药物治疗在慢性硬膜下血肿中的研究进展

Research Progress of Drug Therapy in Chronic Subdural Hematoma

摘要: 慢性硬膜下血肿(chronic subdural hematoma, CSDH)指的是发生于硬脑膜与蛛网膜之间、具有包膜的血肿，出血时间通常在3周以上，好发于65岁以上老年人。CSDH是神经外科常见疾病之一，手术是主要的治疗方法，包括开颅术、钻孔术、以及内镜手术等等。然而无论何种手术，大约27%~33%的患者术后会出现复发，且术后并发症如颅内出血、颅内感染、肺部感染等问题仍比较棘手；随着人口老龄化，发病率逐渐升高，加上越来越多抗血栓药物的使用以及术前并发症如高血压、糖尿病等也提高了术后复发率及并发症发生的概率；此外，对于心肺功能不全、颅内感染的患者，手术是禁忌的。因此，对于复发风险较高或预计手术效果较差或有手术禁忌的患者，单用药物治疗或作为手术的辅助疗法或许可以提供更好的效果。

Abstract: Chronic subdural hematoma (CSDH) refers to a hematoma with an envelope that occurs between the dura mater and the arachnoid membrane. The bleeding time is usually more than 3 weeks, and it usually occurs in the elderly over 65. CSDH is one of the most common diseases in neurosurgery, and surgery is the main treatment including craniotomy, drilling, and endoscopic surgery, etc. However, no matter what kind of surgery, about 27% to 33% of patients will relapse after surgery, and postoperative complications such as intracranial bleeding, intracranial infection, lung infection and other problems are still difficult to deal with. With the aging of the population, the incidence rate is gradually increasing; coupled with the use of more and more antithrombotic drugs and preoperative complications such as hypertension, diabetes, etc., which have also increased the recurrence rate and the probability of complications after surgery. In addition, for patients with cardiopulmonary insufficiency and intracranial infections, surgery is contraindicated. Therefore, for patients with a higher risk of recurrence, poor surgical results, or surgical contraindications, medication alone or as an adjuvant therapy to surgery may provide better results.