口服抗血栓药物对慢性硬膜下血肿的影响

摘要

Objective To explore the effect of oral antithrombotic drugs on chronic subdural hematoma and recurrence.Methods Two hundred and thirty-three chronic subdural hematoma patients with drainage hole surgery in our hospital neurosurgery from January 2002 to December 2012 were analyzed.Based on the history of head trauma within 3 months,patients were divided into traumatic group and non-traumatic group.Anti-thrombotic drugs were used in all patients.Treatment time after injury in patients with traumatic brain injury group and recurrence time in all patients were analyzed.Results Seventy-one cases (67.6％) of non-trauma patients routinely had antithrombotic drugs before surgery,which was significantly higher than 36.7％ (47 cases) of trauma group patients.In traumatic brain injury group,treatment time in patients with preoperative anti-thrombotic drugs was significantly shorter than patients without using such treatment after traumatic brain injury [(27 ± 11) d vs (50 ±14)d,P ＜0.05].30 cases of non-traumatic group (42.2％) used warfarin therapy,including 1 case (1.5％) with AAA common use of warfarin,warfarin INR average of (2.77 ± 0.25).Among trauma group,20 cases (42.6％) using warfarin therapy,3 patients (6.4％) with AAA common warfarin use,warfarin INR average of (1.89 ± 0.67).Non-trauma patients admitted to hospital were significantly higher than the average INR values of trauma group (P ＜ 0.05).Recurrence rate and time to recurrence had no significant differences between patients with and without preoperative anti-thrombotic drugs.Conclusion Oral anti-thrombotic drugs can increase possibility for non-traumatic chronic subdural hematoma and accelerate traumatic chronic subdural hematoma progression.%目的 探讨口服抗血栓药物对慢性硬膜下血肿患者的影响.方法 收集2002年1月至2012年12月在北京安贞医院神经外科行慢性硬膜下血肿钻孔引流手术的233例患者的病历资料进行回顾性分析.根据术前3个月内是否存在颅脑外伤史分为外伤组(128例)与非外伤组(105例),统计患者抗血栓药物的使用情况,外伤组患者伤后就诊时间,患者的复发情况及复发时间.结果 非外伤组105例患者中71例(67.6％)、外伤组128例患者中47例(36.7％)术前常规应用抗血栓药物,非外伤组明显多于外伤组(P＜0.05).外伤组中术前应用抗血栓药物的患者颅脑外伤后就诊时间明显短于未使用此类药物的患者[(27±11)d比(50±14)d,p＜0.05],非外伤组中30例(42.2％)患者使用华法林抗凝治疗,其中1例(1.5％)患者为华法林与抗血小板聚集药物共同使用,华法林INR平均值为(2.77 ±0.25).外伤组中20例(42.6％)患者使用华法林抗凝治疗,其中3例(6.4％)患者为华法林与抗血小板聚集药物共同使用,华法林INR平均值为(1.89 ±0.67).非外伤组患者入院时平均INR水平明显高于外伤组INR值(P＜0.05).术前应用抗血栓药物患者与未使用患者的术后复发率及复发时间差异均无统计学意义(P＞0.05).结论 口服抗血栓药物增加非外伤性慢性硬膜下血肿发生的可能性,加快外伤性慢性硬膜下血肿的进展过程.