钻孔引流术联合阿托伐他汀治疗慢性硬膜下血肿的临床效果

Clinical effect of trepanation and drainage combined with atorvastatin in the treatment of chronic subdural hematoma

目的探讨钻孔引流术联合阿托伐他汀治疗慢性硬膜下血肿(CSDH)的临床效果。方法选取2014年4月至2018年4月我院收治的62例CSDH患者为研究对象,并将其随机分为试验组(钻孔引流术联合阿托伐他汀)和对照组(单纯钻孔引流术),各31例。比较两组患者手术前、后BI评分、CSS评分、术后并发症发生情况、复发率及住院时间,并比较两组术中血肿液及不同时间外周血中IL-6、TNF-α及IL-10的水平。结果术后1、3个月,两组患者BI评分均明显升高,CSS评分均降低,且试验组优于对照组,差异具有统计学意义(P<0.05)。对照组患者复发率明显高于试验组,差异具有统计学意义(P<0.05)。试验组的住院时间明显短于对照组,差异具有统计学意义(P<0.05)。两组患者术中血肿液及不同时间外周血中IL-6、TNF-α及IL-10水平比较,差异均无统计学意义(P>0.05)。两组患者术中血肿液IL-6、TNF-α及IL-10水平明显高于不同时间外周血,差异具有统计学意义(P<0.05)。结论钻孔引流术联合阿托伐他汀可抑制局部的炎症反应,促进血肿吸收及新生血管成熟,进而显著提高CSDH患者的临床疗效,改善患者日常生活能力及神经功能,复发率低且安全性高。

Objective To investigate the clinical effect of trepanation and drainage combined with atorvastatin in the treatment of chronic subdural hematoma (CSDH).Methods Sixty-two patients with CSDH admitted in our hospital from April 2014 to April 2018 were selected as study objects.The patients were randomly divided into experimental group (trepanation and drainage combined with atorvastatin) and control group (trepanation and drainage alone),with 31 cases in each group.The preoperative and postoperative scores of BI and CSS,postoperative complications,recurrence rate and hospitalization time were compared between the two groups.The levels of IL-6,TNF-α and IL-10 in intraoperative hematoma fluid and peripheral blood at different time were compared between the two groups.Results At 1 and 3 months after operation,the BI scores in both groups significantly increased,CSS scores decreased,and those in the experimental group were better than the control group,the differences were statistically significant (P<0.05).The recurrence rate of the control group was significantly higher than that of the experimental group (P<0.05).The hospitalization time of the experimental group was significantly shorter than that of the control group (P<0.05).There were no significant differences in the levels of IL-6,TNF-α and IL-10 in intraoperative hematoma fluid and peripheral blood at different time between the two groups (P>0.05).The levels of IL-6,TNF-α and IL-10 in intraoperative hematoma fluid of the two groups were significantly higher than those in peripheral blood at different time,the differences were statistically significant (P<0.05).Conclusion Trepanation and drainage combined with atorvastatin can inhibit local inflammation,promote absorption of hematoma and maturation of neovascularization,thus significantly improve the clinical efficacy of CSDH patients,improve daily living ability and neurological function of patients,with low recurrence rate and high safety.