本文選題：慢性硬膜下血腫　切入點(diǎn)：血府逐瘀膠囊　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：隨著中國人口向著老齡化社會(huì)的邁進(jìn),老年病日益成為社會(huì)關(guān)注的一個(gè)焦點(diǎn)問題。慢性硬膜下血腫(CSDH)是老年顱內(nèi)血腫最常見的一種,該疾病因起病比較隱匿,常常造成誤診、漏診進(jìn)而延誤病情,且總體預(yù)后不佳。慢性硬膜下鉆孔引流術(shù)是目前CSDH外科手術(shù)治療常用的方法之一,雖然目前我國的醫(yī)學(xué)水平在不斷的提高,診斷的技術(shù)也取得了長足的進(jìn)步,手術(shù)治愈率有了明顯的提高,但是因?yàn)楦啐g患者的手術(shù)耐受度差、體質(zhì)虛弱等多重原因的限制,術(shù)后患者出現(xiàn)血腫清除不徹底、術(shù)后感染、術(shù)后恢復(fù)慢、血腫復(fù)發(fā)等現(xiàn)象時(shí)有發(fā)生,給臨床處理帶來很多不便。因此,通過對(duì)老年患者在圍手術(shù)期配合口服血府逐瘀膠囊進(jìn)行輔助治療,有利于患者的轉(zhuǎn)歸,可收到較好療效。目的:觀察聯(lián)合傳統(tǒng)的中醫(yī)藥血府逐瘀膠囊輔助治療老年慢性硬膜下血腫的臨床效果,為CSDH中西醫(yī)結(jié)合治療提供系統(tǒng)、科學(xué)的理論依據(jù)。方法:收集我院神經(jīng)外科2015年6月-2016年6月慢性硬膜下血腫行手術(shù)治療的病人,共50例。對(duì)符合納入標(biāo)準(zhǔn)的研究對(duì)象進(jìn)行隨機(jī)分組方法分為治療組和對(duì)照組,兩組患者在性別、年齡、出血量、出血部位、格拉斯哥昏迷評(píng)分等方面均無顯著性差異,入選的所有病例均符合納入病例標(biāo)準(zhǔn),排除過敏體質(zhì)或?qū)Χ喾N藥物過敏者、高血壓、糖尿病,凝血功能障礙,有肝、腎、等嚴(yán)重原發(fā)性疾病者,兩組間具有可比性。對(duì)照組采用傳統(tǒng)的鉆孔引流術(shù)進(jìn)行治療,治療組在對(duì)照組基礎(chǔ)上增加血府逐瘀膠囊進(jìn)行輔助治療,比較兩組1.臨床癥狀2.硬膜下血腫量的數(shù)值(影像學(xué)檢查)3.平均住院日4.格拉斯哥昏迷評(píng)分等相關(guān)指標(biāo)予以量化,將所有患者的臨床觀察數(shù)值,輸入計(jì)算機(jī),運(yùn)用spss17.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)數(shù)資料采用t檢驗(yàn)。結(jié)果:1.治療組27例中,女性9例,男性18例,年齡范圍50-79歲,平均年齡60.89±3.122歲;對(duì)照組23例中,女性8例,男性15例,年齡范圍51-79歲,平均年齡59.72±3.341歲。年齡(p=0.5129),年齡對(duì)比結(jié)果(po.05),說明兩組具有可比性。2.兩組患者均由頭部ct檢查進(jìn)行診斷。治療組中單側(cè)血腫者23例,雙側(cè)血腫者4例,按出血部位的不同依次為右側(cè)額顳頂16例,雙側(cè)額頂4例,右側(cè)額頂5例,右側(cè)枕2例。血腫量31-133m1,平均為72.56±5.204m1。對(duì)照組中單側(cè)血腫者21例,雙側(cè)血腫者2例,按出血部位的不同依次為左側(cè)額顳頂13例,雙側(cè)額頂2例,右側(cè)額顳8例。血腫量42-131m1,平均為70.61±4.743m1。出血量及出血部位(p=0.7863),差異無統(tǒng)計(jì)學(xué)意義(p0.05),說明兩組具有可比性。3.治療組27例中,平均gcs評(píng)分13.78±0.3035分;對(duì)照組23例中,平均gcs評(píng)分12.39±0.4859分。gcs評(píng)分(p=0.0081),統(tǒng)計(jì)學(xué)分析,具有顯著性差異(p0.05)。4.治療組27例中,平均術(shù)后血腫的減少量63.30±5.300ml;對(duì)照組23例中,平均術(shù)后血腫的減少量58.52±5.043ml。經(jīng)統(tǒng)計(jì)學(xué)分析:兩組年齡之間p=0.6120,統(tǒng)計(jì)學(xué)處理無顯著性差異(p0.05)。5.治療組27例中,平均住院時(shí)間10.07±0.3373天;對(duì)照組23例中,平均住院時(shí)間12.39±0.6526天。經(jīng)統(tǒng)計(jì)學(xué)分析:兩組年齡之間p=0.0019,統(tǒng)計(jì)顯示兩組具有顯著性差異(p0.05)。6.治療組27例中,治愈率為92.59%,對(duì)照組23例中,治愈率為86.96%。治療組的治愈率高于對(duì)照組。結(jié)論:1.血府逐瘀膠囊可提高老年人慢性硬膜下血腫患者的術(shù)后gcs評(píng)分。2.血府逐瘀膠囊可提高老年人慢性硬膜下血腫的治愈率。3.血府逐瘀膠囊可顯著縮短老年人慢性硬膜下血腫患者的住院日。血府逐瘀膠囊在輔助治療老年慢性硬膜下血腫過程中,可縮短患者的住院時(shí)間、減少并發(fā)癥的發(fā)生、增強(qiáng)老年患者對(duì)于手術(shù)的耐受性、減少復(fù)發(fā)幾率,改善患者生活質(zhì)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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