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1、颅内动脉瘤破裂后在基层医院处理［摘要］目的探讨颅内动脉瘤破裂后在基层医院的处理措施。方法收集我院2010年1月〜2013年2月就诊的颅内动脉瘤破裂出血患者25例，均给予绝对卧床休息，严密监测生命体征，保持呼吸道及大便通畅，控制血压，降低颅内压，防治脑血管痉挛，抗纤溶治疗及腰大池持续引流脑脊液等治疗措施。结果25例患者中2例患者治疗无效死亡；18例患者经保守治疗后症状缓解转上级医院进一步手术治疗，随访证实10例患者恢复良好，7例患者遗留轻度肢体功能障碍，1例复发死亡；另5例患者因经济原因拒绝转上级医院，经治疗症状改善后自行出院，随访1年，4例患者死于再出
2、血，1例患者暂无再出血发生。结论内科保守治疗联合腰大池持续引流脑脊液可有效缓解颅内动脉瘤破裂患者的临床症状及体征，为延期手术患者争取时间。［关键词］颅内动脉瘤；保守治疗；腰大池引流术［中图分类号］R651.1［文献标识码］B［文章编号］2095-0616(2013)13-183-02Afterintracranialaneurysmruptureprocessinginbasic-levelhospitalsLIBaojiaMOQuanSHIGangjiLIANGCaiganLINZitongLAIWeifengTANDa"anDepartmentof
3、Neurosurgery,HuaijiCountyPeople，sHospitalofGuangdongProvince,Huaiji526400,China[Abstract]ObjectiveToapproachthetreatmentmeasuresafterintracranialaneurysmruptureinbasic-levelhospitals・Methods25patientswithintracranialaneurysmrupturebleedingtreatedinourhospitalfromJanuary2010andFe
4、bruary2013werecollectedandgivencompleterestinbed,closelymonitorvitalsigns,keeprespiratorytractanddefecateunobstrueted,controlofthebloodpressure,decreaseintheintracranialpressure,preventionandcureofthecerebralvasospasm,fibrinolytictherapyandlumbarpoollastdrainageofcerebrospinalfl
5、uidweregiven.Results2patientsof25casesdied,symptomsof18patientsafterconservativetreatmentrelievedandwerefurthertreatedbysurgeryinsuperiorhospital,byfollow-upitwasconfirmedthat10patientsrecoveredwell,7patientssufferedmildlimbdysfunction,with1casediedofrecurrence；Theother5patients
6、becauseofeconomicreasonsrefusedhigherlevelhospital,thesymptomsimprovedaftertreatmentanddischargedontheirown,Afteroneyearfollowup,4patientsdiedofbleeding,with1patientsnobleedingoccurredagain.ConclusionInternalmedicineconservativetreatmentincombinationwiththewaistbigpoolcontinuous
7、cerebrospinalfluiddrainagecaneffectivelyrelieveclinicalsymptomsandsignsofpatientswithintracranialaneurysmsrupture,andstriveforthetimefordelaysurgerypatients.[Keywords]Intracranialaneurysm；Conservativetreatment；Waistbigpooldrainage颅内动脉瘤是发生于颅内动脉血管壁上的瘤样突起，发病原因未明，可能与髙血压、动脉硬化及先天性血管发育
8、异常有关。颅内动脉瘤未破裂前患者多无明显的临床症状和体征，破裂后常以蛛网膜下腔出血作为首发症状
