined with atorvastatin calcium tablets in treatment of chronic subdural hematoma

目的探讨实施钻孔引流术联合术后口服阿托伐他汀钙片治疗慢性硬膜下血肿（CSDH）的临床疗效。方法选择武汉大学人民医院神经外科自2014年1月至2017年1月收治的46例CSDH患者，按随机数字表法分为对照组（16例）、实验组（30例）。对照组患者行钻孔引流术治疗，实验组患者于钻孔引流术后第1天开始口服阿托伐他汀钙片（20mg／d），连续服用2个月。比较2组患者治疗前、治疗后2个月血肿量，治疗后1周颅内积气量，引流管留置时间、住院周期、住院费用，治疗后2个月中国卒中量表评分（CSS）、日常生活能力评分（ADL-BI）及视觉模拟评分（VAS）的差异。结果治疗后2个月实验组患者的血肿量低于对照组，差异有统计学意义（P〈0．05）；与治疗前比较，治疗后2个月实验组和对照组患者的血肿量均降低，差异有统计学意义（P〈0．05）。实验组患者治疗后1周颅内积气量，引流管留置时间、住院周期均低于对照组，差异有统计学意义（P〈0．05）。治疗后2个月实验组患者的CSS、VAS评分低于对照组，差异有统计学意义（P〈0．05）；与治疗前比较，治疗后2个月实验组和对照组患者的CSS、VAS评分均降低，差异有统计学意义（P=0．05）。治疗后2个月实验组患者的ADL-BI评分高于对照组，差异有统计学意义（P〈0．05）；与治疗前比较，治疗后2个月实验组和对照组患者的ADL-BI评分均增加，差异有统计学意义（P〈0．05）。结论与单纯使用钻孔引流术比较，钻孔引流术联合阿托伐他汀钙片治疗CSDH更能促进残留血肿吸收。降低颅内积气量。改善患者预后。

Objective To observe the clinical efficacy of drilling and drainage combined with atorvastatin calcium tablets in treatment of chronic subdural hematoma （CSDH）. Methods Totally, 46 patients with CSDH, admitted to and received therapy in our hospital from January 2014 to January 2017, were selected for this research. These patients were divided into control group （n=16） and experimental group （n=30） according to therapeutic schemes. The patients from the control group underwent drilling and drainage. Besides that, the patients from the experimental group were given atorvastatin calcium tablets additionally, 20 mg/d×2 months. Two months after that, the curative efficacy, hematoma volume before and after operation, pneumocephalus volume one week after operation, duration of tube drainage, length of hospital stay, China stroke scale （CSS） scores, activities of daily life-Barthel index scale （ADL-BI） and visual analog scale （VAS） score were compared between the patients from the two groups. Results Two months after treatment, patients from the experimental group had significantly decreased hematoma volume as compared with those from the control group （P〈0.05）. The hematoma volume in both groups 2 months after treatment was significantly decreased as compared with that before treatment （P〈0.05）. The pneumocephalus volume, indwelling time of drainage tube, and hospital stays in the experimental group were significantly shorter/lower than those in the control group （P〈0.05）. The CSS scores and VAS scores in the experimental group 2 months after treatment were significantly lower than those in the control group （P〈0.05）. The ADL-BI scores in the experimental group 2 months after treatment were significantly higher than those in the control group （P〈0.05）. The ADL-BI scores in both groups 2 months after treatment was significantly increased as compared with those before treatment （P〈0.05）. Conclusion As compared with simple use of drilling and drainage, drilling and drainage combined with atorvastatin calcium tablets can help hematoma absorption, decrease incidence of pneumocephalu, and improve prognosis effectively.