慢性硬膜下血肿的药物治疗
许多针对血凝块周围的炎症反应以及新生血管膜的硬膜下血肿新生疗法正在得以研发。
皮质类固醇
皮质类固醇已被提议用作治疗慢性硬膜下血肿的炎症和血管生成的方法。[87]Kolias AG, Chari A, Santarius T, et al. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014 Oct;10(10):570-8.http://www.ncbi.nlm.nih.gov/pubmed/25224156?tool=bestpractice.com 虽然当前结果尚无定论，[88]Prud'homme M, Mathieu F, Marcotte N, et al. A pilot placebo controlled randomized trial of dexamethasone for chronic subdural hematoma. Can J Neurol Sci. 2016 Mar;43(2):284-90.http://www.ncbi.nlm.nih.gov/pubmed/26853325?tool=bestpractice.com 但几项前瞻性随机对照临床试验正在进行中。[89]Thotakura AK, Marabathina NR. Nonsurgical treatment of chronic subdural hematoma with steroids. World Neurosurg. 2015 Dec;84(6):1968-72.http://www.ncbi.nlm.nih.gov/pubmed/26342776?tool=bestpractice.com[90]Emich S, Richling B, McCoy MR, et al. The efficacy of dexamethasone on reduction in the reoperation rate of chronic subdural hematoma - the DRESH study: straightforward study protocol for a randomized controlled trial. Trials. 2014 Jan 6;15:6.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891985/http://www.ncbi.nlm.nih.gov/pubmed/24393328?tool=bestpractice.com[91]Berghauser Pont LM, Dirven CM, Dippel DW, et al. The role of corticosteroids in the management of chronic subdural hematoma: a systematic review. Eur J Neurol. 2012 Nov;19(11):1397-403. [Erratum in: Corrigendum. Eur J Neurol. 2015.]http://www.ncbi.nlm.nih.gov/pubmed/22642223?tool=bestpractice.com[92]Henaux PL, Le Reste PJ, Laviolle B, et al. Steroids in chronic subdural hematomas (SUCRE trial): study protocol for a randomized controlled trial. Trials. 2017 Jun 5;18(1):252.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460366/http://www.ncbi.nlm.nih.gov/pubmed/28583162?tool=bestpractice.com 一项小型病例系列研究发现，皮质类固醇治疗对复发性慢性硬膜下血肿患者有益。[93]Zhang Y, Chen S, Xiao Y, et al. Effects of dexamethasone in the treatment of recurrent chronic subdural hematoma. World Neurosurg. 2017 Sep;105:115-21.http://www.ncbi.nlm.nih.gov/pubmed/28578110?tool=bestpractice.com
血小板活化因子
血小板活化因子已被证明对慢性硬膜下血肿相关的新生血管膜形成具有一定影响。一些小型研究显示，为减少手术需求和降低术后慢性硬膜下血肿的复发率，使用了拮抗剂依替唑仑 (etizolam) 阻止血小板活化因子激活。[94]Hirashima Y, Kurimoto M, Nagai S, et al. Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma - a prospective study to investigate use as conservative therapy. Neurol Med Chir (Tokyo). 2005 Dec;45(12):621-6;discussion 626.https://www.jstage.jst.go.jp/article/nmc/45/12/45_12_621/_pdfhttp://www.ncbi.nlm.nih.gov/pubmed/16377949?tool=bestpractice.com[95]Hirashima Y, Kuwayama N, Hamada H, et al. Etizolam, an anti-anxiety agent, attenuates recurrence of chronic subdural hematoma - evaluation by computed tomography. Neurol Med Chir (Tokyo). 2002 Feb;42(2):53-5;discussion 56.https://www.jstage.jst.go.jp/article/nmc/42/2/42_2_53/_pdfhttp://www.ncbi.nlm.nih.gov/pubmed/11944589?tool=bestpractice.com
氨甲环酸
抗纤溶药物氨甲环酸已被用于治疗慢性硬膜下血肿。[96]Tanweer O, Frisoli FA, Bravate C, et al. Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation. World Neurosurg. 2016 Jul;91:29-33.http://www.ncbi.nlm.nih.gov/pubmed/27032521?tool=bestpractice.com 早期的病例报告显示，在该治疗后，慢性硬膜下血肿得以缓解，且无需再进行手术干预。[96]Tanweer O, Frisoli FA, Bravate C, et al. Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation. World Neurosurg. 2016 Jul;91:29-33.http://www.ncbi.nlm.nih.gov/pubmed/27032521?tool=bestpractice.com 慢性硬膜下血肿患者的氨甲环酸治疗 (Tranexamic Acid in Chronic Subdural Hematomas, TRACS) 研究是目前正在进行的一项随机对照试验，期望评估该药物在不进行手术的情况下治疗慢性硬膜下血肿的优势，并在已接受手术治疗的患者中，评估该药对于抑制复发的效果。[97]Iorio-Morin C, Blanchard J, Richer M, et al. Tranexamic Acid in Chronic Subdural Hematomas (TRACS): study protocol for a randomized controlled trial. Trials. 2016 May 5;17(1):235.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857422/http://www.ncbi.nlm.nih.gov/pubmed/27150916?tool=bestpractice.com
