钻孔引流术治疗口服抗血小板药物老年慢性硬膜下血肿患者疗效分析

目的探讨钻孔引流术治疗口服抗血小板药物老年慢性硬膜下血肿（chronic subdural hematoma, CSDH）患者的疗效。 方法选取2014年7月至2018年12月浙江医院收治的行钻孔引流术治疗的老年CSDH患者59例，其中长期口服抗血小板药物者29例（观察组），未长期服用抗血小板药物者30例（对照组）。观察组患者建议停用抗血小板药物7 d后手术，但期间需行急诊手术则在手术前输注10个单位血小板。所有患者手术前后均口服阿托伐他汀20 mg（1次/d），常规行钻孔引流术。观察比较两组患者术后临床症状及神经功能缺损程度的改善情况、颅内积气及硬膜下积液的变化情况以及血肿复发情况。组间计量资料的比较采用t检验，计数资料的比较采用χ²检验。 结果两组患者术后Bender分级的分布、不同程度脑复张欠佳或少量颅内积气发生率的差异均无统计学意义（χ²=1.344、2.076，P>0.05）。观察组术后复发6例，对照组复发1例，差异有统计学意义（χ²=4.248，P<0.05）。观察组中停药未满1周者和停药满1周者复发率分别为29.6%（5/13）、6.25%（1/16），差异有统计学意义（χ²=4.535，P<0.05）。 结论口服抗血小板药物的老年CSDH患者仍应积极首选钻孔引流治疗，虽然口服抗血小板药物会增加围手术期出血及复发风险，但围手术期合理停用抗血小板药物以及输注血小板可以降低抗血小板药物带来的风险。

Curative effect analysis of trepanation and drainage on the aged patients with chronic subdural hematoma taking oral antiplatelet drugs

ObjectiveTo analyze the trepanation and drainage on the aged patients with chronic subdural hematoma (CSDH) taking oral antiplatelet drugs. Methods59 aged patients with CSDH treated by drilling and drainage from July 2014 to December 2018 in Zhejiang Hospital were selected. 29 patients taking oral antiplatelet drugs were selected as observation group and 30 patients not taking oral antiplatelet drugs were selected as control group. Patients in the observation group were recommended to stop antiplatelet drugs for 7 days before surgery. If emergency surgery was required, 10 units of platelets should be injected before the operation. All patients were given atorvastatin 20 mg (1 time/d) orally before and after surgery, trepanation and drainage was performed routinely. The postoperative clinical symptoms and improvement of neurological defect degree, changes of intracranial pneumatosis and subdural effusion, and recurrence of hematoma in the two groups were observed and compared. T test was used for comparison of measurement data between groups, while chi-square test was used for comparison of enumeration data. ResultsThere were no statistically significant differences in the distribution of post operation Bender grades, the incidence of poor brain recruitment of different degrees or a small amount of intracranial pneumatosis between the two groups (χ²=1.344、2.076, P > 0.05). Postoperative recurrence occurred in 6 patients in the observation group, recurrence occurred in 1 case in the control group, the difference was statistically significant (χ²=4.248, P < 0.05). In addition, the recurrence rate of aged CSDH patients who stopped taking oral antiplatelet drugs for one week before operation 6.25%(1/16)] was lower than patients who stopped taking oral antiplatelet drugs for less than one week 29.6%(5/13)] (χ²=4.535, P < 0.05). ConclusionDrilling and drainage still is the preferred treatment on the aged CSDH patients with taking oral antiplatelet drugs. Although oral antiplatelet drugs can increase the risk of bleeding in perioperative period and recurrence, but reasonably stopping antiplatelet drugs in perioperative period and platelet transfusion can reduce the risk.