逐瘀利水法治疗慢性硬膜下血肿的临床研究

Clinical study on the treatment of chronic subdural hematoma by expelling stasis and water

关键词:  慢性硬膜下血肿  通窍活血汤  二陈汤  钻孔引流术

Key words:  chronic subdural hematoma  Tongqiao Huoxue Decoction  Erchen Decoction  trepanation and drainage

摘要:

[目的] 分析通窍活血汤与二陈汤联合治疗对钻孔引流术后慢性硬膜下血肿（CSDH）患者临床症状及生活质量的影响。[方法] 选择2022年1月—2023年12月收治的60例瘀血夹湿证CSDH患者进行前瞻性研究，采用随机数表法分为2组，每组30例。两组均采用钻孔引流术治疗，对照组术后给予营养神经、改善微循环及对症治疗等，中药组在对照组的基础上术后加用通窍活血汤合二陈汤。两组均疗程8周，对血肿清除率、日常生活活动能力评分、中医症状评分等指标的变化情况进行评估。[结果] 治疗后中药组血肿清除率高于对照组（P＜0.05）；两组患者日常生活活动能力评分较治疗前有改善（P＜0.05），且中药组优于对照组（P＜0.05）；中药组患者头昏沉重胀、身体沉重、口黏、大便不成形、舌苔及脉象的评分低于对照组（P＜0.05），头痛及恶心呕吐症状评分两组差异无统计学意义（P>0.05）。[结论] 通窍活血汤合二陈汤可提高瘀血夹湿患者钻孔引流术后血肿清除率，提高患者的日常生活活动能力，改善患者中医临床症状，值得推广和应用。

Abstract:

[Objective] To analyze the effect of Tongqiao Huoxue Decoction and Erchen Decoction on clinical symptoms and quality of life of patients with chronic subdural hematoma（CSDH） after trepanation and drainage. [Methods] Sixty patients with CSDH syndrome of blood stasis and water dampness treated in our hospital from January 2022 to December 2023 were selected for prospective study and were divided into 2 groups with 30 cases in each group by random number table method. The two groups were treated with trepanation and drainage，the control group was treated with nutritional nerve，microcirculation improvement，and symptomatic treatment，and the Chinese medicine group was treated with Tongqiao Huoxue Decoction and Erchen Decoction based on the control group. Both groups were treated for 8 weeks，and the changes in hematoma clearance rate，and activity of daily living score，traditional Chinese medicine symptom score，and other indicators were evaluated. [Results] After treatment，the clearance rate of hematoma in the Chinese medicine group was higher than that in the control group（P<0.05）. Activity of daily living scores in the 2 groups were improved compared with those before treatment（P<0.05），and the Chinese medicine group was better than the control group（P<0.05）. The scores of dizziness，heaviness，body heaviness，mouth stickiness，unformed stool，tongue coating，and pulse in the Chinese medicine group were lower than those in the control group（P<0.05）. There was no statistical significance in the scores of headache，nausea，and vomiting between the two groups（P>0.05）. [Conclusion] Tongqiao Huoxue Decoction and Erchen Decoction can improve the clearance rate of hematoma after trepanation and drainage in patients with blood stasis and water dampness，improve the patients’ ability of daily living activities，and improve the clinical symptoms of traditional Chinese medicine，which is worthy of promotion and application.