Tong Yanping, Liu Weiming, Xu Long, Ou Yunwei, Li Kangning, Yang Tao, Zhao Tianyou, Guan Ruixi, Fan Yongping
Department of Traditional Chinese Medicine Beijing Tiantan Hospital, Capital Medical University.
Beijing Integrative Medicine on Encephalopathy Research Institution, Beijing Tiantan Hospital Capital Medical University.
Medicine (Baltimore). 2020 Aug 14;99(33):e21674. doi: 10.1097/MD.0000000000021674.
The aim of the study was to observe the efficacy of nonsurgical treatment with Chinese herbal medicine (CHM) for chronic subdural hematoma (CSDH). This study includes clinical results of a STROBE-compliant retrospective study.Forty patients diagnosed with CSDH were recruited from outpatient. Different CHM prescriptions were dispensed for each patient based on syndrome differentiation until the patient had a stable neurologic condition for 2 weeks and/or CSDH completely resolved according to the computed tomography scan. Markwalder grading scale for neurologic symptoms and head computed tomography scan for hematoma volumes were performed before and after CHM treatment to evaluate efficacy.Patients received uninterrupted CHM treatment for 2.81 ± 1.45 months (0.75-6 months). The hematoma volume significantly reduced from 73.49 ± 35.43 mL to 14.72 ± 15.94 mL (P < .001). The Markwalder grading scale scores of patients at the end of CHM treatment decreased significantly, from 1.3 ± 0.69 to 0.15 ± 0.36 (P < .001). Ninety percent of the patients showed >50% decrease in the hematoma volume and complete improvement in neurologic symptoms. The linear regression analysis suggested that change in hematoma was significantly related to the duration of CHM treatment (R = 0.334; P < .001; Ŷ = 25.03 + 11.91X). Leonurus heterophyllus Sweet (Yi-Mu-Cao, 90.5%), Semen persicae (Tao-Ren, 88.8%), and Acorus tatarinowii Schott (Shi-Chang-Pu, 86.2%) were the top 3 single Chinese herbs prescribed in CHM treatment.The CHM treatment for CSDH based on syndrome differentiation with appropriate duration relieved neurologic symptoms quickly and promoted hematoma absorption effectively. It could be an effective nonsurgical therapy for CSDH.
本研究旨在观察中药非手术治疗慢性硬膜下血肿（CSDH）的疗效。本研究纳入了一项符合STROBE标准的回顾性研究的临床结果。从门诊招募了40例诊断为CSDH的患者。根据辨证为每位患者开具不同的中药方剂，直至患者神经状况稳定2周和/或根据计算机断层扫描CSDH完全消退。在中药治疗前后进行神经症状的Markwalder分级量表和血肿体积的头部计算机断层扫描以评估疗效。患者接受了2.81±1.45个月（0.75 - 6个月）的不间断中药治疗。血肿体积从73.49±35.43 mL显著减少至14.72±15.94 mL（P <.001）。中药治疗结束时患者的Markwalder分级量表评分显著降低，从1.3±0.69降至0.15±0.36（P <.001）。90%的患者血肿体积减少>50%且神经症状完全改善。线性回归分析表明血肿变化与中药治疗持续时间显著相关（R = 0.334；P <.001；Ŷ = 25.03 + 11.91X）。益母草（益母蒿，90.5%）、桃仁（桃仁，88.8%）和石菖蒲（石菖蒲，86.2%）是中药治疗中开具最多的前3味单味中药。基于辨证并给予适当疗程的中药治疗CSDH能迅速缓解神经症状并有效促进血肿吸收。它可能是一种治疗CSDH的有效的非手术疗法。
