摘要
慢性硬膜下血肿(chronic subdural hematoma, CSDH)是桥静脉撕裂所致,常发生于50岁以上老人,可无明确或仅轻微头部外伤史,有的患者合并出血性疾病。目前手术治疗的方式主要包括钻孔冲洗引流术、内镜下血肿清除术、开颅血肿清除术及脑膜中动脉栓塞术。近年来对于CSDH术后复发原因的研究越来越多,据统计,CSDH术后的复发率达2.5%~33%。最近,对使用纤维蛋白溶解剂作为外科治疗的辅助手段来解决血肿复发问题的相关研究逐渐增加。有研究发现在CSDH术后患者中应用尿激酶可预防血肿复发。常规鞘内应用尿激酶和组织型纤溶酶原激活剂可能是治疗慢性硬膜下血肿的新方向。然而,缺乏确凿的临床证据,需要进一步的前瞻性对照研究来证实这种治疗策略的益处和安全性,并确定最佳的药物和剂量方案。
Chronic subdural hematoma (CSDH) is caused by the tear of the bridging vein, and it often occurs in the elderly over 50 years old. There may be no clear history of or only minor head trauma, and some patients are complicated by bleeding diseases. The current surgical treatment methods mainly in-clude drilling irrigation and drainage, endoscopic hematoma evacuation, craniotomy hematoma evacuation and middle meningeal artery embolization. In recent years, more and more studies have been conducted on the reasons for recurrence after CSDH surgery. According to statistics, the re-currence rate after CSDH surgery is 2.5%~33%. Recently, there has been an increase in the use of fibrinolytic agents as an adjunct to surgical treatment to address hematoma recurrence. Studies have found that the application of urokinase in patients after CSDH can prevent hematoma recur-rence. Routine intrathecal application of urokinase and tissue plasminogen activator may be a new direction for the treatment of chronic subdural hematoma. However, conclusive clinical evidence is lacking and further prospective controlled studies are needed to confirm the benefit and safety of this treatment strategy and to determine the optimal drug and dosage regimen.
出处
《临床医学进展》
2022年第5期3805-3812,共8页
Advances in Clinical Medicine
