氨甲环酸联合钻孔引流术治疗慢性硬膜下血肿

Clinical study of tranexamic acid combined and burr hole drainage with irrigation treatments for chronic subdural hematoma

目的研究慢性硬膜下血肿钻孔引流术联合血肿腔内应用氨甲环酸对慢性硬膜下血肿(CSDH)术后复发率的影响。方法采用前瞻性随机对照研究,将本院近2年内慢性硬膜下血肿50例随机分为实验组和对照组,每组25例。实验组行钻孔引流术,同时血肿腔注入氨甲环酸治疗,对照组仅行钻孔引流术,其它常规治疗两组均相同。分别检测两组患者手术冲洗前后血肿液及手术后血肿腔引流液的D-二聚体,术后随访6个月,分析复发率。结果两组患者血肿液D-二聚体在术中冲洗前均高于正常,在术中冲洗后均降低,两组比较均无统计学差异(P>0.05)。术后2天,实验组血肿腔引流液D-二聚体显著低于对照组,统计有显著差异(P<0.05)。50例患者术后均全部治愈出院,实验组25例有2例复发,对照组有8例复发,实验组复发率显著低于对照组,统计有显著差异(P<0.05)。结论血肿腔局部纤溶功能亢进在慢性硬膜下血肿发病机制及复发中起重要作用,术中氨甲环酸在血肿腔内局部应用可抑制其纤溶功能亢进,显著降低术后血肿腔引流液D-二聚体浓度,从而显著降低慢性硬膜下血肿患者的术后复发率,值得临床推广应用。

Objective To investigate the influence of hematoma cavity applications tranexamic acid and bun hole drainage with irrigation treatment on the postoperative recurrence rate of chronic subdural hematoma. Methods During a 2-year period,a prospective randomized controlled trial was conducted on 50 consecutive patients with chronic subdural hematoma. These patients were divided randomly into experimental and control groups in the trial, 25 patients in each group. All patients in experimental group underwent burr hole drainage with irrigation and hematoma cavity in- jection of tranexamic acid.The control group received only burr hole drainage with irrigation.Other conventional treatment in both groups was same. Before burr hole irrigation, after burr hole irrigation and operation, D-dimer was measured in the two groups patients hematoma fluid. Recurrence rate was analysis by postoperative follow-up for 6 months. Results Before washing hematoma cavity in operation, D-dimer in hematoma fluid of two groups was higher than that of the normal. After washing hematoma cavity in operation,D-direct in hematoma fluid were lower than that of the normal. These differences between the two groups were not statistically significant （P〉0.05）. After operation 2 days, D-dimer in hematoma fluid of the experi- mental group was significantly lower than the control group,It was statistically significant （P〈0.05）. 2 of 25 cases in experimental group were recur- rence, but eight eases recurrence in control group. The recurrence rate of the experimental group was significantly lower than the control group. There was statistical significant difference （P〈O.05）. Conclusion Local hyperfibrinolysis in hematoma cavity may play an important role in the pathogen- esis and postoperative recurrence of chronic subdural hematoma. The local application of tranexamic acid in hematoma cavity could significantly reduce the postoperative recurrence rate of chronic subdural henmtoma by inhibit hyper-fibrinolysis and decrease D-dimer. It is worthy to be clinically applied.