Therapeutic Effect Of Simvastatin On Postoperative Patients With Chronic Subdural Hematoma

Objective: To investigate the effects of 20 mg and 40 mg simvastatin on residual blood,neurological function and recurrence of patients with chronic subdural hematoma after operation,and to observe the occurrence of adverse reactions related to simvastatin.Methods: Eighty patients with chronic subdural hematoma admitted to the Department of Neurosurgery,Second People's Hospital of Chengdu from November 2016 to December 2018 were enrolled.They were randomly divided into group A and group B with 40 cases in each group.All patients underwent single hole drilling and drainage under general anesthesia.After operation,they were given conventional treatment such as prevention of infection,promotion of brain relaxation,symptomatic support.On this basis,patients in group A were given simvastatin 20 mg per night from the first day after surgery;group B patients received simvastatin 40 mg from bedtime every night after surgery.All patients took simvastatin for 3 months and were followed for 3 months.The baseline data of the two groups were observed and recorded.Head CT examination was performed on the 1st day,1st week,1st month,2nd month and 3rd month respectively to calculate residual blood volume and evaluate Markwalder's classification;the ADL grade assessment was performed before and the third month after operation;the number of recurrence cases within 3 months was counted.The adverse reactions related to simvastatin were observed during the experiment.SPSS 21.0 statistical software was used to analyze the relevant data of the two groups of patients.Results: During the 3-month follow-up period,one patient was lost to follow-up in group A,and one patient was unable to adhere to medication,a total of 38 patients completed the trial;one patient in group B was lost to follow-up,and two patients were unable to adhere to medication,a total of 37 patients completed the experiment.There were no significant differences in the baseline data between gender,age,weight,hematoma location,preoperative hematoma volume,preoperative ADL score,and preoperative MGS grade(P>0.05).There was no significant difference in hematomavolume between group A and group B at the 1st day,1st week and 1st month after operation(P>0.05),but the hematoma volume in group A was significantly higher than that in group B at the 2nd and 3rd months after follow-up(P<0.05).There was no significant difference in MGS grade between the 1st day,1st week and 1st month after the operation in group A and group B(P>0.05),but the MGS grade of group A was higher than that of group B at the 2nd and 3rd months of follow-up,the difference was statistically significant(P<0.05);The ADL scores of group A and group B at the 3rd month after operation were significantly higher than those before operation,and the difference was statistically significant(P<0.05).The difference between the 3rd month after operation and the preoperative ADL score in group A was significantly lower than that in group B,and the difference was statistically significant(P<0.05).Within 3 months of follow-up,3 cases(7.89%)recurred in group A and 1 case(2.70%)recurred in group B there was no significant difference in recurrence rate between the two groups(P>0.05).During the experiment,there were 3 cases(7.89%)of adverse reactions related to simvastatin administration in group A,including 2 cases(5.26%)of mild nausea and vomiting and 1 case(2.63%)of mild liver dysfunction(transaminase elevation 3 times lower than normal);In group B,4 cases(10.81%)had adverse reactions related to taking simvastatin,including 1 case(2.70%)of mild nausea and vomiting,1 case(2.70%)of mild diarrhea,and 2 cases(5.41%)of mild liver dysfunction(transaminase elevation 3times lower than normal).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion: Simvastatin 40 mg is more effective than 20 mg in promoting residual blood absorption and neurological function recovery in patients with chronic subdural hematoma after operation,but the recurrence rate and drug-related adverse reactions have no significant difference.