慢性硬膜下血肿患者226例症状特点和中医证候要素分析

Analysis of symptoms and TCM syndrome elements in 226 patients with chronic subdural hematoma

目的:探讨慢性硬膜下血肿(CSDH)患者的临床特点及中医证候要素分布。方法:选取首都医科大学附属北京天坛医院中医科门诊2016年6月—2022年10月诊治的CSDH患者,采集、分析一般情况、既往史、刻诊症状及中医证型分布。结果:共纳入226例CSDH患者,男女比例约为3∶1,平均年龄为(66.6±14.4)岁,71.2%(161/226)的患者发病前有明确近期手术史或外伤史,其中头部外伤史121例(53.5%),31.0%(70/226)的患者有抗凝或抗血小板聚集药物服用史,24.3%(55/226)的患者为手术治疗后血肿复发,其中6例患者(2.7%)已多次手术。年龄≥60岁,既往有高血压病史、高血糖史、高脂血症史、心脏病史、脑疾病史患者更易发作CSDH,且更易伴发活动障碍及言语不利症状(P<0.05,P<0.01)。临床症状主要表现为头痛、头晕、活动障碍、言语不利等。结论:CSDH以老年人多见,术后易复发,临床症状多样,中医证候以血瘀为核心,兼有气虚、痰湿、肾虚等证。

Objective:To explore the clinical characteristics and distribution of traditional Chinese medicine(TCM)syndrome elements in patients with chronic subdural hematoma(CSDH).Methods:Patients with CSDH treated at the TCM outpatient clinic of Beijing Tiantan Hospital,Capital Medical University from June 2016 to October 2022 were selected.General information,medical history,diagnostic symptoms,and the distribution of TCM syndrome types were collected and analyzed.Results:A total of 226 CSDH patients were included in the study,with a male-to-female ratio of approximately 3∶1.The average age was(66.6±14.4) years.71.2%(161/226) of the patients had a clear history of recent surgery or trauma before the onset of the disease,among which head injury accounted for 121 cases(53.5%).31.0%(70/226) of the patients had a history of taking anticoagulant or antiplatelet aggregation drugs.24.3%(55/226) of the patients experienced a recurrence of hematoma after surgical treatment,including 6 patients(2.7%) who had undergone multiple surgeries.Patients aged over 60 with a history of hypertension,hyperglycemia,hyperlipidemia,heart disease,or brain disease were more prone to develop CSDH and were more likely to suffer from mobility disorders and dysphasia(P<0.05,P<0.01).The main clinical symptoms were headache,dizziness,mobility disorders,and dysphasia.Conclusion:CSDH is more common in the elderly and prone to recurrence after surgery.The clinical symptoms are diverse,and the core TCM syndromes are centered around blood stasis,accompanied by qi deficiency,phlegm and fluid,and kidney deficiency.