血府逐瘀胶囊治疗老年慢性硬膜下血肿的临床研究
发布时间：2018-03-07 21:26
本文选题：慢性硬膜下血肿 切入点：血府逐瘀胶囊 出处：《大连医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：随着中国人口向着老龄化社会的迈进,老年病日益成为社会关注的一个焦点问题。慢性硬膜下血肿(CSDH)是老年颅内血肿最常见的一种,该疾病因起病比较隐匿,常常造成误诊、漏诊进而延误病情,且总体预后不佳。慢性硬膜下钻孔引流术是目前CSDH外科手术治疗常用的方法之一,虽然目前我国的医学水平在不断的提高,诊断的技术也取得了长足的进步,手术治愈率有了明显的提高,但是因为高龄患者的手术耐受度差、体质虚弱等多重原因的限制,术后患者出现血肿清除不彻底、术后感染、术后恢复慢、血肿复发等现象时有发生,给临床处理带来很多不便。因此,通过对老年患者在围手术期配合口服血府逐瘀胶囊进行辅助治疗,有利于患者的转归,可收到较好疗效。目的:观察联合传统的中医药血府逐瘀胶囊辅助治疗老年慢性硬膜下血肿的临床效果,为CSDH中西医结合治疗提供系统、科学的理论依据。方法:收集我院神经外科2015年6月-2016年6月慢性硬膜下血肿行手术治疗的病人,共50例。对符合纳入标准的研究对象进行随机分组方法分为治疗组和对照组,两组患者在性别、年龄、出血量、出血部位、格拉斯哥昏迷评分等方面均无显著性差异,入选的所有病例均符合纳入病例标准,排除过敏体质或对多种药物过敏者、高血压、糖尿病,凝血功能障碍,有肝、肾、等严重原发性疾病者,两组间具有可比性。对照组采用传统的钻孔引流术进行治疗,治疗组在对照组基础上增加血府逐瘀胶囊进行辅助治疗,比较两组1.临床症状2.硬膜下血肿量的数值(影像学检查)3.平均住院日4.格拉斯哥昏迷评分等相关指标予以量化,将所有患者的临床观察数值,输入计算机,运用spss17.0软件进行统计分析。计数资料采用t检验。结果:1.治疗组27例中,女性9例,男性18例,年龄范围50-79岁,平均年龄60.89±3.122岁;对照组23例中,女性8例,男性15例,年龄范围51-79岁,平均年龄59.72±3.341岁。年龄(p=0.5129),年龄对比结果(po.05),说明两组具有可比性。2.两组患者均由头部ct检查进行诊断。治疗组中单侧血肿者23例,双侧血肿者4例,按出血部位的不同依次为右侧额颞顶16例,双侧额顶4例,右侧额顶5例,右侧枕2例。血肿量31-133m1,平均为72.56±5.204m1。对照组中单侧血肿者21例,双侧血肿者2例,按出血部位的不同依次为左侧额颞顶13例,双侧额顶2例,右侧额颞8例。血肿量42-131m1,平均为70.61±4.743m1。出血量及出血部位(p=0.7863),差异无统计学意义(p0.05),说明两组具有可比性。3.治疗组27例中,平均gcs评分13.78±0.3035分;对照组23例中,平均gcs评分12.39±0.4859分。gcs评分(p=0.0081),统计学分析,具有显著性差异(p0.05)。4.治疗组27例中,平均术后血肿的减少量63.30±5.300ml;对照组23例中,平均术后血肿的减少量58.52±5.043ml。经统计学分析:两组年龄之间p=0.6120,统计学处理无显著性差异(p0.05)。5.治疗组27例中,平均住院时间10.07±0.3373天;对照组23例中,平均住院时间12.39±0.6526天。经统计学分析:两组年龄之间p=0.0019,统计显示两组具有显著性差异(p0.05)。6.治疗组27例中,治愈率为92.59%,对照组23例中,治愈率为86.96%。治疗组的治愈率高于对照组。结论:1.血府逐瘀胶囊可提高老年人慢性硬膜下血肿患者的术后gcs评分。2.血府逐瘀胶囊可提高老年人慢性硬膜下血肿的治愈率。3.血府逐瘀胶囊可显著缩短老年人慢性硬膜下血肿患者的住院日。血府逐瘀胶囊在辅助治疗老年慢性硬膜下血肿过程中,可缩短患者的住院时间、减少并发症的发生、增强老年患者对于手术的耐受性、减少复发几率,改善患者生活质量。
[Abstract]:With the development of Chinese population towards the aging society, the elderly disease has increasingly become a focus of the society. Chronic subdural hematoma (CSDH) is one of the most common intracranial hematoma in the elderly, because of illness onset is hidden, often resulting in misdiagnosis, missed diagnosis and delay treatment, and general poor prognosis of chronic subdural. Drilling drainage is the CSDH surgical treatment is one of the commonly used methods, although China's medical standards continue to improve, the diagnostic technology has made considerable progress, the cure rate has been significantly improved, but because of poor surgical tolerance in elderly patients, physical weakness and other multiple reasons, postoperative hematoma completely, postoperative infection, postoperative recovery time, hematoma recurrence and other phenomena occur, for clinical treatment to bring a lot of inconvenience. Therefore, the elderly patients in the perioperative period with All take Xuefuzhuyu capsule adjuvant therapy, is conducive to the recovery of patients, can get better curative effect. Objective: To observe the clinical effect of traditional Chinese medicine combined with Xuefuzhuyu capsule in the treatment of chronic subdural hematoma, combined with treatment of CSDH system for traditional Chinese medicine and Western medicine, scientific theory. Methods: the treatment of hematoma collect the surgical department of neurosurgery in our hospital in June 2015 June -2016 years of chronic subdural patients, a total of 50 cases. To meet the inclusion criteria of the study were randomly divided into treatment group and control group, two groups in gender, age, amount of bleeding, the bleeding site, there was no significant difference between Glasgow coma score. In all cases conform to the inclusion criteria, exclusion of allergic or multi drug allergy, hypertension, diabetes mellitus, blood coagulation dysfunction, liver, kidney, and other serious diseases, two groups Between comparable. The control group used traditional drilling drainage treatment, the treatment group in the control group based on the increase of Xuefuzhuyu capsule adjuvant therapy, numerical hematoma volume between the two groups of 1. clinical symptoms of 2. subdural (imaging) 3. average hospitalization related indicators on Glasgow coma score to 4. to quantify the clinical observation value, all patients entered into the computer, using SPSS17.0 software for statistical analysis, count data using t test. Results: 1. of 27 cases in the treatment group, 9 cases were female, 18 were male, age 50-79 years old, the average age of 60.89 + 3.122 years; the control group of 23 cases, 8 cases 15 cases of male, female, age range 51-79, mean age 59.72 + 3.341 years old. The age (p=0.5129), age (po.05), the results that the two groups were comparable in two groups of.2. patients were diagnosed by head CT examination. 23 cases of unilateral hematoma in the treatment group, double 渚ц鑲胯，
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