阿托伐他汀联合地塞米松对老年慢性硬膜下血肿钻孔引流术后复发的预防

Atorvastatin combined with dexamethasone in preventing recurrence of CSDH in the elderly after trepanation and drainage

目的探讨阿托伐他汀联合地塞米松治疗老年慢性硬膜下血肿(CSDH)钻孔引流术后的临床疗效。方法选择CSDH患者70例,根据随机数字表法分为阿托伐他汀组和阿托伐他汀联合地塞米松组(联合组),每组35例。2组均采用钻孔引流手术方式。患者于术后当天开始药物治疗,共28 d。随访期84 d。比较2组血肿复发率、神经功能恢复情况及并发症发生率。神经功能恢复情况包括格拉斯哥昏迷评分(GCS)、神经功能评分(MGS)。结果联合组钻孔引流术后血肿复发率明显低于阿托伐他汀组(0 vs 11.4%,P=0.039)。2组癫痫、感染、胃溃疡发生率比较,差异无统计学意义(P>0.05)。联合组治疗后MGS明显低于阿托伐他汀组,GCS明显高于阿托伐他汀组[(0.8±0.5)分vs(1.5±0.9)分,(12.8±1.9)分vs(10.3±2.5)分,P<0.05]。结论老年CSDH患者钻孔引流术后,使用阿托伐他汀联合地塞米松的治疗方案,可显著降低血肿复发率,并改善神经功能及远期预后。

Objective To study the clinical effect of atorvastatin combined with dexamethasone on chronic subdural hematoma(CSDH)in the elderly after trepanation and drainage.Methods Seventy elderly CSDH patients were divided into atorvastatin treatment group(n=35)and atorvastatin combined with dexamethasone treatment group(n=35).The patients in two groups began to receive pharmacotherapy from the day after trepanation and drainage for 28 days and were followed up for 84 days.The recurrent rate of CSDH,neurological function recovery(GCS,MGS)and postoperative complications were compared between the two groups.Results The recurrent rate of CSDH was significantly lower in atorvastatin combined with dexamethasone treatment group than in atorvastatin treatment group(0 vs 11.4%,P=0.039).No significant difference was detected in incidence of epilepsy,infection,gastric ulcer between the two groups(P>0.05).The MGS was significantly lower while the GCS was significantly higher in atorvastatin combined with dexamethasone treatment group than in atorvastatin treatment group(0.8±0.5 vs 1.5±0.9,12.8±1.9 vs 10.3±2.5,P<0.05).Conclusion Atorvastatin combined with dexamethasone can significantly reduce the recurrent rate of CSDH in the elderly after trepanation and drainage and improve their neurological function and long-term outcome.