化瘀涤痰方治疗慢性硬膜下血肿临床疗效及外周血炎性细胞因子的变化

Clinical Effect of Huayu Ditan Recipe on Chronic Subdural Hematoma and Changes of Peripheral Blood Inflammatory Cytokines

目的:观察化瘀涤痰方治疗慢性硬膜下血肿的临床疗效。方法:选择87例膝骨关节炎患者,按照随机数字表法分为对照组(42例)和治疗组(45例),对照组单纯常规西医对症治疗,治疗组在常规西医治疗的基础加用化瘀涤痰方。分别采用改良Rankin量表(Modified Rankin Scale,MRS)、Barthel指数(Barthel Index,BI)评价患者治疗前及术后3 d、1个月和2个月的病残程度、日常生活活动能力,检查颅脑CT评估血肿吸收情况,田氏公式法计算血肿体积,结合症状体征及血肿吸收情况,比较两组患者临床治疗效果,并进行安全性评价,同时用ELISA检测外周血白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)的含量。结果:治疗2个月后,治疗组总有效率91.1%明显高于对照组81.0%;治疗组MRS评分和血肿体积低于对照组,治疗组Barthel指数高于对照组,以上差异均有统计学意义(P<0.05)。治疗过程中,治疗组出现1例不良反应(2.2%),对照组出现1例不良反应(2.4%),差异无统计学意义(P>0.05)。两组患者IL-8、IL-6、TNF-α和CRP等炎性因子水平均较治疗前明显降低(P<0.05),其中治疗组降幅大于对照组(P<0.05)。结论:化瘀涤痰方能有效治疗老年慢性硬膜下血肿,同时能有效改善炎症反应,促进血肿的吸收,改善患者的日常生活能力,降低患者的致残率。

Objective:To observe the clinical efficacy of Huayu Ditan Recipe in the treatment of chronic subdural hematoma.Methods:Eighty-seven patients with knee osteoarthritis admitted to our hospital were randomly divided into the control group(42 cases)and the treatment group(45 cases).The control group was given simply conventional western medicine.The treatment group was added Huayu Ditan Recipe on the basis of conventional Western medicine treatment.The modified Rankin Scale(MRS)and Barthel Index(BI)were used to evaluate the degree of disability and activities of daily living before and 3 days,1 and 2 months after surgery.Brain CT was used to evaluate hematoma absorption.The volume formula of hematoma was calculated by Tian’s formula method.Combined with symptoms and signs and hematoma absorption,the clinical effects of the two groups were compared,and the safety evaluation was performed.Simultaneously blood interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,C-reactive protein(CRP)content were detected by ELISA.Results:After 2 monthstreatment,the total effective rate of the treatment group was 91.1%,significantly higher than that of the control group(81.0%).The MRS score of the treatment group was lower than that of the control group,and the treatment group had higher BI than the control group.The hematoma volume of the treatment group was lower than that of the control group.The differences were statistically significant(P<0.05).During the treatment,there were 2 adverse events(6.5%)in the treatment group and 3 adverse events(9.4%)in the control group.The difference was not statistically significant(P>0.05).The levels of inflammatory factors such as IL-8,IL-6,TNF-αand CRP were significantly lower in the two groups(P<0.05),and the decrease in the treatment group was greater than that in the control group(P<0.05).Conclusion:Huayu Ditan Recipe can effectively treat chronic subdural hematoma in the elderly,and can effectively improve the inflammatory response,promote the absorption of hematoma,improve the daily living ability of patients,and reduce the disability rate of patients.