老年慢性硬膜下血肿术后血肿残留患者应用云南红药胶囊联合阿托伐他汀治疗的效果观察

摘要

目的 探讨云南红药胶囊联合阿托伐他汀对老年慢性硬膜下血肿术后血肿残留患者的临床疗效及近中期预后.方法 选取2013年10月至2015年10月河北省保定市第二中心医院收治的老年慢性硬膜下血肿术后血肿残留患者76例,应用随机数字表法分为对照组与观察组,各38例.2组均为慢性硬膜下血肿术后1周明确诊断为血肿残留患者,对照组给予口服阿托伐他汀治疗,观察组在对照组的治疗基础上联合云南红药胶囊治疗,2组均持续治疗1个月.比较治疗前及治疗1、3个月血肿量的变化及治疗1个月的临床疗效,治疗前及治疗1个月后对2组患者进行日常生活能力量表(ADL)及神经功能缺损量表(CSS)评估,记录用药期间的不良反应,治疗6、12、18个月后随访观察疾病复发率.结果 治疗前2组血肿量比较差异无统计学意义(P＞0.05),治疗1、3个月后2组血肿量均较治疗前减少,且观察组低于对照组,差异均有统计学意义(均P ＜0.05).观察组治疗1个月后总有效率高于对照组[89.5％(34/38)比68.4％(26/38)],差异有统计学意义(x2=5.067,P=0.024).治疗前2组患者ADL及CSS评分比较,差异均无统计学意义(均P ＞0.05),治疗1个月后2组ADL评分均高于治疗前,且观察组高于对照组;治疗1个月后2组患者CSS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(均P＜0.05).2组治疗期间不良反应发生率比较差异无统计学意义(P＞0.05).治疗12、18个月后观察组疾病复发率均低于对照组[7.9％(3/38)比28.9％(11/38),7.9％(3/38)比34.2％(13/38)],差异均有统计学意义(均P＜0.05).结论 联合采用阿托伐他汀及云南红药胶囊治疗老年慢性硬膜下血肿术后血肿残留效果显著,可减少血肿量,改善患者神经功能及日常生活能力,降低疾病复发风险,且不会增加不良反应发生风险.%Objective To explore the clinical effect of Yunnan Hongyao capsules combined with atorvastatin on elderly patients with residual hematoma after chronic subdural hematoma (CSDH) surgery.Methods Seventy-six elderly patients with residual CSDH after surgery were enrolled from October 2013 to October 2015 in the Second Central Hospital of Baoding,Hebei Province;they were randomly divided into control group and observation group,with 38 cases in each group.The control group took atorvastatin after surgery and the observation group took atorvastatin and Yunnan Hongyao capsules for 1 month.Hematoma volume 1,3 months after treatment,the 1-month clinical effective rate,scores of the Activity of Daily Living Scale (ADL) and the Chinese stroke scale (CSS) before and 1 month after treatment,adverse reactions during treatment and the 6-,12-,18-month recurrence rates were analyzed.Results There was no significant difference of hematoma volume between groups before treatment(P ＞0.05);1,3 months after treatment,hematoma volume significantly decreased compared to that before treatment,and it was significantly less in observation group than that in control group(P ＜ 0.05).One month after treatment,the clinical effective rate in observation group was significantly higher than that in control group[89.5％ (34/38) vs 68.4％ (26/38)] (x2 =5.067,P =0.024).There were no significant differences of ADL and CSS scores between groups before treatment (P ＞ 0.05);1 month after treatment,the ADL score was significantly higher and the CSS score was significantly lower than those before treatment;the ADL score after treatment in observation group were significantly higher and the CSS score was significantly lower than those in control group(P ＜ 0.05).The adverse reaction rate had no significant difference between groups(P ＞ 0.05).The 12-and 18-month recurrence rates in observation group were significantly lower than those in control group [7.9％ (3/38) vs 28.9％ (11/38),7.9％ (3/38) vs 34.2％ (13/38)] (P ＜ 0.05).Conclusion Combined use of atorvastatin and Yunnan Hongyao capsules treating elderly patients with residual CSDH can effectively reduce hematoma volume,improve neurological function and activity of daily living,reduce recurrence risk and improve the prognosis.