【摘要】 目的探讨口服氨甲环酸对混杂密度慢性硬膜下血肿保守治疗的疗效。方法选取2013年1月至2016年6月就诊于我院的混杂密度慢性硬膜下血肿22例,全组病例均行头颅CT平扫确诊。所有患者均口服氨甲环酸250mg每日3次,治疗1~3月,随访4~6个月。比较患者用药前后血肿量的变化,神经功能恢复情况,观察头颅CT的演变过程。结果有效16例(72.7%),无效4例(18.2%),失访2例(9.1%)。16例(72.7%)在治疗1个月后,头疼、肢体乏力等临床症状均有改善,3个月后临床症状基本消失,头颅CT示血肿明显吸收。3例因口服药物3~4周后临床症状加重收住院行手术治疗,术后继续口服氨甲环酸,随访6个月无1例复发。1例在服药1个月后临床症状明显好转,血肿大部分呈低密度影,血肿吸收减少,后因消化道不适停止服药。2例分别在服药8周及12周后失访。结论口服氨甲环酸保守治疗混杂密度慢性硬膜下血肿安全有效,同时可减少混杂密度CSDH钻孔引流术后复发。更多还原

【Abstract】 Objective To examine the efficacy of oral tranexamic acid in the conservative treatment of mixed-density chronic subdural hematoma(CSDH).Methods A total of 22 patients with CT-confirmed mixed-density CSDH in our hospital from January 2013 to June 2016 were included in this study.All patients received an oral dose of 250 mg tranexamic acid three times a day for 1 to 3 months,and were followed up for 4 to 6 months.The change in hematoma volume and recovery of neurological function after treatment were examined,and the changes in head CT were also observed.Results Of the 22 patients,16(72.7%) showed response,4(18.2%) showed no response,and 2(9.1%) were lost to follow-up.Clinical symptoms,including headache and limb weakness,were improved in 16 patients after 1 month of treatment with oral tranexamic acid; after 3 months,these symptoms almost disappeared in these patients,with significant hematoma absorption on head CT.Clinical symptoms were exacerbated in 3 patients after 3 to 4 weeks of treatment,and the patients were admitted to the hospital for surgery; oral administration of tranexamic acid was continued in these patients after surgery,and no relapse was observed during the 6 months of follow-up.One patient had significantly improved clinical symptoms after 1 month of treatment,with mostly low-density hematoma and reduced hematoma absorption; however,treatment was discontinued in this patient later on due to gastrointestinal discomfort.Two patients were lost to follow-up at weeks 8 and 12 of treatment,respectively.Conclusions Oral tranexamic acid is safe and efficacious in the conservative treatment of mixed-density CSDH,and can reduce postoperative relapse of mixed-density CSDH following trepanation and drainage.更多还原