Study On New Methods Of Drug Treatment For Chronic Subdural Hematoma

ObjectiveChronic subdural hematoma（CSDH）is one of the most common conditions encountered in old people.Surgical decompression through burr hole craniotomy（BHC）and drainage is the first choice for patients with CSDH.However,despite surgical treatment,recurrence and complication rates of CSDH are still relatively high.And the treatment had not progressed significantly over the years.In recent years,the aging trend of China’s population has become obvious,so it is necessary to analyze its pathogenic characteristics.Meanwhile,based on the research progress of relevant drugs in recent years,it is necessary to explore new treatment methods.In this study,a retrospective study of chronic subdural hematoma was conducted in our hospital in the past 15 years.To elucidate the clinical features and the current epidemiology of CSDH under the background of population aging.Meanwhile,the effects of atorvastatin in the treatment of chronic subdural hematoma alone and combined with surgery for chronic subdural hematoma were investigated.Methods and ResultThis study included patients with diagnosed CSDH who were treated in the Department of Neurosurgery,Southwest Hospital,Army Medical University,from 2003 to 2017.There were 1028 patients were enrolled.Clinical and demographic characteristics were collected including:patient age,sex,history of trauma,accompanying disease,treatment procedure and outcome at discharge.All patients were stratified by decade and every 5 years respectively.The clinical characteristics and epidemiology changing trends of CSDH patients in different periods and different age groups,as well as the relationship between various factors and patients’prognosis were described respectively.Mean±standard devieation（SD）were used to describe continuous variables and the dichotomous variable is expressed as a percentage.The t-test Of two independent samples was used to compare the continuous variables.The correlation analysis between the classification variables was performed with x² test.The statistical significance was set at p<0.05.The result showed that the age of CSDH patients was yonger,the average age dropped from 70.3 to 60.7 in 15 years.The time of onset peak fell from the 7^th（in their 70s）decade of life during 2003-2007 to the 6^th decade（in their 60s）of life during 2013-2017.Of all patients,47.9%patients had a history of trauma.The rate of trauma in CSDH patients is increasing year by year.There was no significant difference in treatment efficiency and mortality over 15 years（P=0.840,0.185）.To investigate the efficacy of atorvastatin in the treatment of CSDH,a total of 310 CSDH patients were enrolled in our hospital between January 2013 and December 2016.All patients were divided into three groups:65 patients received oral atorvastatin treatment,120 patients underwent burr-hole drainage and 125 patients were treated with atorvastatin as an adjunct to burr hole craniotomy.The dose of atorvastatin was 20mg per day.After the initial treatment,they would be followed up every month until 6 months.Atorvastatin The t-test of two independent samples was used to compare the continuous variables.The correlation analysis between the classification variables was performed with x² test.Multivariate regression model analyzed the association between administration of atorvastatin perioperatively and recurrence rates.The statistical significance was set at p<0.05.Odds ratios（OR）,95%confidence intervals（CI）are presented.The result showed that 65 patients were treated with oral atorvastatin alone and the cure rate was 76.9%.120 patients underwent BHC treatment aloneand the cure rate was 85%.There were no significant statistical difference between the two groups（P=0.171）.The GOS score was significantly better in the oral atorvastatin group than in the surgery group at 6months（P=0.047）and the complication rate（0%vs.3,1%,P=0.034）,direct health cost（11131yuan vs 37943 yuan,P<0.01）and hospitalization days（5.02 day vs 16.67 day,<0.01）was also significantly lower than the surgery group.Of the 245 patients who underwent drilling and drainage,125 patients were treated with oral atorvastatin as an adjunct to BHC.The recurrence rate was 4.8%in the atorvastatin+BHC group.And the postoperative recurrence rate of 120 patients in the BHC group was 15%.There was a significant difference between the two groups（P=0.039）.Multivariate analysis showed that the recurrence rate of atorvastatin was significantly lower than that of surgery alone.Conclusion1.Among the causes of chronic subdural hematoma,the proportion of trauma increased year by year,mainly due to falls;there was no significant change in the efficiency of treatment for patients during the 15 years.2.In the treatment of chronic subdural hematoma,the oral administration of atorvastatin can cure CSDH.Compared to the surgery,atorvastatin can significantly reduce the mortality,complication,treatment cost and shorten hospital stay without significantly affecting the recurrence rate.3.In surgical treatment of CSDH with BHC,administration of atorvastatin is associated with a lower recurrence rate without an increase in morbidity and mortality.